Overview of Professionalism Competence: Bringing Balance to the Medical Education Continuum

Overview of Professionalism Competence: Bringing Balance to the Medical Education Continuum

Barry A. Doublestein (Regent University, USA), Walter T. Lee (Duke University Medical School, USA) and Richard M. Pfohl (Leadership Peaks, LLC, USA)
Copyright: © 2020 |Pages: 17
DOI: 10.4018/978-1-7998-2949-2.ch010


Lately, the term ‘high-value care' has become a popular mantra among healthcare leaders and policymakers. These people claim that changes are necessary in healthcare to reduce costs, minimize overuse, and optimize outcomes. While few can argue that changes are needed in these areas, there is disagreement as to how to make the largest impact. The authors agree with those who believe that the greatest potential for success is found in professionalism improvements, not through payment or policy reforms. While medical education prides itself on producing highly competent and technically proficient physicians, it has generally neglected professionalism development considering these skills something to be acquired outside of formal medical education. The authors consider recent efforts to define professionalism competency and offer a useful model that brings parity to physician training. If professionalism is the bedrock of high-value care, the time has come to provide physicians with the skills to excel.
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Healthcare is an economic system which is engaged in a constant balancing act of providing care to people while making sure that reimbursements are sufficient to support the continuation of the infrastructure used to provide that care. By its nature, it depends upon profit in order to reinvest into research and development which brings about new technologies that make the care more efficient and effective. There is often friction between those that are concerned over the economic viability of the infrastructure through which patients receive care and those that carry out the processes that actually bring about the best health outcomes for their patients. While these providers are cognizant of the costs most of the time, they are often willing to do everything possible to bring about health and wellness as their primary purpose even when those costs are very high.

While the healthcare infrastructure is important to the delivery of care, it does not, on its own, provide value, for it only produces value when someone uses it to treat people. Jac Fitz-enz in his book, The ROI of Human Capital: Measuring the Economic Value of Employee Performance, says that people alone generate value. People are the only element with the inherent power to generate value. All other variables—cash and its cousin credit, materials, plant and equipment, and energy—offer nothing but inert potentials. By their nature, they add nothing, and they cannot add anything until some human being, be it the lowest-level laborer, the most ingenious professional, or the loftiest executive, leverages that potential by putting it into play. (Fitz-enz, 2000, p. xii). If it is people who put the potential into play, they alone, are the factor that determines the value of the patient/provider encounter. They also hold the power to stifle or damage value if they fail to put the potential into play.

Putting the potential into play, is fundamentally about being competent in the use of the ‘tools-of-the-trade,’ which are the technical skills used to provide care during the patient encounter. However, it is also about how those skills are carried out as the provider engages with patients and their families, peers, and fellow healthcare team members; something that is often overlooked or undervalued. These skills have often been called ‘soft skills (McClelland, 1973; Goleman, 2013; Murphy, Putter, Johnson, 2014),’ but use of the term offers up connotations of being somewhat subservient, or less important, than the technical skills. Nothing could be further from the truth; these skills are at least equally as important as the technical skills, and may even be more important as they relate to a ‘value-added’ experience for the patient.

Lately, the term, ‘high-value care,’ has become a popular mantra among healthcare leaders and health-policy makers. Those that use the term claim that changes are necessary to reduce costs, minimize overuse, and optimize outcomes throughout the US healthcare system (Marcotte, Moriates, Wolfson, Frankel, 2019). Marcotte, et al, however, claim that professionalism, not payment or policy reform, offers the greatest potential for improving healthcare outcomes. The authors of this chapter agree whole-heartedly with them that professionalism is the bedrock of high-value care. Therefore, the aim of this chapter, and its follow-up found in Chapter 11, is to offer a challenge to the medical education community to elevate the importance of these non-technical skills in the training of physicians, for it is here where the greatest potential for improvement of health outcomes is made.

Since the authors of this chapter believe that the term ‘soft skills’ inadequately describes the scope of their use, they propose the term, ‘professionalism competence,’ as an apt descriptor to cover these non-technical skills. Instead of ignoring or relegating professionalism competence to secondary status, its importance must be recognized and promoted throughout the medical education continuum, finally bringing long-overdue balance to training.

Unfortunately, the current medical education system is more focused on providing rising-physicians with the ‘skills of the trade’ (Cooke, Irby, O’Brien, 2010) than how those skills are used to provide value to the patient, their families, and fellow healthcare team members.

Key Terms in this Chapter

Clinical Competence: The end result of clinical medical education in which the physician becomes a physician – where they consistently demonstrate the attitudes, values, and behaviors expected of one who has come to think, act, and feel like a physician ( Cruess, Cruess, & Steinert, 2016 ).

Emotional Intelligence (EI): EI is one equally important element of the Professionalism Intelligence Model. It is focused on how one feels as a physician. EI is being aware of one’s self and of others and being able to manage one’s inner world and relationships with others ( Goleman, 1995 ).

Cognitive Intelligence (CI): CI, is one equally important element of the Professionalism Intelligence Model. It is focused on how one Thinks as a physician. While IQ is a measure of an individual’s personal information bank which includes their memory, vocabulary, and visual-motor coordination ( Stein & Book, 2003 ) CI is about how one handles or expresses that personal information as they go about their daily lives ( Doublestein & Pfohl, 2013 ).

Professional Competence: The term used to define the skills necessary to deliver high-value care. Professionalism competence is a set of high performing non-technical actions practiced with skill as one engages with patients, peers, and members of the healthcare team. People operating in accordance with these high-performing actions result in highly competent humanistic, ethically vigilant, reflective, socially responsive and responsible, resilient physicians ( Weld, 2015 ). These skills transcend the traits, trappings, and traditions of being a physician.

High-Value Care: Healthcare to patients which is cost-conscience, coordinated, and highly-efficient resulting in optimized outcomes. This type of care is focused on best practices from a technical and delivery perspective. Some believe high-value care is advanced through payment or policy reform. While important, its greatest opportunity for reform comes through professionalism advancements ( Marcotte, Moriates, Wolfson, & Frankel, 2019 ). Professionalism is the bedrock of high-value care.

Leadership Intelligence (LI): LI is one equally important element of the Professionalism Intelligence Model. It is focused on how one Acts as a physician . LI consists of practices (behaviors or acts) that leaders employ to make extraordinary things happen as they engage with others ( Kouzes & Posner, 2012 AU31: The citation "Kouzes & Posner, 2012" matches multiple references. Please add letters (e.g. "Smith 2000a"), or additional authors to the citation, to uniquely match references and citations. ).

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