Tıpta Profesyonelizm ve Tıp Eğitimine Entegrasyonu

Yıl 2022, Cilt: 21 Sayı: 65, 119 - 137, 31.12.2022

Emre Emekli , Özlem Coşkun , Işıl İrem Budakoğlu

https://doi.org/10.25282/ted.1044721

Öz

Amaç: Son yıllarda tıpta profesyonelizm kavramı ile ilgili literatürde çok fazla çalışma göze çarpmaktadır. Bu çalışmalarda profesyonelizmin herkes tarafından kabul gören bir tanımı mevcut değildir, birçok tanımı yapılmaktadır. Ayrıca yapılan çalışmalar tıp fakültesi mezunlarında profesyonel mesleki davranışların oluşturulmasında öğretimin önemi konusunda nettir. Bu amaca ulaşmada yardımcı olabilecek birçok öğretim stratejisi ve değerlendirme aracıyla da karşılaşmak mümkündür. Bu nedenlerle derlememizde tıpta profesyonelizm ve müfredata entegrasyonu literatüre dayanılarak açıklanmış ve Türkçe alan yazına katkıda bulunması amaçlanmıştır.
Yöntem: Geleneksel derleme yöntemi ile hazırlanmıştır. Profesyonelizm kavramının etimolojik kökeni açıklanmış, daha sonra tıp tarihinde profesyonelizm kavramı özetlenmiştir. Literatürdeki profesyonelizm tanımları tartışılmıştır. Sonraki bölümde tıp eğitimine profesyonelizm entegrasyonundaki adımlardan bahsedilmiş, kullanılabilecek öğretim yöntemleri özetlenmiştir.
Bulgular: Profesyonelizm kavramı literatürde çeşitli tanımlamaları yapılan, ortak bir tanımın yapılamadığı bir kavram olarak göze çarpmaktadır. Ancak kısaca profesyonelliği dinamik bir süreç olarak tanımlayabilir, belirli bir alanda yüksek oranda bilgi, uygulama becerisi ve uzmanlaşma olarak adlandırılabiliriz. Hekimlik de eski çağlardan beri var olan sayılı profesyonel mesleklerdendir. Hala günümüzde Hipokrat tarafından gündeme getirilmiş bir takım etik ilkeler varlığını sürdürmektedir. Tarihsel olarak da hekimlikten profesyonelizm temelinde beklenen değerler zaman zaman değişiklik göstermiş, hekimlik profesyonelliği üstüne eklenen veya kaybedilen değerlerle günümüze dek gelmiştir.
Sonuç: Güncel literatürde de artık profesyonelliğin tıp fakültelerinde öğretilmesi gerektiği ve nasıl öğretilebileceği ile ilgili yapılan çalışmalar artmaktadır. Ancak ilginin artmasına rağmen başarılı uygulama örneklerindeki yetersizlik göze çarpmaktadır. Bu nedenle tıp eğitiminde profesyonelizm entegrasyonunun nasıl yapılabileceği ile ilgili güncel literatürü de dikkate alarak tıpta profesyonelizm tanımından, profesyonelizm eğitimde sıklıkla kullanılan öğretim modellerinden, resmi, yazılı olmayan ve örtük müfredattan yazımızda kısaca söz ettik. Literatürde yapılan önemli ölçüde çalışmalar bulunmaktadır, biz de bunları kısaca gözden geçirdik. Ancak buna rağmen konu ile ilgili çok daha fazla araştırmaya ihtiyaç olduğu açıktır.

