Professionalism

 A Guide to Professional Behaviour for Student Physicians

Upon entering medical school, new students are rapidly faced with situations that may be novel to them and may require a re-evaluation of the student's stand on an issue.  This guide to professional behaviour is an attempt to help the student physician to deal with the myriad of complex and potentially controversial situations that will inevitably arise.

Ethics and Morals are words that convey an amorphous sense of an individual's core being; these elements of an individual's character are gradually formed over the course of a person's lifetime and are modified by the stresses of experience.  They cannot be learned from a textbook or in a lecture theatre.  They are the products of an infinite variety of cultural, social, familial and interpersonal influences that every human being integrates in his or her own fashion.  As future doctors, you have a particular responsibility to evaluate carefully and to assess your own values and ethical systems, because your decisions seriously affect other people's lives.  Few other occupational or social groups function from such a standpoint.

As future doctors, you are sometimes expected to fill shoes that may feel too big rather early in your careers.  The purpose of this document is to get you thinking now about some of the issues you may face in the continuum of the next few years of medical school and the practice years that follow.  A second purpose is as a reference to use in dealing with issues that are not clearly defined as black or white, but that require some thought and self-evaluation.

You will probably find that your level of understanding of some of the items in the GUIDE will change with time and experience - that is a sign of growth; for along with all the academic growth you will experience over the course of your years as a student physician, there comes a great deal of spiritual growth that is necessary for you to become a competent and humane physician.

Relationships with Colleagues

1. Student physicians should realize that their colleagues have a diversity of knowledge and background. Each will bring his or her own expertise to bear on a problem and recognize that, whatever the emphasis; colleagues share a common goal of becoming effective and humane physicians.
2. Student physicians should give criticism or feedback to colleagues considerately and constructively. In turn, they should accept criticism graciously, using peer assessment as an important part of the evaluative process.
3. Motivation for medical education should be the aspiration for excellence rather than for external recognition, prestige or financial reward. Student physicians are expected to establish their own educational goals and standards, which should exceed the minimum levels of performance required by the Faculty.
4. Achievement of educational goals should be assessed by self- and peer-evaluation in addition to formal certifying evaluations.
5. Student physicians, together with faculty, are responsible for establishing a supportive environment of cooperation in their learning endeavours. They should refrain from any behaviour that obstructs or detracts from the learning opportunities for their colleagues. Many of the areas covered in this document may raise issues for group discussion among students and with faculty. This is encouraged and can be used as another learning resource.
6.  Student physicians must be vigilant in their concern for the physical and emotional well-being and professional conduct of their colleagues. Where concerns surface and the subject of concern do not respond to a discussion of the problem, the concern(s) should be raised confidentially with appropriate authorities. Self-destructive behaviour or breech of the standards of the profession supercedes an individual's right to privacy. Hold in confidence opinions expressed to you about colleagues, junior or senior. Use discretion in deciding if the nature of these opinions necessitates raising them with the subject.
7. The relationship between student physicians and faculty members should be one of collegiality. The junior members should respect the superior knowledge and experience of their seniors who, in turn, should appreciate the limitations of their juniors but respect their desire for knowledge. Should this relationship break down, either junior or senior should be prepared to approach the other and discuss the problem.
8. As partners with faculty in the educational program, student physicians are obliged to provide feedback about all aspects of the curriculum in order that it may be continually improved. Conversely, the Faculty is obliged to provide student physicians with as much information about their performance in meeting the objectives of the MD degree.
9. In a clinical situation where the student physician objects to either the practical or ethical aspects of patient management, the student must always defer to the physician who is responsible for care of the patient. The collegial relationship should permit subsequent private discussion during which the student's concerns can be resolved.

Relationships with Patients and their Families

1.  
   1. Clarify your status as a student in medical school. Don't give the patient unrealistic expectations of your abilities or title.
   2. Show consideration for the feelings of the patient; do not cause unnecessary emotional or physical discomfort.
   3. Perform on patients only those procedures that are appropriate, taking into account the nature of the problem and the comfort and safety of the patient, colleague or bystander with the appropriate supervision when necessary.
   4. Appreciate that the patient is assisting you in your education as well as requiring your best efforts at excellent care. In recognition of the patient's contribution to the relationship, reciprocate by providing extra attention in the form of support, explanation or even just a sympathetic ear.
   5. Know your limitations and seek help from others more skilled. Recognize that professional behaviour is dictated by law and the regulations of individual institutions and organizations, as well as by ethical considerations.
   6. Ensure that your behaviour is not influenced by the patient's ethnic origin, age, gender, cultural background or value system, except where these factors specifically have medical significance.
   7. In the event of an ethical conflict with a patient, which has ramifications for patient care, the student physician's responsibility is to refer quickly and efficiently to a colleague who does not perceive such a conflict. Your ethical code must not be imposed on patients.
   8. Refrain from inappropriately divulging confidential information concerning patients.

