Guiding Principles of Professionalism

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A. Preamble

Medicine is one of the oldest of the learned professions. A professional is one who is in command of a specialized body of knowledge and skills, and is given specific rights not typically allowed to the public. Along with those rights, the professional has specific responsibilities or duties not generally expected of the public.

The singularity of medicine is that it deals with human health. Patients are potentially at their most vulnerable when establishing a relationship with a physician. That the patient’s relationship with his/her physician involves a dependency that encompasses life and death adds further to the uniqueness of this relationship.

The label of professional is not a right but must be earned. The special contract physicians have with society has professionalism as its foundation. Professionalism consists of fundamentally important qualities including altruism, compassion and empathy, respect for patients and health care workers, commitment to ongoing excellence, honesty, trustworthiness, integrity, accountability, recognition of limits, collaboration, and duty to society.

Professional development is an on-going process at all levels of training and practice. The purpose of this document is to outline those elements of professionalism expected of our medical students. It is not meant to be all encompassing, providing exact guidelines for all possible situations. Rather, four broad categories of professional behaviors are described below, with specific principles cited for each in bold print, and examples provided for some of the principles in regular text. While this document was developed with medical students in mind, it is generally applicable to all medical professionals.

B. Professional responsibility

  1. Students have a responsibility to actively participate in their education and to work to improve the educational environment for future students.
  2. Students should have a willingness to pursue life-long, self-directed learning, which is an essential attribute of any professional.
  3. Students should act responsibly in their personal and academic lives with regard to meeting deadlines, financial obligations and other comparable responsibilities.
  4. Preparation for class and during clinical rotations sets a good example for peers, maximizes every student’s learning opportunity, and demonstrates respect for the teachers and peers.
    1. Respecting one’s peers in a classroom or in the hospital setting includes behaviors such as arriving on time, exhibiting respectful body language, listening attentively, turning off cell phones and allowing all present to engage in discussion.
  5. Students should report to the appropriate supervisor potentially serious errors that others have committed.
  6. Students should contribute to their community.
    1. Students are encouraged to participate in the first- and second-year teaching groups.
    2. These provide a service to the larger St. Louis community, while teaching students how to communicate with people of diverse backgrounds.
    3. Students are encouraged to serve at the Saturday Neighborhood Health Clinic and other community service and teaching activities.
  7. Students should be aware of the larger social and economic context in which disease occurs, and take advantage of opportunities to deepen their knowledge about this topic.

C. Competence and self-improvement

  1. In order to function at the expected level, students should attend to their own physical and emotional health.
    1. The experience of being a medical student can be physically and emotionally challenging. Students need to be able to identify when they are overwhelmed to the point where they may not be able to function appropriately. Students are encouraged to seek educational assistance and/or the emotional support of others in these instances.
  2. Recognizing and admitting errors in patient care are key to being a good physician.
    1. Students should view mistakes as part of learning. Assuming responsibility for mistakes is critical for
      professional development.
    2. Developing productive strategies for dealing with mistakes and non-confrontational ways of correcting them is essential.
  3. Feedback, advice and criticism from residents, fellows and faculty fosters personal and professional development, and should be taken in the context of mentoring.
    1. Students should assume that opinions of their faculty/residents/fellows that may seem unclear are usually solidly founded, and accept feedback regarding their performance openly and maturely from individuals more experienced than they.
    2. Students should provide suggestions and examples for improving the mentoring environment by forthrightly evaluating their instructors.
  4. Students should identify and correct errors in patient care as soon as possible or notify those who can correct it.
  5. Students should balance personal and professional interests.
    1. Students should not over-commit.
    2. Students should communicate schedule conflicts to course directors, lecturers, and/or house staff.