Anahtar Kelimeler

Tıp Eğitimi, Formal Müfredat, Örtük Müfredat, Refleksiyon, Durumsal Öğrenme

Professionalism in Medicine and Integrating Professionalism into the Medical Curriculum

Öz

Aim: In recent years, there has been a lot of research in the literature on the concept of professionalism. There is no universally accepted definition of professionalism in these studies. In addition, the studies are clear about the importance of teaching professionalism and the formation of professional behaviors in medical schools. It is also possible to encounter many teaching methods and assessment methods that can help achieve this goal. For these reasons, in our review, professionalism in medicine and its integration into the curriculum are explained based on the literature and it is aimed to contribute to the Turkish literature.
Methods: This article is a narrative review. Firstly, etymological origin of the concept of professionalism is explained, professionalism in the history of medicine is summarized. The definitions of professionalism
in the literature are discussed. Lastly, the steps in the integration of professionalism into medical curriculum are mentioned and the teaching methods that can be used are summarized.
Results: It is known that various definitions of professionalism are made in the literature and a common definition cannot be made. We can briefly define professionalism as a dynamic process, and we can
describe it a high level of knowledge, application skills and specialization in a certain field. Medicine is one of the few professional professions that have existed since ancient times. There are still some ethical
principles accepted by Hippocrates today. Historically, the values expected from medicine on the basis of professionalism have changed from time to time.
Conclusions: In the current literature, it is accepted that professionalism should be taught in medical schools and studies on how to teach professionalism are increasing. Despite the increasing interest, there
is a lack of successful implementation examples. Therefore, considering the current literature on how to integrate professionalism in medical education, we briefly mentioned the definition of professionalism in
medicine, the teaching models frequently used in professionalism education, and the formal, informal and hidden curriculum. There are significant studies in the literature, and we have briefly reviewed them.
However, it is clear that much more research is needed on the subject.

Anahtar Kelimeler

Medical Education, Formal Curriculum, Hidden Curriculum, Reflection, Situated Learning