"Intellectual honesty is the cornerstone of the development and acquisition of knowledge.  Knowledge is cumulative and further advances are predicated on the contributions of others.  In the normal course of scholarship these contributions are apprehended, critically evaluated and utilized as a foundation for further inquiry.  Intellectual honesty demands that the contribution of others be acknowledged.  To do less is to cheat.  To pass off contributions and ideas of another as one's own is to deprive oneself of the opportunity and challenge to learn and to participate in the scholarly process of acquisition and development of knowledge.  Not only will the cheater or intellectually dishonest individual be ultimately his/her own victim, but also the general quality of activity will be seriously undermined.  It is for these reasons that the University insists on intellectual honesty in scholarship.  The control of intellectual dishonesty begins with the individual's recognition of standards of honesty expected generally and compliance with those exceptions."

 

Intellectual dishonesty may take many forms, e.g. unauthorized use of material in examinations and tests and unauthorized copying of the work (published and unpublished) of others, falsification in the results of reports and laboratory experiments and use of commercially prepared essays in place of one's own work.

• Intellectual dishonestly in a student physician has serious implications for quality of patient care. For example, cheating on evaluations as a student may evolve into such behaviour as a physician who cheats by reporting as negative the results of procedures that were actually omitted.

• Before entry to the medical profession, a student may have felt able to justify intellectual dishonesty by the flawed rationalization that it was a "means to an end" (i.e. entry to Medical School). Such thinking is absolutely unacceptable in a student physician. The "end" now is not the MD degree but excellence in patient care, and intellectual dishonesty at any stage of medical education detracts from attainment of the goal.

• Student physicians have extraordinary obligations to maintain the highest standards of integrity. Society and the Profession demand nothing less, recognizing the serious consequences of dishonesty in a physician.

 

In 1998 the Calgary Medical Students Association, the student body and the Curriculum Committee of the Faculty of Medicine approved the Student Code of Conduct.  Following its approval, the student body developed the Student Professionalism Committee to provide a mechanism to enforce concerns raised regarding student professionalism.  The primary focus of the Student Professionalism Committee is to prevent problems/difficulties related to ethics and professionalism and to be supportive of students who may be experiencing/encountering problems, difficulties or obstacles relating to these matters.

University of Calgary Medical School Student Code of Conduct

As a student in the Faculty of Medicine at the University of Calgary, I assume the responsibility for the health and well being of others.  This undertaking requires that I maintain the highest standards of ethical behaviour.  Accordingly, I have adopted the following as principles to guide me throughout my academic, clinical and research work.  I will uphold both the spirit and the letter of this code.

Honesty

• I will maintain the highest standards of academic honesty.
• I will record accurately all historical and physical findings, test results and other information pertinent to the care of my patient to the best of my ability.
• I will conduct research in an unbiased manner, report results truthfully and credit ideas developed and work done by others.
• I will admit to errors I have made.

 

Confidentiality

• I will regard confidentiality as a central obligation of patient care.
• I will limit discussions of patients to members of the health care team in appropriate settings.
• I will respect the privacy, rights and dignity of patients.

 

Respect for others

• I will not discriminate on such grounds as age, gender, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, disability or socioeconomic status.
• I will interact in a considerate manner with all others providing patient care.
• I will uphold, protect and promote a classroom atmosphere conducive to learning.
• I will provide feedback in an appropriate manner and language.
• I will not subject my peers to unwanted romantic or sexual overtures.
• I will treat institutional staff and representatives, as well as faculty and patients, respectfully in all circumstances.

 

Responsibility and Accountability

• I will set patient care as the highest priority in the clinical setting.
• I will recognize my own limitations and will seek help when my level of experience is inadequate to handle a situation.
• I will not exploit my relationships with my patients or their families for educational, emotional, financial or sexual purposes.
• In my demeanor, use of language and appearances, I will conduct myself professionally in a health care setting and in the classroom.
• I will not use alcohol or drugs in any way that could interfere with my academic, professional and clinical responsibilities.
• I will respect the reputations of members of the health care team including my classmates; however, I will report unprofessional conduct to an appropriate group or individual.
• I will not misuse faculty resources, e.g., computers.
• I will inform the appropriate people when I am not available to fulfill my responsibilities.
• I will arrive to teaching sessions, including small group sessions, on time and take responsibility for my share of work.

 

Expectations of Faculty, Residents and Fellows

• I have the right to expect clear guidelines regarding assignments and examinations as well as to have testing environments that are conducive to academic honesty.
•  I cannot be compelled to perform procedures or examinations that I feel are unethical or beyond the level of my training.
• I have the right not to be subjected to romantic or sexual overtures from those who are supervising my work.
• I have the right to be challenged to learn, but not abused, harassed or humiliated.
• I have the right to expect prompt, frequent and constructive feedback from faculty and supervisors.
• I have the right to have my research contributions appropriately represented and acknowledged.