2.4: School of Medicine Professionalism Principles

The following professionalism principles must be met in order for a student to qualify for conferral of the MD degree from the Stanford University School of Medicine.

Professionalism comprises those attributes and behaviors that serve to maintain patient interests above physician self-interest. Professionalism extends beyond interactions with patients and their families, however. Professionalism also involves relationships and interactions between all those involved in medical education and the delivery of patient care including physicians, students, administrators, and allied health professionals. It has implications for research activities and interactions with for-profit companies, governmental agencies, and other outside entities. Professionalism should pervade all of our activities in medicine and should include:

  • A commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge.
  • A commitment to sustain the interests and welfare of patients.
  • A commitment to be responsive to the health needs of society.
 

The elements of professionalism include altruism, accountability, responsibility, excellence, duty, honesty, integrity, and respect for others. Physicians, students of medicine, and all staff participating in medical student education and patient care at Stanford University School of Medicine are expected to aspire to these ideals, further defined as:

Altruism is the unselfish regard for and devotion to the welfare of others and is a key element of professionalism. Self-interest or the interests of other parties should not interfere with the care of one’s patients and their families.

Accountability and responsibility are required at many levels – individual patients, society and the profession. First, there must be accountability to one’s patients and to their families. There must also be accountability to society for addressing the health needs of the public and to ensure that the public’s needs are addressed. One must also be accountable to the profession to ensure that the ethical precepts of practice are upheld. Inherent in responsibility is reliability in completing assigned duties or fulfilling commitments. There must also be a willingness to accept responsibility for errors.

Objectives and Expectations

1.     Adheres to Stanford School of Medicine and Stanford Hospital policies

2.     Arrives on time and prepared for educational and patient expectations

3.     Fulfills obligations and commitments in timely fashion

4.     Respectfully and tactfully questions policies, procedures and practices perceived as unfair

5.     Takes responsibility for shortcomings and areas for improvement

6.     Recognizes errors and impairments in peers and reports these to appropriate entities

7.     Maintains personal control amidst adverse or trying circumstances

8.     Takes initiative, perseveres, and is able to prioritize and to manage time

9.     Takes on appropriate share of team work

10.  Reports accurately and fully on patient care activities

11.  Always ensures transfer of responsibility for patient care

12.  Informs supervisor/team when mistakes occur or when faced with a conflict of interest

Excellence entails a conscientious effort to exceed ordinary expectations and to make a commitment to life-long learning. Commitment to excellence is an acknowledged goal for all physicians and students of medicine. A key to excellence is the pursuit of and commitment to providing the highest quality of health care through lifelong learning, education, and reflection. One must seek to learn from errors and aspire to excellence through self-evaluation and acceptance of the critiques of others.

Objectives and Expectations

1.     Demonstrates ability to practice awareness and self-reflection for lifelong personal and professional development

2.     Balances availability to others with care for oneself

3.     Recognizes the impact of personal biases on professional conduct

4.     Actively solicits and incorporates feedback in a timely fashion

5.     Demonstrates caring, compassion and commitment to the physical and emotional wellness of self

6.     Addresses own gaps in knowledge and/or skills

7.     Pursues and commits to providing the highest quality of health care through lifelong learning, education and reflection

Duty is the free acceptance of a commitment to service. This commitment entails being available and responsive when “on call,” accepting inconvenience to meet the need of one’s patients, enduring unavoidable risks to oneself when a patient’s welfare is at stake, advocating the best possible care regardless of ability to pay, seeking active roles in professional organizations, and volunteering one’s skills and expertise for the welfare of the community.

Objectives and Expectations

1.     Demonstrates caring, compassion and commitment to the physical and emotional wellness of others

2.     Constructively approaches conflict resolution

3.     Provides constructive feedback to improve instruction

4.     Actively participates in peer and faculty oral feedback sessions and written assessments

5.     Shares responsibility for group learning, feedback, and discussions

6.     Recognizes difficulties in peers and assists them in obtaining help or remediation

7.     Intervenes on behalf of colleagues when others behave unprofessionally; addresses unprofessional behavior

8.     Advocates on behalf of patients

9.     Collaborates with communities to address the social determinants of health

10.  Advocates for traditionally underserved populations

11.  Identifies barriers to care and advocates to reduce those barriers

Honesty and integrity are the consistent regard for the highest standards of behavior and the refusal to violate one’s personal and professional codes. Honesty and integrity imply being fair, being truthful, keeping one’s word, meeting commitments, and being forthright in interactions with patients, peers, and in all professional work, whether through documentation, personal communication, presentations, research, or other aspects of interaction. They require awareness of situations that may result in conflict of interest or that result in personal gain at the expense of the best interest of the patient.

Objectives and Expectations

1.     Forthright in interactions with patients, peers and in all professional work

2.     Summarizes material in one’s own voice

3.     Reports accurate data

4.     Admits errors and omissions

5.     Identifies situations where confidentiality is expected and important

6.     Demonstrates ability to negotiate informed consent

7.     Identifies components of patient competence as it relates to informed consent

8.     Understands the role of proxies when patients are unable to provide consent

9.     Demonstrates awareness of situations that may result in conflict of interest or that result in personal gain at the expense of the best interest of the patient or others

Respect for others is the essence of humanism, and humanism is central to professionalism. This respect extends to all spheres of contact, including but not limited to patients, families, other physicians, and professional colleagues, including nurses, residents, fellows, and medical students. One must treat all persons with respect and regard for their individual worth and dignity. One must listen attentively and respond humanely to the concerns of patients and family members. Appropriate empathy for and relief of pain, discomfort, and anxiety should be part of the daily practice of medicine. One must be fair and nondiscriminatory and be aware of emotional, personal, family, and cultural influences on patient well- being and patients’ rights and choices of medical care. It is also a professional obligation to respect appropriate patient confidentiality.

Objectives and Expectations

General Professionalism

1.     Demonstrates respect for patients and colleagues

2.     Demonstrates empathy and compassion for others

3.     Is fair and nondiscriminatory

4.     Exhibits sensitivity to cultural differences among patients and colleagues

5.     Is actively inclusive of others to achieve common educational and patient goals

6.     Maintains appropriate boundaries in work relationships

7.     Uses humor appropriately

8.     Ensures that their appearance is appropriate

Team Work

9.     Takes initiative and works collaboratively on a team

10.  Clarifies expectations and clinical responsibilities, including the student’s role on the team

11.  Communicates with their team regarding conflicting responsibilities

12.  Recognizes that relationships between physicians and other healthcare workers are sometimes characterized by unequal levels of authority, yet does not abuse their authority

Patient Care

13.  Demonstrates caring and rapport with patients.

14.  Demonstrates sensitivity to and actively addresses patients' needs.

15.  Exhibits sensitivity to cultural differences among patients.

16.  Listens attentively and responds humanely to the concerns of patients and family members.

17.  Includes patients and families in decision making.

18.  Respects patients’ dignity

19.  Maintains appropriate boundaries in dealing with patients and their families.

20.  Demonstrates appropriate empathy for and relief of pain, discomfort, and anxiety.

21.  Extends themself to meet patient and family needs.

22.  Takes time and effort to explain information to patients.

23.  Shows sensitivity when discussing clinical information with patients.

24.  Maintains decorum even when patients or others behave inappropriately.

25.  Maintains composure and seeks consultation as necessary when working with challenging patients.

updated August 2019