Medical Professionalism Across Cultures: A Literature Review.

This article was migrated. The article was marked as recommended. The review aims to identify the cultural perspectives of medical professionalism by identifying relevant literature from the Middle East, East/South Asia, and the Western world that discuss definitions. A literature search was conducted using the "Summon" search engine, and 200 articles sorted by relevancy were manually reviewed. Based on the surveys and documents gathered from each of the regions, the definitions seem to be fairly consistent in their recognition of characteristics important to the concept of medical professionalism. These include several characteristics, with some of the most common being personal character, respect for patient autonomy, responsibility, and social obligations; the main difference lies in emphasis with the West focusing on societal issues and patient rights, the Middle East focusing on morality and personal character, and East Asia focusing on respect, responsibility, and other duties. These differences are reviewed and the cultural sources are further expanded upon.

Addiction medicine and continuing medical education.

Addictive disorders are one of the most common problems encountered by primary care physicians. In the last decades there has been a significant effort by organizations, universities, and private foundations to increase the teaching of alcohol and drug abuse issues to medical students, residents and practitioners. Still, up to now, the subject has not been presented appropriately at either the undergraduate or graduate medical education level and the majority of physicians in practice have not been adequately instructed in addiction medicine. This article reviews the literature on addictive disorders and medical education, exploring issues concerning continuing medical education (CME) in particular. The authors discuss the problems relative to this subject and the educational techniques and methods most appropriate to changing attitudes and behaviors of physicians. They also design an approach to a CME program on addictive disorders for primary care physicians that incorporates multiple teaching/learning methodologies.

Primary hepatic carcinoma. Its incidence and relationship to HBsAg.

The records of all patients with primary hepatic carcinoma diagnosed between 1971 and 1976 at Michael Reese Hospital in Chicago were reviewed. Of 175,953 discharges only 43 were for primary hepatic carcinoma; one for 4,080 admissions as compared to one per 193 admissions for primary colonic carcinoma. The patients ranged in age from three to 80 years with a mean age of 60.25 years. Twenty-one patients were represented by the 43 admissions. Twelve patients were black, eight were caucasian, while 12 patients were found to have cirrhosis of which at least eight patients had micronodular cirrhosis. Since this was a retrospective study only 12 patients had HBsAg and Ab determinations. One was positive for both antigen and antibody, while one was positive for antigen only and one for antibody only. Tissue diagnosis revealed hepatocellular carcinoma in 19 patients and cholangiocellular carcinoma in two. Most patients lived on to three years after diagnosis.

Effect of a medical care evaluation program on physician knowledge and performance.

A model program designed to increase the educational value of medical care evaluation committee meetings was studied to determine its effect on the knowledge and clinical performance of participating physicians. The members of hospital committees in which the program was successfully implemented showed a statistically significant gain in knowledge of the topics discussed by their committees. In addition, several members made substantial changes in their patient care practices. These changes resulted not so much from the acquisition of new medical information as from a rethinking of patient management strategies, stimulated by peer discussion during committee meetings. A structure that encourages such discussions can be incorporated in other types of patient-care-oriented committee activities as well.

Teaching problem-oriented recording: a systematic approach.

Medical students and practitioners usually learn how to use problem-oriented medical records (POMR) by haphazard means. In attempting to put system into the teaching of POMR, the authors devised teaching case material and two instructional formats: self-instruction and workshop. The results of a controlled study with second-year medical students to determine the relative effectiveness of instructional formats and case materials are presented. At the end of instruction POMR performance was measured by assessing the student's ability to convert a case to POMR format. The results suggest that all student groups attained an acceptable performance level no matter which format they experienced.

Format review: evaluating implementation of the problem-oriented medical record.

As interest in the problem-oriented medical record (POMR) develops, and more medical settings begin to implement the system, many observers are expressing a desire to know how well the system is being used and accepted. Moreover, settings currently using the POMR system have a need to document the effectiveness of their POMR program as a means of insuring continued progress and for addressing difficulties and obstacles affecting its use. Format review is a technique for reviewing patient records and describing patterns of POMR use. Patient records of an institution are reviewed concurrent to the patient's contact with the institution. Data collected from each record is summarized to provide an overview on patterns of POMR use and to identify areas of difficulty. These findings can serve as the basis for educational and administrative intervention to improve use of POMR. The format review technique is explained and examples of its application are given. The technique has been used at Michael Reese Hospital and Medical Center over the past two years, and has proven to be a useful tool in describing the implementation progress of POMR.

Increasing the educational value of medical care evaluation: a model program.

A model medical care evaluation (MCE) program, designed to increase the educational value of MCE activities, was implemented in three clinical departments at the Michael Reese Hospital and Medical Center. The program was evaluated by means of quantitative and qualitative observational techniques, questionnaires, and interviews and by comparing committees for which the implementation was highly successful with those for which it was less successful. The results confirmed the educational value of the following features of the model program: (a) a focus on the process of care rather than standards of care, (b) prior review of records and their presentation as case problems, (c) educational emphasis by the committee chairperson, and (d) attendance by at least four physicians. Implications for other types of hospital quality assurance or educational activities are discussed.