Kaynakça

• 1. Altirkawi K. Teaching professionalism in medicine: what, why and how? Sudanese journal of paediatrics. 2014;14(1):31-8.
• 2. Arnold L. Assessing professional behavior: yesterday, today, and tomorrow. Academic medicine. 2002;77(6):502-15.
• 3. Mıdık Ö. Tıbbi Profesyonellik ve Tıbbi Etik: Aynı mı Farklı mı? Tıp ve Sağlık Eğitiminde Etik ve Profesyonelizm (ed. Alimoğlu MK). 2019. Ankara: Türkiye Klinikleri. p. 1-8.
• 4. https://sozluk.gov.tr/ (erişim tarihi: 20.12.2021)
• 5. Alidina K. Professionalism in post-licensure nurses in developed countries. Journal of Nursing Education Practice 2012;3:128.
• 6. Kirk LM. Professionalism in medicine: definitions and considerations for teaching. Proceedings (Baylor University Medical Center). 2007;20(1):13-6.
• 7. Cirhinlioğlu Z. Meslekler ve Sosyoloji. Gündoğan Yayınları. 1996. Ankara.
• 8. Karasu K. Profesyonelleşme Olgusu ve Kamu Yönetimi. Mülkiyeliler Birliği Vakfı Yayınları. 2001. Ankara.
• 9. Barley RS. Technicians in the Workplace: Ethnographic Evidence for Bringing Work into Organizational Studies. Administrative Science Quartedly. 1996;41:404-41.
• 10. Seçer Ş. Mesleki yaşam modelinin oluşturulması ve mesleki analizlerde kullanımı (Doktora tezi). Dokuz Eylül Üniversitesi. 2007. İzmir.
• 11. Retief FP, Cilliers L. Mesopotamian medicine. South African medical journal. 2007;97(1):27-30.
• 12. Metwaly AM, Ghoneim MM, Eissa IH, Elsehemy IA, Mostafa AE, Hegazy MM, et al. Traditional ancient Egyptian medicine: A review. Saudi journal of biological sciences. 2021;28(10):5823-32.
• 13. Achterberg J. Kadın Şifacılar. (Çev. Ed. Altınok B). 2009. İstanbul: Everest Yayınları.
• 14. Cartwright FF. A social history of medicine. 1977. London and New York. Cambridge University Press p.209
• 15. Hilton S, Southgate LJT. Professionalism in medical education. Teaching and Teacher Education 2007;23(3):265-79.
• 16. Nutton V. Hellenism postponed: some aspects of Renaissance medicine, 1490-1530. Sudhoffs Archiv. 1997;81(2):158-70.
• 17. Thistlethwaite J, Spencer J. Professionalism in medicine. 2018. CRC Press.
• 18. Pauli HG, White KL, McWhinney IR. Medical education, research, and scientific thinking in the 21st century (part one of three). Education for health. 2000;13(1):15-25.
• 19. Warner J. The Art of Medicine in an Age of Science: Reductionism, Holism, and the Doctor-Patient Relationship in the United States, 1890‒1960. 2014;120:55-91.
• 20. Drake RL. A retrospective and prospective look at medical education in the United States: trends shaping anatomical sciences education. Journal of anatomy. 2014;224(3):256-60.
• 21. Bonner TN. The German model of training physicians in the United States, 1870-1914: how closely was it followed? Bulletin of the history of medicine. 1990;64(1):18-34.
• 22. Steinecke A, Terrell C. Progress for whose future? The impact of the Flexner Report on medical education for racial and ethnic minority physicians in the United States. Academic medicine. 2010;85(2):236-45.
• 23. Ludmerer KM. Commentary: Understanding the Flexner report. Academic medicine. 2010;85(2):193-6.
• 24. Gabe J, Monaghan L. Key Concepts in Medical Sociology. 2013. London: SAGE Publications.
• 25. Weitz R. The Sociology of Health, Illness, and Health Care: A Critical Approach. 2003. Belmont: Wadsworth Pub. Co.
• 26. Haug MR. A re-examination of the hypothesis of physician deprofessionalization. Milbank Q. 1988;66 Suppl 2:48-56.
• 27. McKinlay JB, Marceau LD. The end of the golden age of doctoring. International journal of health services. 2002;32(2):379-416.
• 28. Hugman R. Consuming health and welfare. The Authority of the Consumer (Editör: Abercrombie N, Keat R, Whiteley N). 2003. London: Routledge. p. 202-16.
• 29. Cirhinlioğlu Z. Hekimlerin Sınıfsal Konumu Üzerine Bri Deneme. Toplum ve Hekim. 1998;13(4).
• 30. Leicht KT, Fennell ML, Freidson E. Professional work, a sociological approach. Canadian Journal of Sociology. 2003;28(1):112-3.
• 31. Haug MR. Deprofessionalization: An Alternate Hypothesis for the Future. 1972;20(1):195-211.
• 32. di Luzio G. A Sociological Concept of Client Trust. 2006;54(4):549-64.
• 33. Castellani B, Wear D. Physician Views on Practicing Professionalism in the Corporate Age. Qualitative Health Research. 2000;10(4):490-506.
• 34. Birden H, Glass N, Wilson I, Harrison M, Usherwood T, Nass D. Teaching professionalism in medical education: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25. Medical teacher. 2013;35(7):e1252-66.
