ARTICLE
Auteur(s) :, William D James*
Department of Dermatology, University of Pennsylvania Health
System 3600 Spruce Street, Philadelphia, Pennsylvania 19104,
USA.
accepté le 20 Février 2004
Dr Peter McCoombs’ discussion of innovations in his departmental
teaching conferences [1], which inject broad socioeconomic and
ethical issues into the curriculum, is to be applauded. Certainly
the United States’ Accreditation Council of Graduate Medical
Education is encouraging such change in the way we teach our young
physicians. Including various aspects of professionalism and
interpersonal and communications skills is key to fulfilling
program requirements. More importantly it is of vital importance to
ensure the success of our profession in the future to have
well-rounded, thoughtful doctors who have entered a public debate
on these issues. Dedicated time for personal reflection is needed
to give perspective to the busyness we find ourselves involved with
daily. A forum to commit to a value openly among colleagues helps
us to express our core beliefs and to become aware of those most
closely held feelings of our fellow man. Such interchange clearly
reinforces the importance of listening, empathy, and understanding
that is needed for effective interpersonal communication.Moreover
the small group discussion format described can be classified as
modified problem-based learning activity. This active participatory
format is enjoyable and nurturing, enhances the depth of
understanding and retention of material, and encourages innovation
and discovery-style learning. Certainly the virtues of small group
problem-based learning have been emphasized for the past decade
with many medical schools and some residencies turning to this
process as their main educational structure [2, 3]. Residents are
diverse in their intake preferences and how they process
information, as well as their interactive styles, so a small
percentage do not thrive in this type of session. The facilitator
of these sessions may assist the process by not only asking leading
questions and raising issues to be considered, but should encourage
participation by ensuring all learners are actively engaged.By
extending the resident learning sessions to include the subjects Dr
McCoombs lists, he is encouraging his trainees to become more
self-aware and mindful of their core values. The formal lecture
format has severe limitations when subjects with little cognitive
structure are to be imparted. Professionalism and to a lesser
degree interpersonal and communications skills are rather best
modeled by teachers and mentors in their everyday practice and
interactions. While ethical guidelines are codes that provide a
framework, the learner needs to see their role models setting the
example on a day-to-day basis. In a complementary manner, exploring
peer moral and ethical standards in a non-threatening, open,
accepting forum guided by a thoughtful, reflective physician helps
to center the trainee on important aspects of professionalism.At
times it may be tempting to try to move mountains through a grand
stroke by authoring an influential essay or delivering an “I have a
dream” speech, but alas these opportunities and those that seize
them come along for only fleeting moments in history. If we strive
to live our lives such that even one mind at a time is influenced
positively, great changes will result. Our patients and our
profession will benefit from the innovation Dr McCoombs has made in
his curriculum and I again congratulate him.
References
1 McCombs PR. Crossing the Rubicon: Preparing residents for
professional life after residency. Eur J Dermatol 2004; 14: 371-4;
(pages…).
2 Strathman E. Problem-based learning. Arch Dermatol 2002;
138: 1299-302.
3 Albanese MA, Mitchell S. Problem-based learning: A
review of literature on its outcomes and implementation issues.
Acad Med 1992; 68: 52-81.
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