Teaching and assessing trainees’ professionalism now represents an explicit expectation for Accreditation Council Graduate Medical Education–accredited radiology programs. Challenges to meeting this expectation include variability in defining the construct of professionalism; limits of traditional teaching and assessment methods, used for competencies historically more prominent in medical education, for professionalism; and emerging expectations for credible and feasible professionalism teaching and assessment practices in the current context of health-care training and practice.
This article identifies promising teaching resources and methods that can be used strategically to augment traditional teaching of the cognitive basis for professionalism, including role modeling, case-based scenarios, debriefing, simulations, narrative medicine (storytelling), guided discussions, peer-assisted learning, and reflective practice. This article also summarizes assessment practices intended to promote learning, as well as to inform how and when to assess trainees as their professional identities develop over time, settings, and autonomous practice, particularly in terms of measurable behaviors. This includes assessment tools (including mini observations, critical incident reports, and appreciative inquiry) for authentic assessment in the workplace; engaging multiple sources (self-, peer, other health professionals, and patients) in assessment; and intentional practices for trainees to take responsibility for seeking our actionable feedback and reflection. This article examines the emerging evidence of the feasibility and value added of assessment of medical competency milestones, including professionalism, coordinated by the Accreditation Council Graduate Medical Education in radiology and other medical specialties. Radiology has a strategic opportunity to contribute to scholarship and inform policies in professionalism teaching and assessment practices.
Introduction
Teaching and assessing trainees’ development of competence in professionalism now represents an explicit expectation for Accreditation Council Graduate Medical Education (ACGME)-accredited programs in radiology. Existing peer-reviewed publications in medical education, including publications in Academic Radiology , have identified challenges for teaching and assessing competency in professionalism. These challenges include variability in defining professionalism and ethics, as well as the predominance of traditional methods for teaching (eg, lectures) that emphasized efficiently transmitting knowledge about the cognitive basis of other medical competencies historically more prominent in medical training. Additional challenges include that the implicit curriculum, in which learners see and hear practices disparaging or contradicting professionalism, heavily influences what trainees learn about professionalism. Professionalism education can also be challenged to help trainees anticipate and reflect on perceived threats to professionalism from the larger social context, in, for example, perceptions of vulnerability to market pressures over patient advocacy, or gender or class-based harassment.
To address these challenges and expectations, this article identifies defined expectations for developing competency in professionalism, and reviews teaching approaches for professionalism that acknowledge and work with each learners’ (medical student or resident) unique professional experiences and interactions affecting their understanding of professionalism. It also identifies assessment approaches intended to promote safe and effective learning of professionalism, and considers opportunities for radiology educators to contribute to scholarly evaluation of professionalism teaching and assessment practices and policies for evaluating professionalism education.
Definition of Competence in Professionalism
The social contract underlies the “ why ” of professionalism; the definition of “ what ” the ACGME explains professionalism consists is that “residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles…” To meet this definition, residents are “expected to demonstrate respect, altruism, honesty, compassion and integrity; demonstrate a commitment to ethical principles; and demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities” .
Professionalism can also be framed in terms of roles, duties, actions, skills, behavior, beliefs, and attitudes.
Teaching Professionalism
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Teaching Methods
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Small Group Case Study Discussions
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Role Modeling
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Storytelling or Narrative Medicine
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TABLE 1
Articles Related to Imaging Professionalism and Ethical Principles that Can Serve as Springboards for Discussions Related to Aspects of Radiologic Professionalism
Subject Area Article Title Reference Commoditization in radiology “Masters of radiology panel discussion: the commoditization of radiology” Am J Roentgenol. 2011 Apr;196(4):843-7. Utilization management “Utilization management in radiology, part 2: perspectives and future directions” J Am Coll Radiol. 2012 Oct;9(10):700-3. Academic radiology in healthcare today “Academic radiology in the new health care delivery environment” Acad Radiol. 2013 Dec;20(12):1511-20. Imaging over utilization “Imaging abuse” J Am Coll Radiol. 2015 May;12(5):525-6. The impaired colleague “The impaired radiologist” J Am Coll Radiol. 2015 Mar;12(3):302-6. Overdiagnosis and overtreatment “Responding to the challenge of overdiagnosis” Acad Radiol. 2015 Aug;22(8):945-6. The disruptive colleague “The disruptive radiologist” J Am Coll Radiol. 2015 Aug;12(8):800-4. Containing imaging utilization “From gatekeeper to steward: the evolving concept of radiologist accountability for imaging utilization” J Am Coll Radiol. 2015 Dec;12(12 Pt B):1446-8. Working with millennials “Teaching and working with millennial trainees: impact on radiological education and work performance” J Am Coll Radiol. 2017 Jan;14(1):92–95.
