The Philippine Board of Ophthalmology embarks on a difficult task of mandating teaching of ethics and professionalism for residency Training Programs in Ophthalmology in the country. This is the first lecture in that conference defining both ethics and medical professionalism.

1. What is Medical Professionalism?
Alvina Pauline D. Santiago, MD
December 7, 2018

2. CHED: 10 Program Outcomes for Medicine
1. Clinical Competence
2. Communicate effectively
3. Lead and manage health care
teams
4. Engage in research activities
5. Collaborate with
interprofessional teams
6. Systems-based approach to
healthcare
7. Continuing personal and
professional development
8. Ethical, professional and
legal standards
9. Nationalism,
internationalism, dedication
to service
10. Social accountability
CHED Memorandum Order 18, Series of 2016. Policies, Standards and Guidelines for the Doctor of Medicine Program, https://ched.gov.ph/wp-
content/uploads/2017/10/CMO-18-s.-2016.pdf. Accessed November 11, 2018.

3. •Health Care Ethics
•Bioethics
•Set of moral principles,
beliefs, and values that
guide us in making choices
about medical care
From Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.
Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/

4. • Evaluating merits and difficulties of medical procedures
• To be ethical must meet all 4 principles:
• Autonomy
• Justice
• Beneficience
• Non-maleficence
Photograph from https://doctorinprogress.com/2018/03/04/medical-ethics/
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013.
2. Medical Ethics 101: What are the basic priniciples of medical ethics?
https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm

5. Autonomy
• Honor patient’s right to make own decision
• Autonomy of thought, intention, action when making decisions
• Free of coercion or coaxing
• Fully informed consent
• All risks and benefits declared
• Likelihood of success
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013.
2. Medical Ethics 101: What are the basic priniciples of medical ethics?
https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.

6. Beneficence
• For patient’s own good
• Procedure provided with intent of doing good for patient
• Physician should
• develop and maintain skills and knowledge
• Update training
• Consider patient’s individual circumstances
• Strive for net benefit
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013.
2. Medical Ethics 101: What are the basic priniciples of medical ethics?
https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.

7. Non-maleficence
• Procedure does not harm
• First do no harm
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013. Medical Ethics 101: What are the basic
priniciples of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
2. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.

8. Justice
• Be fair and treat like cases alike
• Burden and benefit of new procedures distributed equally among all
groups in society
• Uphold existing laws
• Fair to all players involved
1. Fair distribution of scarce resources
2. Competing needs
3. Rights and obligations
4. Potential Conflicts with Existing laws
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York, Oxford: Oxford University Press, 2013.
2. Medical Ethics 101: What are the basic priniciples of medical ethics?
https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
3. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.

9. Accreditation Council for Graduate Medical
Education (ACGME) Core Competencies
• Practice-based learning and improvement
• Patient care and procedural skills
• Systems-based practice
• Medical Knowledge
• Interpersonal and communication skills
• Professionalism
NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). January 12, 2017
https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December 2, 2018.

10. ACGME: Professionalism Principles
• Treat all people with respect, compassion, and dignity
• Patient needs will supersede a resident’s self interest
• Accept and understand accountability to patient, colleagues and
society
• Treating diverse patient population with sensitivity and respect.
NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7).
https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/

11. ACGME: Professionalism Sub-competencies
• Demonstrating professional conduct and accountability
• Demonstrating humanism and cultural proficiency
• Maintaining Emotional, physical and mental health
• Pursuing continual personal and emotional growth
NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7).
https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/

12. Medical Professionalism
ACGME Core
Competencies
1999
Medical
Professionalism
Project
1999
Professionalism
Charter
2002
Adoption by Major
Physician
Organizations
Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical
Center)vol. 20,1 (2007): 13-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018

13. Professionalism Charter
• Primacy of patient welfare
• Altruism, trust, patient interest
• “market forces, societal pressures and administrative exigencies” must NOT
compromise this principle
• Patient autonomy
• Incorporates honesty
• Educate and empower patients to make appropriate medical decisions
• Social justice
• Physician’s societal contract and distributive justice
• Consider available resources and needs of all patients while taking care of
individual patient
American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical
professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium-
physician-charter. Accessed December 4, 2018.