• 35. van Mook WN, van Luijk SJ, O'Sullivan H, Wass V, Harm Zwaveling J, Schuwirth LW, et al. The concepts of professionalism and professional behaviour: conflicts in both definition and learning outcomes. European journal of internal medicine. 2009;20(4):e85-9. 36. Hoff TJ. Medical professionalism in society. The New England journal of medicine. 2000;342(17):1289-90.
• 37. Project Team Consilium Abeundi van Luijk SJe. Professional behaviour: teaching, assessing and coaching students. Final report and appendices. 2005. Maastricht: University Press Maastricht.
• 38. ABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Annals of internal medicine. 2002;136(3):243-6.
• 39. Ong YT, Kow CS, Teo YH, Tan LHE, Abdurrahman A, Quek NWS, et al. Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019. Medical teacher. 2020;42(6):636-49.
• 40. O'Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum: AMEE Guide No. 61. Medical teacher. 2012;34(2):e64-77.
• 41. Daloğlu M. Tıp eğitimi programlarında profesyonelizm. Tıp ve Sağlık Eğitiminde Etik ve Profesyonelizm (ed. Alimoğlu MK). 2019. Ankara: Türkiye Klinikleri. p.15-21.
• 42. Papadakis MA, Teherani A, Banach MA, Knettler TR, Rattner SL, Stern DT, et al. Disciplinary action by medical boards and prior behavior in medical school. The New England journal of medicine. 2005;353(25):2673-82.
• 43. Van Luijk SJ, Smeets JGE, Smits J, Wolfhagen I, Perquin MLF. Assessing professional behaviour and the role of academic advice at the Maastricht Medical School. Medical teacher. 2000;22(2):168-72.
• 44. Archer R, Elder W, Hustedde C, Milam A, Joyce J. The theory of planned behaviour in medical education: a model for integrating professionalism training. Medical education. 2008;42(8):771-7.
• 45. Cruess RL. Teaching professionalism: theory, principles, and practices. Clinical orthopaedics and related research. 2006;449:177-85.
• 46. Kolb DA. Experiential learning: Experience as the source of learning and development. 2014. London. Pearson Education.
• 47. Yardley S, Teunissen PW, Dornan T. Experiential learning: transforming theory into practice. Medical teacher. 2012;34(2):161-4.
• 48. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Medical teacher. 2009;31(8):685-95.
• 49. Quick KK, Blue CM. Using Situated Learning Theory to Build an Interactive Learning Environment to Foster Dental Students' Professionalism: An Ignite Project. Journal of dental education. 2019;83(3):334-41.
• 50. Cruess SR, Cruess RL. Professionalism must be taught. British medical journal. 1997;315(7123):1674-7.
• 51. Choo Hwee P, Hwee Sing K, Yong Hwang MK, Mei AHY. The informal curriculum: what do junior doctors learn from a palliative care rotation? BMJ supportive & palliative care. 2020;10(1):114-7.
• 52. Mahood SC. Medical education: Beware the hidden curriculum. Canadian family physician. 2011;57(9):983-5.
• 53. Joynt GM, Wong WT, Ling L, Lee A. Medical students and professionalism - Do the hidden curriculum and current role models fail our future doctors? Medical teacher. 2018;40(4):395-9.
• 54. Rosenthal L, Levy SR, London B, Lobel M, Bazile C. In Pursuit of the MD: The Impact of Role Models, Identity Compatibility, and Belonging Among Undergraduate Women. Sex roles. 2013;68(7-8):464-73.
• 55. Lublin JR. Role modelling: a case study in general practice. Medical education. 1992;26(2):116-22.
• 56. Wright S. Examining what residents look for in their role models. Academic medicine. 1996;71(3):290-2.
• 57. Hodges BD, Ginsburg S, Cruess R, Cruess S, Delport R, Hafferty F, et al. Assessment of professionalism: recommendations from the Ottawa 2010 Conference. Medical teacher. 2011;33(5):354-63.
• 58. Alimoğlu MK. Etik ve profesyonelizm eğitiminde öğrencilerin değerlendirilmesi. Tıp ve Sağlık Eğitiminde Etik ve Profesyonelizm (ed. Alimoğlu MK). 2019. Ankara: Türkiye Klinikleri. p.36-40.
• 59. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. Academic medicine. 2009;84(5):551-8.
• 60. Li H, Ding N, Zhang Y, Liu Y, Wen D. Assessing medical professionalism: A systematic review of instruments and their measurement properties. PloS one. 2017;12(5):e0177321.
• 61. Tay KT, Ng S, Hee JM, Chia EWY, Vythilingam D, Ong YT, et al. Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018. Journal of medical education and curricular development. 2020;7:2382120520955159.