All healthcare educational curricula aim to foster the development of safe and professional clinicians. The professional values and behaviours of clinicians determine how team members interact and support each other. They are crucial for safe and effective patient care. Simulation provides a unique opportunity for learners to demonstrate and observe professional attitudes and behaviours, and to explore and reflect on their own underlying values. However, as healthcare educators, we often lack the basic vocabulary and consistency in terminology to support learning conversations. The Generic Professional Capabilities Framework (GPCF) published by the General Medical Council in the United Kingdom gives a detailed description of essential capabilities that underpin professional medical practice. Specific descriptors relating to professionalism are essential when addressing the challenges of communicating and developing complex professional behaviours. They are helpful when diagnosing and supporting learners or clinicians in difficulty and fundamental in the identification and promotion of positive professional behaviours. In this article, we highlight key opportunities in using such frameworks in simulation-based education to explore and champion a focus on professionalism. They also provide accessible terms and phrases that will aid healthcare educators and clinical supervisors to introduce consistent professionalism-specific terminology into their everyday practice, for simulation design and delivery, and for clinical debriefing and feedback.
What this essay adds
Healthcare professionals work in complex and challenging environments. Professionalism is a complex construct which encompasses a set of values, skills and behaviours expected from those whom society deems an expert [1–3]. All undergraduate and postgraduate healthcare educational curricula aim to foster the development of safe, competent and professional clinicians, with the necessary insights, skills and attitudes to perform at a consistently high standard in a wide range of relevant environments. The professional values and behaviours of these clinicians often determine how team members interact and support each other, and are therefore crucial for safe and effective patient care.
The State of Medical Education and Practice reports of the UK General Medical Council (GMC) estimate that more than 82% of complaints against doctors requiring full GMC investigation relate to professional values, behaviours and generic capabilities such as their probity, honesty, integrity, self-awareness, respect, communication or professional performance [4–7]. This raises fundamental questions about how effectively the challenges of supporting the development of such complex professional behaviours are addressed and how expectations are communicated across a wide range of clinical, professional and cultural contexts. Greater clarity and precision in the language being used to describe appropriate professional values, behaviours and capabilities, therefore, become an essential requirement for effective high-quality clinical education, training and practice.
Current thinking on patient safety focuses on the importance of learning from performance variability [8]. This requires appropriate vocabulary to describe success, failure and everyday clinical practice in order to clarify and identify ways to improve. Positive learning and learning from success have permeated education in general and simulation in particular [9–11]. Specific yet accessible descriptors characterizing the various domains and aspects of professionalism are essential to communicate, reinforce and promote appropriate values and positive behaviours, as well as to identify and support learners or colleagues in difficulty.
As healthcare educators, we often lack consistency and precision in the terminology and constructs employed to support the design and delivery of simulation-based interactions focussed on professionalism [12,13]. This is also particularly relevant to clinical learning conversations such as post-event debriefing. Therefore, the vocabulary we draw upon needs to provide accessible and accurate ways to articulate key concepts that allow clinicians, educators and learners to nurture their shared understanding of professional values, behaviours, and capabilities across socially and culturally diverse settings. Furthermore, clarity in the explicit conceptualization and broad scope of what professionalism entails in each sociocultural context will aid metacognitive learning processes and foster greater educational consistency between simulation and clinical environments [14].
Multiple perspectives have been explored internationally in an attempt to provide a common understanding of professionalism in healthcare professions, from epistemological methodologies to socio-political considerations [15]. There is much congruence across these various approaches. The GPCF published by the GMC in the United Kingdom gives a detailed description of essential capabilities that underpin medical professional practice [16]. This framework outlines expected core learning outcomes for all UK medical undergraduate and post-graduate curricula. In addition, many of its descriptors are generic, and may be applicable to the development of professionalism across all healthcare professions.
Simulation-based education and training (SBET), if used appropriately, provides a uniquely safe opportunity for learners to demonstrate, explore, and reflect on their professional attitudes and behaviours and their underlying personal and professional values. SBET has been employed to foster the development of professional behaviours and capabilities across multiple settings, including medicine, nursing and allied healthcare education [17–20]. It can play a key role in the development of personal insight in individuals and clinical teams [21–25].
The particular utility of simulation to create behaviourally anchored experiential learning opportunities, enhanced by effective debriefing and shared reflective practice, is illustrated by the work carried out by the Welsh School of Anaesthesia [26]. They developed SBET activities with a dedicated focus on professional values and behaviours as described in the UK GPCF in 2019. Materials and course delivery were peer-reviewed by multi-professional and international educators. The key to success in this experience was a specifically trained faculty group adopting the agreed framework and associated nomenclature for professional practice. The theme of faculty development for professionalism training in simulation was explored further by multi-professional experts and participants at the workshop ‘Looking beyond the behaviour: improving the language to debrief on professionalism’, held during the 2021 SESAM Annual Meeting.