14. Professionalism Charter
A Set of Professional Responsibilities /Commitment
• Professional competence
• Honesty with patients
• Patient Confidentiality
• Maintaining appropriate relations with patients [and colleagues]
• Improving quality of care
• Improving access to care
• Just distribution of finite resources
• Scientific knowledge
• Maintaining trust by managing conflicts of interest
American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical
professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium-
physician-charter. Accessed December 4, 2018.

15. Medical
Professionalism
https://slideplayer.com/slide/4898007/16/images/2/ETHICAL+AND+LEGAL+UNDERSTANDING.jpg

16. Medical Professionalism
A set of values, behaviors, relationships that underpins the trust the
public has in its physicians.
• Integrity
• Compassion
• Altruism
• Continuous improvement
• Excellence
• Partnership with healthcare team
• Honor
1. Engel et al, Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi:
https//doi.org/10.1136/bmj.b4716.
2. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
3. Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008.
https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings-
Fund-May-2008_0.pdf.
4. Working Party of the Royal College of Physicians Clinical Med 2005 Nov-Dec; 5 (6 Suppl 1): S5-40.

17. • Belief system
• Profess to each
other & public
• Shared competency
standards
• Ethical values
• Expectations
ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf

18. ABMS Medical Professionalism
1. Ethical value system
2. Knowledge and technical
skill
3. Interpersonal skills
necessary to work with
patients (Art of Medicine)
ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf
Acquire
AdvanceMaintain

19. ABMS Medical Professionalism
Defining
Redefining
DebatingDeclaring
Distributing
Enforcing
ACTIVE &
ITERATIVE
ABMS. ABMS Definition of Medical Professionalism. 2012 https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf

20. ABMS Medical Professionalism Competencies
• Commitment to carrying out professional responsibilities
• Adherence to ethical principles
• Demonstration of compassion, integrity and respect for others
• Responsiveness to patient needs superseding self interests
• Respect for patient privacy and autonomy
• Accountability to patients, society and the profession
• Sensitivity and responsiveness to a diverse patient population
ABMS. ABMS Definition of Medical Professionalism. 2012. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf

21. Medical
Professionalism in
Action
Patients Trust MDs,
MDs should show respect
for human life.
1. Make the care of patient your first concern
2. Protect and promote health of patient and
public
3. Provide good standard of practice and care
A. Keep knowledge and skill up to date
B. Recognize limits of competence
C. Work with colleagues in patient’s best
interest
4. Treat patients as individuals. Respect their
dignity.
A. Treat patients politely and considerately.
B. Respect patient’s right to confidentiality.
Levenson R, Dewar S, Shepherd S. Understanding doctors,
harnessing professionalism, 2008.
https://www.kingsfund.org.uk/sites/default/files/Understanding-
Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar-
Susan-Shepherd-Kings-Fund-May-2008_0.pdf.

22. Medical
Professionalism in
Action
Patients Trust MDs,
MDs should show respect
for human life.
5. Work in partnership with patients.
A. Listen to patients, respond to concerns &
preferences
B. Give patients the information they want or
need in a way they can understand
C. Respect patients’ right to reach decisions with
you about treatment & care
D. Support patients in caring for themselves to
improve and maintain their health
6. Be honest and open. Act with integrity.
A. Act without delay if you have good reason to
believe that you or a colleague may be
putting patients at risk
B. Never discriminate unfairly against patients or
colleagues
C. Never abuse your patients’ trust in you or the
public’s trust in the profession
Levenson R, Dewar S, Shepherd S. Understanding doctors,
harnessing professionalism, 2008.
https://www.kingsfund.org.uk/sites/default/files/Understanding-
Doctors-Harnessing-professionalism-Ros-Levenson-Steve-Dewar-
Susan-Shepherd-Kings-Fund-May-2008_0.pdf.

23. 68 Behavioral Signs of Professionalism
1. Practices in ethical manner
2. Honest
3. Discusses confidential
information only with
appropriate people
4. Good hygiene
5. Refers patients to appropriate
specialists
6. Attention to cleanliness and
comfort of patient areas
7. Maintains patient privacy
during exams
8. Listens carefully
9. Answers questions from
patients and families
10. Physically and psychologically
fit for practice
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-
573.

