TOWARD A FULL INTEGRATION OF TEACHING /LEARNING PROFESSIONALISM AND CLINICAL COMPETENCE IN MEDICAL STUDENTS

The development of professionalism in medical students is a challenging task faced in every medical curriculum. This chapter briefly summarizes some of the international achievements in this field and reports about the initial experience at the Faculty of Medicine and Dentistry of “Sapienza” University of Rome. A vertical integration of teaching/learning professionalism throughout the formal curriculum was set up, according to a spiral learning educational design. The principles of “assessment for learning” were also taken into account, with repeated and progressive tests. We conceive professionalism as the expression of the relationship between the profession and the social and cultural context in which healthcare professionals function. Professionalism encompasses the ability of critical reflection on technical expertise. It is expressed through the ability to act and make decisions when dilemmas or elements of complexity are present. We started offering a special stream of courses along the six years of our curriculum. These courses only partially relate to the acquisition of specific technical knowledge or skills, and mainly deal with the general ability of using knowledge to set and solve problems of increasing complexity. In this light, we focused on the integration of clinical reasoning in problematic socio-cultural, ethical and emotional-relational contexts. According to these principles, a set of multidimensional assessment methods was designed. To set a baseline of data for assessment, a cross-sectional survey was led using three instruments, selected from the literature and translated into Italian. They were designed to measure knowledge and attitudes towards socio-cultural competence, empathy, and the interactions with self, patients, colleagues, and institutions. The Italian versions of the instruments were validated and data were collected from students at the first and third year of course. This first set of empirical data showed a progression of scores from the first to the third year. The next step will be the full integration of clinical reasoning in the framework of professionalism, through the development of Virtual Patients (VPs) and of scripts for Simulated Patients (SPs) in which problems of diagnostic and therapeutic management are embedded in realistic, complex situations requiring communication skills and socio-cultural and ethical competencies. VPs are computer-based simulations, while SPs are probably the best way to assess both clinical competence and professionalism at large. Our final aim is to draw a progress line for the multidimensional assessment of developing professionalism from the first to the sixth year of medical curriculum, moving toward a systemic approach.