Our experience has allowed us to identify the GPCF domains best suited for healthcare simulation and to summarize terminology and phrases with educational utility (Table 1). This table of useful descriptors provides a lens that enables learning and reflection on professional values and behaviours either by design of simulation experiences with aligned and clearly expressed learning objectives; by stealth in those activities in which professionalism is not a stated or explicit learning outcome but where there is a latent intention that it may be discussed; or by opportunism when situations emerge spontaneously.
| Domain | Behaviour descriptors |
|---|---|
| Professional values and behaviours | Demonstrate to all • Honesty, integrity, openness, accountability • Respect, courtesy, compassion, empathy • Emotional resilience • Situational awareness • Self-awareness/ self-monitoring • Managing complexity and uncertainty Demonstrate to patients, relatives and carers • Dignity, confidentiality • Listen to and accept different insights and preferences • Take prompt action to preserve safety and quality of care Demonstrate to colleagues • Support, collaboration • Respect towards differences of opinion • Contribute to safe learning and working environments • Exemplify a professional role model |
| Communication and interpersonal skills | • Establish an effective partnership with patients and/or service users • Demonstrate adequate verbal and non-verbal communications skills, including: ○ effectively managing challenging conversations ○ using translation services where appropriate ○ appropriate safeguards of remote consultations • Embrace shared decision-making • Demonstrate social and cultural awareness • Appraise own performance and that of others as a means of reflecting on and improving practice |
| Leadership and team-working | • Demonstrate appropriate leadership and/or followership • Supervise, challenge, influence, appraise, and mentor colleagues/peers to support and enhance their performance • Effectively participate in multidisciplinary and interprofessional team working |
| Patient safety and quality improvement (QI) | • Raise safety concerns and act on them appropriately • Demonstrate cognitive and interpersonal behaviours that contribute to optimal team performance • Demonstrate respect for and recognition of the roles of other health professionals in the effective delivery of patient care • Effectively pre-brief, debrief and learn from own performance and that of others |
| Safeguarding vulnerable groups | • Recognize and take responsibility for safeguarding children, young people and adults, using appropriate systems for identifying, sharing information, recording and raising concerns, obtaining advice, and taking action • Apply mental capacity legislation in clinical practice • Apply equality and diversity legislation, including disability discrimination requirements, in the context of patient care |
Originally summarized by CDN and IC for SESAM 2021 workshop ‘Looking beyond the behaviour: improving the language to debrief on professionalism’.
The wide applicability and usefulness of these descriptors range from multi-professional SBET to everyday clinical or professional conversations in healthcare environments. However, realizing this value entails careful consideration of the following aspects:
SBET can improve learning and enhance the quality of patient care [33,34]. Simulation helps learners develop complex sets of skills required for safe clinical practice, and grow as healthcare professionals through contextualized experiential activities [35,36]. Accurate, neutral and precise language in the descriptions of professional values, behaviours and capabilities is crucial to facilitate this learning, and its usefulness manifests itself through a range of layers:
– Micro level: aiding self-reflection, description and discussion between individuals such as team members, learners and facilitators.
– Meso level: assisting team-based learning, training and debriefing, and contributing to departmental conversations on issues such as professional behaviour, clinical risk, clinical harm, improvement or patient feedback. This approach can also improve the effectiveness of leaders in their communication of expectations with colleagues, teams and departments.
– Macro level: This approach enables leaders, institutions, policy-makers, regulators and healthcare systems to effectively communicate professionalism expectations and describe concerns through the deployment of accessible, consistent and precise language. It will also facilitate accurate communication between patients, professionals, institutions, commissioners and regulators.
Notably, this language is essential in identifying and reinforcing positive behaviours as well as recognizing needs for remediation in clinical and learning environments, impacting not only training, development and assessment, but also promoting professionalism in the wider healthcare workforce.
The broader approach and lexicon of professionalism incorporate human factors and non-technical skills principles and concepts. However, its particular utility lies in the holistic and foundational nature that professionalism plays in establishing the values, behaviours and capabilities of clinicians and as such, it clarifies the motivation, responsibilities and expectations of all healthcare professionals. Its application extends to socially and culturally diverse settings, and will have utility in characterizing current and emergent challenges. It provides the elemental building blocks of what is professionally acceptable and so will facilitate the description and variability of what might be deemed appropriate, albeit in the context of temporal variability, across different socio-cultural environments both from professional and patient perspectives.
Further research is required to identify and evaluate current familiarity with, and use of existing professionalism taxonomies and frameworks at an individual, team and institutional level as well as explore the cultural variations in their description and expectation.
All authors have contributed substantially to writing and reviewing this article, and have approved the final version.
None declared.
None declared.
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None declared.
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