24. 68 Behavioral Signs of Professionalism
11. Works in patients best interest
regardless of personal gain
12. Maintains appropriate
behavior with patients and
families
13. Seeks help when needed
14. Pays attention to detail
15. Takes genuine interest in
patient’s health
16. Always gives best effort
17. Shows respect for patients and
families
18. Communicates clearly and
effectively
19. Takes responsibility for own
actions and decisions
20. Keeps patient and/or family
informed and up to date.
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

25. 68 Behavioral Signs of Professionalism
21. Follows up to ensure proper
care.
22. Discusses confidential
information in appropriate
settings.
23. Delivers appropriate care
regardless of patient’s personal
characteristics
24. Communicates with other health
professionals to coordinate care.
25. Prepares before seeing patient
(e.g., reviews chart)
26. Explores patient’s needs and
concerns
27. Open to patient getting a second
opinion.
28. Shows compassion and care
29. Involves patient and/or family in
decision-making
30. approachable
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

26. 68 Behavioral Signs of Professionalism
31. Responds to phone calls,
pages, emails in a timely
manner
32. Controls own emotions and
maintains composure
33. Personable and polite
34. Shows respect for physician
colleagues
35. Greets patients appropriately
36. Tailors information to patient’s
and family’s needs
37. Communicate orders clearly
and effectively
38. Documents work that has
been done
39. Maintains appropriate
behavior with coworkers
40. Serves as patient advocate
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

27. 68 Behavioral Signs of Professionalism
41. Shows respect for clinical and
administrative staff
42. Keeps current with medical
literature
43. Speaks respectfully about
patients
44. Demonstrates team player
mentality
45. Willing to admit mistakes
46. Admits when doesn’t know
something
47. Use resources effectively and
efficiently to optimize patient
care
48. Willing to report impaired
physicians
49. Answers questions from clinical
and administrative staff
50. Speaks respectfully about other
healthcare providers or
specialties
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

28. 68 Behavioral Signs of Professionalism
51. Shows sensitivity to different
cultures
52. Will to take action if physicians
deliver substandard care
53. Shows commitment to self-
improvement and lifelong
learning
54. Keeps time commitments or
acknowledges waiting time.
55. Maintains professional behavior
outside hospital or office
[including social media]
56. Available to patients and families
when needed
57. Takes patient’s values and
situation into account
58. Serves as a positive role model
59. Dresses appropriately
60. Responds appropriately to
constructive feedback
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

29. 68 Behavioral Signs of Professionalism
61. Completes documentation and
letters in a timely manner.
62. Keeps personal reactions to
self
63. Provides constructive criticism
to help solve problems
64. Balances personal needs and
patient obligations
65. Encourages personal and
professional growth of staff
66. Avoids nonscientific
relationships with
pharmaceutical companies
67. Shows awareness of test and
treatment costs
68. Shows awareness of public
health issues relevant to
practice
Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.

30. Very Important
Behaviors
Green M, Zick A, Makoul G. Defining
professionalism from the perspective of patients,
physicians and nurses. Acad Med 2009; 84: 566-
573.

31. Very Important
Behaviors
Green M, Zick A, Makoul G. Defining
professionalism from the perspective of patients,
physicians and nurses. Acad Med 2009; 84: 566-
573.

32. https://doi.org/10.21315/eimj2017.9.1.9
Roslan NS, Yusoff MSB, 2017.
Simplified Thematic Engagement of
Professionalism Scale. Education in
Medicine Journal 9(1): 87-97

33. 98% of medical
students report
witnessing
unprofessional
behavior from
faculty
Feudner C, Crhistakis DA, Christakis NA. Do Clinical clerks suffer ethical
erosion? Students perceptions of their ethical environment and personal
development. Acad Med 1994: 69: 670-679.

34. Professionalism is a competency that
needs to be achieved not only in
medical education but also in
practice.
1. References 6-16 of Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad
Med 2009; 84: 566-573.