Acad Radiol, Academic Radiology; Am J Roentgenol, American Journal of Roentgenology; J Am Coll Radiol, Journal of the American College of Radiology.
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Reflective Practice
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A Graduated Path to Achieving Independence
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Peer-assisted Learning
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TABLE 2
Peer-assisted Learning Domains and Examples of Learning Activities with Radiology
Domain Activity Resource development Critical appraisal (of literature) skills checklist collection (eg, STARD)
Modality-based radiology protocol handbooks
Symptom-based appropriate imaging workup handouts (eg, ACRAC)
Radiological reasoning podcast
Radiology resident on call survival manual Teaching and learning delivery Teaching peers to teach (eg, fourth year and first year residents)
Communication skills sessions (eg, role playing or podcasts)
Planning a resident-led teaching session (eg, 3D printing)
Delivering a workshop on global radiology for medical students Research and evaluation Exploring the impact of health-care reforms on radiology practice in the future
Integrating (inter)active teaching techniques for todays’ learners
Transforming the radiology physics curriculum to meet the new ABR core examination requirements
The use of social media among radiology residents Mentoring and support Buddy call and on-call assistant (eg, medical students and first year residents shadow and assist radiology residents on call)
Networking events to share advice for fellowship and career planning
Support tutors for revision classes as well as core examination preparation
Informal advice and guidance for work-life balancing Peer assessment Peer-led case development and assessment for on-call readiness examinations
Resident-led content development and assessment for a “beyond the image” curriculum (covering aspects of radiologic professionalism)
Peer input, development, and assessment for “essentials of radiology business practice skills” curriculum
3D, three dimensional; ABR, American Board of Radiology; ACRAC, American College of Radiology Appropriateness Criteria; STARD, Standards for Reporting of Diagnostic Accuracy Studies.
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Guided Discussions
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TABLE 3
Topic Areas Within the Curriculum for Professionalism and Ethics and Suggested Teaching Methodologies for Each
Topic Content or Area Suggested Teaching Methods Challenging work shifts (on call), cases, or patients Reflective writing, discussions (guided or facilitated), peer-assisted learning Communication of unexpected, urgent, or significant incidental findings Short didactic introduction to ACR communication guideline, role playing, case or scenario presentation/discussion Controversies (eg, health-care reform, rationing in health care) Assigned prereading (“flipped classroom”), group discussion (guided or facilitated) Cultural and religious aspects that affect radiological decision-making Narrative medicine/Storytelling Imaging appropriateness and optimization (ACRAC, imaging wisely, choosing wisely) Case or scenario presentation with facilitators and small group discussions Imaging prioritization (eg, where resources or scanner time is relatively limited) Cases or scenarios, role playing, group discussion (guided or facilitated) Informed consent for procedures or tests Role playing, case or scenario presentation/discussion Patient preferences for screening or diagnostic testing Storytelling/Narrative Medicine Radiological professionalism guidelines (eg, physicians charter, ACR Code of Ethics) Short didactic sessions with provision of links and handouts to regulation websites Teamwork/Interdisciplinary teams Workshop, role playing Technology and teaching Workshop Work-life balance/Mindfulness Group discussion (guided or facilitated), panel discussion (with invited peers or faculty)
ACR, American College of Radiology; ACRAC, American College of Radiology Appropriateness Criteria.
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Assessing Medical (Radiological) Professionalism
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Assessing Related Professional Competencies and Skills
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Assessing Professional Virtues and Identity: Chasing a Moving Target!
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Managing Lapses in Professionalism
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Engaging in Scholarly Inquiry
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Conclusions
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