D. Respect for others and professional relationships

  1. Students should conduct themselves with manners and consideration of all others, and be respectful of others’ time.
  2. While individual effort is important in developing a medical knowledge base, much of what students learn in medical school will depend on a collaborative effort with their peers.
    1. From the first day of medical school, students should encourage each other and collaborate with their peers when appropriate in the learning environments of lectures, small group discussions, and lab sessions. In doing so, they are laying the foundation for the truly collaborative nature of medicine.
    2. During the clinical years, students should understand that their peers are a valuable resource. Likewise, a student should assist peers in patient care responsibilities.
    3. In all cases, students should respect the work and learning opportunities of their classmates and they should share educational opportunities with their peers. Professional behaviors include listening to other’s presentations, and encouraging others’ opportunities to present, ask/answer questions, admit patients, participate in surgical cases/procedures, or perform duties.
  3. Respect for the ethnic and cultural diversity of classmates provides for a more nurturing environment for all.
    1. Students should be aware that their classmates come from a wide variety of religious and ethnic backgrounds and that they will have differing lifestyles and viewpoints. This diversity is an important resource in our community, contributing to personal and professional growth of all.
    2. Students should be sensitive to the importance of these issues and should seek opportunities to enhance appreciation of multiple cultures through dialog, educational opportunities, etc.
  4. Students should be supportive of peers during difficult times in their personal and professional lives.
    1. Students must appreciate that their peers may have issues in their personal or professional lives (e.g. family, medical, academic, or administrative problems) that may affect their interactions with others. In these circumstances, students should make every attempt to be sympathetic and to offer their support to those students.
  5. Participation and teamwork enhances the educational experience.
    1. The learning process is a partnership between students and faculty. Students should actively participate in this partnership by providing feedback to professors by way of evaluations and surveys.
    2. Contributing to the overall functioning of the team maximizes both learning and patient care in the clinical setting.
  6. Understanding the appropriate venues for feedback to house staff/fellows/faculty is critical to successfully resolving conflicts .
    1. Students should be aware of the hierarchy of the team, and appropriate mechanisms for handling disagreement with faculty/residents/fellows. Conflicts can be translated into productive outcomes if handled appropriately.
    2. www.universitycompliance.wustl.edu/codeofconduct
  7. Maintaining a professional relationship with teachers (including faculty/residents/fellows and TAs) is important, especially during times when these teachers are in a position to grade or evaluate the student.
    1. Students should avoid behaviors that could potentially be construed as attempting to influence the faculty, for example running personal errands.
    2. The University has specific codes and regulations regarding romantic relationships between a student and a teacher, including faculty/resident/fellows (www.wustl.edu/policies/consent.html)
      Students engaged in such relationships should review these codes and avoid any situation that can cause potential conflict of interest in the academic setting.
  8. Patients should be treated as individuals in the context of their family, culture and community. Personal bias should be subordinated when possible to further the therapeutic relationship.
    1. Use of offensive language or gestures is unacceptable.
    2. At times, some religious beliefs will require the use of alternative care approaches.
    3. Students, like practicing physicians, should not refuse to participate in the care of a patient with a communicable disease unless this represents a meaningful threat to the student’s own health. In contrast, a student who is verbally or physically threatened by a patient may ask to be excused from care of that patient.
  9. Students should treat hospital staff with appreciation and respect as they are vital members of the health care team.

E. Honesty and integrity

  1. Student work should be original.
    1. Only authorized resources should be used during examinations, quizzes or graded course work. WUSM has a zero tolerance policy for plagiarism. [link to University’s definition]
    2. When students are aware that a classmate has submitted work that is not their own (cheated), they should discuss this situation with the Course Master and/or the Associate Dean for Student Affairs.
  2. Students must respect patients’ rights and maintain confidentiality, in accordance with HIPAA guidelines.
    1. Students should be ever aware that patients are ill and have the right to refuse care, particularly when poorly provided.
    2. Patient information should only be discussed with appropriate people at appropriate times.
    3. Patient records should not be photocopied carelessly or removed from appropriate areas.
    4. Patient information should be disposed of appropriately to prevent careless transmission of patient information.
  3. Students should clearly communicate their abilities and level of training to patients.
    1. If a student does not know the answer to a patient’s question, it is his/her responsibility to admit this lack of knowledge.
    2. Even if other members of the health care team introduce students to patients as “doctor,” the student should never do so as it leads to a false perception of expertise on the patient’s part.
    3. Students should always be truthful with the house staff and other medical staff in terms of patient care and never compromise patient care as a consequence of personal gain.
  4. Students should not participate in any aspect of patient care if under the influence of a substance that may compromise his/her judgment or otherwise cause the patient harm. Likewise, students should report any member of the health care team who may be participating in patient care while under the influence of a judgment-impairing substance.
  5. Any student who is impaired by physical or psychological illness should excuse him/herself from patient care responsibilities, and should also respect recommendations to do so from colleagues or supervisors.
  6. Although students are often tired or under stress, they should attempt to maintain an appropriate level of composure at all times.
  7. Students should be appropriately attired for all patient care duties.
  8. Students should carefully consider their participation in benefits provided by pharmaceutical companies or other medically-related businesses.
  9. Students should respect the laws of federal, state and local governments in both professional and private life.

Washington University School of Medicine Professionalism Concern Form

Please see Appendix B in the “Rules Governing Review of Student Performance” booklet.