35. Course of an
EyeMD’s Career
Entering the
Profession
Practicing the
Profession
Managing
Professionally
Leading the
Profession
Building on
professionalism in
partnership
https://png2.kisspng.com
https://www.accessnz.com

36. Students and doctors in training need to be
exposed to the ESSENCE of MEDICAL
PROFESSIONALISM first hand
Learning not only from teachers, but also from
colleagues and from the culture of institutions and
organizations where they work.
Levenson R, Dewar S, Shepherd S. Understanding doctors, harnessing professionalism, 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-professionalism-Ros-
Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf.

37. https://static1.squarespace.com
https://cdn3.iconfinder.com

38. https://www2.deloitte.com
RESIDENCY
PRACTICE

39. Maintaining Ethics and Professionalism
is a
LIFETIME COMMITMENT
Teaching Ethics and Professionalism
is a
LIFETIME COMMITMENT

40. “A true professional not only follows
but loves the processes, policies and
principles set by his profession.”
― Amit Kalantri, Wealth of Words

41. References
1. American Board of Medical Specialties. ABMS Definition of Medical Professionalism. https://www.abms.org/media/84742/abms-definition-of-medical-professionalism.pdf. Acccessed 112518.
2. American Board of Internal Medicine Foundation. American College of Physicians–American Society of Internal Medicine Foundation. European Federation of Internal Medicine Medical professionalism in
the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243–246. http://annals.org/aim/fullarticle/474090/medical-professionalism-new-millennium-physician-charter. Accessed
December 4, 2018.
3. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York, Oxford: Oxford University Press, 2013.
4. Commission on Higher Education Memorandum Order No. 18, Series of 2016. Policies, Standards, and Guidelines for the Doctor of Medicine (MD) Program.
5. Engel N, Dmetrichuk J, Shamks AM. Medical professionalism: can it and should it be measured? BMJ 2009; 339: b4716. doi: https//doi.org/10.1136/bmj.b4716.
6. Feudner C, Christakis DA, Christakis NA. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad Med 1994: 69: 670-679.
7. Green M, Zick A, Makoul G. Defining professionalism from the perspective of patients, physicians and nurses. Acad Med 2009; 84: 566-573.
8. Health Care Ethics: Overview of the Basics—Vermont Ethics Network. https://www.vtethicsnetwork.org/ethics.html.. Accessed November 1, 2018
9. Kirk L. “Professionalism in medicine: definitions and considerations for teaching” Proceedings (Baylor University. Medical Center)vol. 20,1 (2007): 13-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/. Accessed December 2, 2018
10. Levenson R, Dewar S, Shepherd S. Understanding doctors: harnessing professionalism. King’s Fund and RCP 2008. https://www.kingsfund.org.uk/sites/default/files/Understanding-Doctors-Harnessing-
professionalism-Ros-Levenson-Steve-Dewar-Susan-Shepherd-Kings-Fund-May-2008_0.pdf. Accessed November 18, 2018.
11. Medical Ethics 101: What are the basic principles of medical ethics? https://web.stanford.edu/class/siw198q/websites/reprotech/New%20Ways%20of%20Making%20Babies/EthicVoc.htm
12. Medical Protection Society. Professionalism: A Medical Protection Guide. https://mpscdnuks.azureedge.net/resources/docs/mp/publications/practice-matters/professionalism-a-medical-protection-
guide.pdf.
13. NEJM Knowledge+ Team. Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7). https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/. Accessed December
2, 2018.
14. Rajaratnam V. Medical Professionalism Workshop 11 May 2013. https://www.slideshare.net/vaikunthan/medical-professionalism-workshop-11-may-2013. Accessed November 23, 2018.
15. Roslan NS, Yusoff MSB, 2017. Simplified Thematic Engagement of Professionalism Scale. Education in Medicine Journal 9(1): 87-97. https://doi.org/10.21315/eimj2017.9.1.9. Accessed November 1,
2018
16. Schröder-Bäck P, Duncan P, Sherlaw W, Brall C, Czabanowska K. Teaching seven principles for public health ethics: towards a curriculum for a short course on ethics in public health programmes. BMC
Med Ethics. 2014;15:73. Published 2014 Oct 7. doi:10.1186/1472-6939-15-73. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196023/. Accessed November 1 2018