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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 24  |  Issue : 1  |  Page : 1-3

Role modeling: A powerful tool to imbibe professionalism in medical practice


1 Department of Health Services, O/o Directorate General Medical Services (Navy), Government of India, New Delhi, India
2 Department of Internal Medicine, Army Hospital Research and Referral, New Delhi, India
3 Department of Pediatrics, Army Hospital Research and Referral, New Delhi, India

Date of Submission21-Feb-2022
Date of Decision22-Feb-2022
Date of Acceptance23-Feb-2022
Date of Web Publication26-Mar-2022

Correspondence Address:
Col (Dr) Subhash Chandra Shaw
Department of Pediatrics, Army Hospital Research and Referral, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_28_22

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How to cite this article:
Chawla N, Singhal A, Shaw SC. Role modeling: A powerful tool to imbibe professionalism in medical practice. J Mar Med Soc 2022;24:1-3

How to cite this URL:
Chawla N, Singhal A, Shaw SC. Role modeling: A powerful tool to imbibe professionalism in medical practice. J Mar Med Soc [serial online] 2022 [cited 2022 Jul 4];24:1-3. Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/1/1/339536



Professional competence was defined by Epstein and Hundert, about 20 years back, as the habitual and judicious use of technical skills, communication, knowledge, emotions, values, reflection, and clinical reasoning in daily practice for the benefit of an individual as well as community being served.[1] Later on, the key elements of professionalism were identified by the American Board of Internal Medicine as altruism, accountability, duty, excellence, honor, integrity, and respect for others.[2] Altruism deserves a special mention. It basically means placing the interests of patients above those of the health-care professionals, such as continuing to work or providing medical advice and support even outside contracted hours, giving free treatment to the poor patients even in payable service health-care systems, and an extraordinary willingness to go extra mile in professional practice.[3] Thus, professionalism is not a single skill, but a multidimensional competency that constructs with many diverse components. Importance of professionalism is not only restricted to clinical services but also true for diagnostic services.[4],[5] Every specimen/slide/sample in the laboratory or radiological imaging belongs to a patient and should be treated as human value. Human value behind every such sample/specimen is to be viewed with the utmost professionalism and needs to be addressed in a timely manner with good-quality control practices.

Most of the key attributes of professionalism are related to soft skills. Teaching professionalism is not the same as imparting technical knowledge and skills, and the methods described in the literature for teaching professionalism are motivation (both intrinsic and extrinsic), observation of role models, feedback, reflection, and reflective practice. However, one of the best methods to impart professional values is observation of role models. Teachers have always been considered as role models by the students, and both their positive and negative behavior patterns are likely to be imbibed by their students.[6] Hence, as a role model, a teacher or a mentor can be a powerful force in molding students into what they ultimately become. It also becomes crucial that a teacher models good soft skills for the students to emulate.

Hence, what should be the characteristics of a role model? A role model is not the same as mentoring and teaching in the sense that a teacher is someone who can teach you something or facilitate your learning, while a role model is a person from whom you want to gain some of his or her attributes.[7] Role modeling is much more encompassing and the characteristics would encompass not only clinical competencies alone but also teaching skills and personal qualities. In clinical competencies, a teacher should have excellent knowledge and skill about the subject domain, effective communication skills, and sound clinical reasoning. Among the teaching skills, one should have awareness that the teacher is being observed for being a role model, and the teacher should be explicit about what is being modeled. The teacher must make time for teaching, must show respect for needs of the students, should provide timely feedback, and should encourage reflection in students. Among the personal qualities, the teacher should be perceived as compassionate and caring and should have impeccable honesty and integrity. The teacher should be enthusiastic about the practice of medicine, should have effective interpersonal skills, should have commitment to excellence, should be collegial, and should demonstrate humor.[8]

Are the medical teachers today effective role models? The interns have often felt that the medical faculty should be more aware of their behavior and attitudes in practice, especially their interaction with other colleagues.[9] Similarly, many residents have reported witnessing their supervising physicians referring to patients, the students and even their own colleagues in a derogatory manner.[10]

Next, to ponder is whether role modeling really influences a student? What is the evidence so far? Well, there is ample evidence of this effect. Evidence exists that as many as 90% of medical graduates do remember their role models who shaped their professional attitudes. Exposure to a particular role model in clinical field has been found to be strongly associated with the choice of medical students in choosing clinical field for residency training. Further understanding of which characteristics one looks for in their respective role models should help identify the mentors and teachers shaping career choices.[11] Similarly, the imitation of role models has been found to help students initially to adapt to the clinical environment.[12] Three basic patterns of modeling are known to exist. These are Active Identification, Active Rejection, and Inactive Orientation. Active identification includes classic modeling in which one emulates the role model. Active identification is generally the most common student–physician interaction. Active rejection means rejecting the attributes of negative role models. The presence of the rejection patterns and inactive patterns emphasizes the tendency of students to pick and choose selectively, as they consider alternative models, and they may view some of their clinical teachers as anti-models.[13]

