Newswise — The American health care landscape has changed significantly in the three decades since the landmark “DeCamp Report” first argued that ethics training should be required for all medical students, yet the fundamental importance of professionalism and ethical practice has only solidified. To accommodate 21st century ethical concerns and begin resolving discordant approaches to medical ethics training, scholars from leading medical schools across the United States have issued updated education recommendations in the journal Academic Medicine.
The “Romanell Report” builds on the DeCamp Report to address contemporary concerns, including cultural diversity, clinician work-life balance, and team-based health care coordination. The report also highlights the enduring goals of medical professionalism, citing the need for “sustaining medicine as a public trust, rather than a guild primarily concerned with protecting the economic, political, and social power of its members.”
In a separate perspective article published in the same issue, some contributors to the Romanell Report expand on its ideas and provide recommendations for how professionalism can be integrated into medical education, from the pre-medical curriculum to medical school to residency training.
“We all want medical students and doctors in training to abide by ethical norms and conduct themselves professionally; the question is, how do we get there?” says Joseph Carrese, MD, MPH, faculty at the Johns Hopkins Berman Institute of Bioethics and lead author on the Romanell Report. “We need to have some agreement on educational goals, methods to teach, and assessment strategies if we want to train all future medical professionals effectively,” says Carrese, also a professor at Johns Hopkins School of Medicine and co-author of the perspective accompanying the report.
The Romanell Report expands the Decamp Report’s list of learning objectives for medical ethics education and addresses new issues including teaching methods, assessment strategies, learning environment, and ensuring sufficient support and rewards for faculty.
“It is crucial to have skilled and engaged faculty to teach, mentor and assess our learners, so focusing on faculty should be a top priority,” says Carrese.
The report discusses the difficulty of assessing crucial desired character attributes of professionalism like humility, compassion, and integrity. “If assessment is limited only to what is formally taught, to what can be quantitatively assessed, or to the requirement of positive change, we risk a much less nuanced evaluation of some of the most important qualities of professionalism,” the report states, calling for a hybrid assessment strategy incorporating both quantitative and qualitative methods.
“We need to recognize the limitations of quantitative assessment strategies and be flexible enough to adopt novel strategies that better fit the outcome of interest,” says Gail Geller, ScD, MHS, a co-author on the Romanell Report and also a faculty member at the Berman Institute.
The report also discusses the importance of connecting changes in ethics education to patient outcomes, and cites a 2011 study by Hojat, et al, on the relationship between physician empathy and improved glucose control.
“Ultimately, all medical education and training is about preparing future doctors to provide excellent and respectful care, broadly defined, to their patients and making patients’ needs their top priority,” says Carrese. “That’s the main goal of ethics education, and that’s the main focus of a true medical professional.”
The Romanell Report and perspective article are products of the Project to Rebalance and Integrate Medical Education (PRIME), funded by the Patrick and Edna Romanell Fund for Bioethics Pedagogy of the University of Buffalo. PRIME was a national working group convened in 2010, focused on medical ethics and humanities education as they relate to professionalism in medical school and residency training. PRIME led to the founding of the Academy for Professionalism in Health Care as an organization devoted to professionalism education. Dr. Carrese was a participant in the PRIME project and is currently Chair, Board of Directors of the Academy for Professionalism in Health Care.
The Essential Role of Medical Ethics Education in Achieving Professionalism: The Romanell Report. Academic Medicine: http://journals.lww.com/academicmedicine/Abstract/publishahead/The_Essential_Role_of_Medical_Ethics_Education_in.98809.aspx
Perspective: Transforming Educational Accountability in Medical Ethics and Humanities Education Toward Professionalism. Academic Medicine:http://journals.lww.com/academicmedicine/Abstract/publishahead/Transforming_Educational_Accountability_in_Medical.98892.aspx
Basic Curricular Goals in Medical Ethics (The DeCamp Report). The New England Journal of Medicine:http://www.nejm.org/doi/full/10.1056/NEJM198501243120430
About the Johns Hopkins Berman Institute of BioethicsOne of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental and private sector organizations to address and resolve ethical issues. Institute faculty members represent diverse disciplines including medicine, nursing, law, philosophy, public health and the social sciences. More information is available at www.bioethicsinstitute.org.