Hence, what could be the strategies to improve role modeling by medical faculty? First and foremost, be aware of being a role model, remember that a teacher is being keenly watched by the students. Each faculty when one joins a medical college or a teaching institute should be made aware of the same as the juniors and students are imbibing the values unknowingly. Second, one must demonstrate competence in the respective field, have protected time for teaching, including student-centric teaching, and be enthusiastic about teaching more often, whether it is conducting rounds in the wards or academic activities in the Department of Laboratory Sciences or Department of Radiology. The medical teacher must be accessible, must develop good rapport with the students, and often should give autonomy to students for decision-making, thereby providing room for decision-making. An excellent role model would encourage dialog and socialize easily with colleagues and junior staff, show a positive attitude, have a good sense of humor, and share professionally memorable experiences, even giving personal examples. A positive role model should also work to improve the institutional culture, show leadership ability including assuming responsibility in difficult scenarios, and engage in pertinent staff development. Thus, excellence in role modeling embraces all the outstanding criteria of clinical competence, proficiency in clinical teaching, and humanistic personal attributes.[8],[14]

Can role modeling be acquired by the physician teachers and their behavior be modifiable? The values discussed so far can be worked on over time and can be imbibed by a teacher with experiential learning. Findings from the study by Wright et al. suggest that the physicians who spend more than 25% of their time teaching with their trainees, those who spend more than 25 h/week of time in teaching and conducting rounds, those who have had training in formal teaching, those who stress the importance of doctor–patient relationship in one's teaching, and those who can build positive relationships with patients and can demonstrate to the trainees the value of a comprehensive and holistic approach to patient care are often considered as excellent role models. As most of these particular attributes associated with excellence in role modeling represent behaviors that are modifiable and the skills that can be acquired, their study suggested that, with the right environment, right training, and appropriate advice, physicians could become excellent role models.[15]

Medical literature considers role modeling to be extremely powerful, at times underexploited teaching strategy. There is sufficient evidence today that the students can identify positive role models and positive role models devote more time to teaching and often stress the value of the doctor–patient relationship and the psychosocial aspects of medicine. Simultaneously, the faculty must encourage their students to observe and to give critical feedback.[11] The physicians who are great role models should be identified at all institutions, encouraged to spend time with their students, and possibly be rewarded too. Students, on the other hand, should be encouraged to assess critically the attributes of their clinical preceptors and to imbibe the attributes that are perceived to be useful and worth adopting. As correctly articulated for prospective role model teachers by Tosteson, “We must acknowledge. that the most important, indeed the only, thing we have to offer our students is ourselves. Everything else they can read in a book.”[16]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226-35.  Back to cited text no. 1
    
2.
O'Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum: AMEE Guide No. 61. Med Teach 2012;34:e64-77.  Back to cited text no. 2
    
3.
Jones R. Declining altruism in medicine. BMJ 2002;324:624-5.  Back to cited text no. 3
    
4.
Domen RE, Johnson K, Conran RM, Hoffman RD, Post MD, Steinberg JJ, et al. Professionalism in pathology: A case-based approach as a potential educational tool. Arch Pathol Lab Med 2017;141:215-9.  Back to cited text no. 4
    
5.
Leung AN. Professionalism in radiology. J Thorac Imaging 2014;29:284-6.  Back to cited text no. 5
    
6.
Modi JN, Anshu, Gupta P, Singh T. Teaching and assessing professionalism in the Indian context. Indian Pediatr 2014;51:881-8.  Back to cited text no. 6
    
7.
Wright SM, Carrese JA. Excellence in role modelling: Insight and perspectives from the pros. CMAJ 2002;167:638-43.  Back to cited text no. 7
    
8.
Cruess SR, Cruess RL, Steinert Y. Role modelling – Making the most of a powerful teaching strategy. BMJ 2008;336:718-21.  Back to cited text no. 8
    
9.
Asghari F, Fard NN, Atabaki A. Are we proper role models for students? Interns' perception of faculty and residents' professional behaviour. Postgrad Med J 2011;87:519-23.  Back to cited text no. 9
    
10.
West CP, Shanafelt TD. The influence of personal and environmental factors on professionalism in medical education. BMC Med Educ 2007;7:29.  Back to cited text no. 10
    
11.
Wright S, Wong A, Newill C. The impact of role models on medical students. J Gen Intern Med 1997;12:53-6.  Back to cited text no. 11
    
12.
Benbassat J. Role modeling in medical education: The importance of a reflective imitation. Acad Med 2014;89:550-4.  Back to cited text no. 12
    
13.
Shuval JT, Adler I. The role of models in professional socialization. Soc Sci Med 1980;14A: 5-14.  Back to cited text no. 13
    
14.
Haque M. Influence of Role Model for Professional Development in Medical Education. J Glob Pharma Technol 2017;12:10-8.  Back to cited text no. 14
    
15.
Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med 1998;339:1986-93.  Back to cited text no. 15
    
16.
Tosteson DC. Learning in medicine. N Engl J Med 1979;301:690-4.  Back to cited text no. 16
    




 

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