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APHC Conference Content
by Leann Poston
The APHC conference, Navigating the Professionalism Challenges of Evolving Technologies: Getting Serious About Digital Professionalism - from Social Media to Electronic Records to Artificial Intelligence, included two symposiums, a keynote speaker and fireside chat, 18 oral presentations, five poster presentations, two problem-solving sessions, two workshops, and two games. Summaries of some of the sessions are included below.
Digital Professionalism, Artificial Intelligence, and YOU
John Banja, PhD, a medical ethicist at the Center for Ethics at Emory University discussed the recent advances in artificial intelligence technology and what it means for health care delivery. Health care for physicians changed in the mid-80s with managed care - the biggest change agent in most physicians' careers. The power of physicians began to sink, and many physician groups went under. Health care had become commodified and competitive. Media reports of medical errors and corporate greed accelerated the demise of trust in healthcare, but the individual physician-patient relationship survived.
A true professional is someone who has succeeded in a knowledge-gathering process followed by enculturation and continued but contextualized training and experience. The licensure verifies that they have gone through this didactic path and can deliver health care following standards of care.
The pandemic seems to have exacerbated a continued negative trend affecting health care professionals, including burnout, moral distress, poor morale, resignations, and substance abuse. John discussed the tragedy of RaDonda Vaught, who was convicted of negligent homicide in the death of Charlene Murphy. Meaning? A nurse was criminally prosecuted for careless mistakes. Nurses saying there but by the grace of God go I. Medication mistakes are common.
Artificial intelligence may help with robotic-assisted surgeries, image recognition algorithms, monitoring systems, AI automation, and precision medicine. These technologies don't get tired or incur extra costs, and these applications are limited by the imagination of programmers and the physical and chemical limitations of the technology.
Concerns:
· The de-skilling threat: automation can lead to skill loss by physicians and other healthcare providers.
· Legal liability issues may emerge when the AI disappoints us. What happens when the technology model becomes the standard of care, and the physician disagrees with the model? The physician could be sued whether they follow the model or not.
· Loss of healing as a derivative of the geographical and psychological proximity of the physician-patient relationship.
· Integration of AI and humans: would AI have prevented the Vaught/Murphey tragedy?
· Clinical education of the future: We will need to train healthcare professionals on how to navigate and operate this technology.
· Medical ethics today versus 50 years ago: changes in terms of honesty with patients, teamwork, medical errors, confidentiality, and relationships with patients.
Implication: Professionalism is a moving target shaped by technology and the changes it makes in the environment in which medicine is practiced.
Ethical practices: We experiment and create them, hope they're good, and hope we have the freedom to change them if they are not good.
Ethical and Practical Dilemmas for Student Professionalism in Digital Learning Environments Problem Solving
Flavio Marconi Monteiro, EdD, Senior Medical Educator, Office of Educational Development at the University of Texas Medical Branch, and Karen Szauter, MD, Assistant Dean of Educational Affairs at the University of Texas Medical Branch, presented Ethical and Practical Dilemmas for Student Professionalism in Digital Learning Environments - a problem solving session. This presentation used scenarios to discuss ethical dilemmas facilitated by the use of digital technology in instructional settings and analyzed potential strategies to encourage student professionalism in these settings.
Professionalism in medicine is a physician charter that focuses on the primacy of patient care, patient autonomy, and social justice and the contract/covenant with society that results. The presentation opened with an example of how the professionalism program was developed at UTMB. The next step was to take the proposed professionalism framework to a digital environment. The COVID pandemic opened the door to a world of technology which increased the risk of unprofessional behavior among learners, teachers, and professionals.
These scenarios were presented:
· Medical student Facebook page of a patient with COVID who posted, "This was my patient today. COVID. This is completely unnecessary. Vaccines are available to everyone."
· A medical student posted to a social media account of a non-UTMB account, "COVID vaccines are unnecessary and have harms that are not being publicized," which was signed by a medical student at UTMB. The site was publicly accessible.
· Students must attend and track required workshops using an easy-to-access app. Students sign in and do the class online. More students signed in and evaluated the class than attended the required course.
· Students had digital sign-in and evaluation of a course. They were required to keep their cameras on. Students signed in and then uploaded a video loop of themself at the computer "participating," which played throughout the session.
Digital resources have opened new ways for students to compromise their decision-making, and collaboratively developed guidelines can assist students in their professional development.
Fireside Chat
Ashley Moyse interviewed Fabrice Jotterand in this fireside chat. Dr. Jotterand's scholarship and research interests focus on issues involving neuroethics, ethical issues in psychiatry and mental health, the use of neurotechnologies in psychiatry, the philosophy of medicine, medical professionalism, neurotechnologies, human identity, and moral/political philosophy. He has published more than 80 articles, book chapters, reviews in leading academic journals, and seven books.
Fabrice is initially from Switzerland; he described several philosophers who impacted his intellectual formation. He stresses the importance of intellectual friendships to discuss and exchange ideas. To navigate these friendships, you need respect, humility, and courage. He said that we need to challenge the mindset of scientism and realize that medicine is a science and an art and then a virtue. Addressing current issues in medicine cannot use only science. Medicine is based on science, but its application requires the humanities. He said that his role is to be critical but supportive and to help healthcare professionals succeed and provide compassionate care.
In answer to Ashley's question about his research agenda, Fabrice says that he is curious and asks questions. Fabrice said that medicine is in an anthropological crisis. In light of all these powerful technologies, we are challenged to consider what it means to be human and to be a professional.
Among other roles, the doctor is an innovator, and we need to consider how this relates to technological advances. Fabrice said doctors need to be excited about innovation, but technology adoption needs to be filtered. Physicians need to ask whether it will undermine their agency as human and qualified physicians and the impact on the patient.
What if we think about medical education and professionalism through the lens of the philosophy of medicine? What does it mean to be a moral agent? Challenge and shape the identity of students without negating their identity. What is missing is an understanding of the nature of the profession and what it means to be a professional.
Fabrice's research direction is to examine anthropological frameworks prevalent in medicine and try to challenge and understand them. Then look into the future and try to understand what this means for the future of medical education.
When asked how he would incorporate rival understandings of what it means to be human, Fabrice said that he would approach the problem from a particular standpoint. He would engage with others to stretch himself. The key is to start with a particular standpoint and clarify from there.
How NOT to Lose Your Medical License
How NOT to Lose Your Medical License Before You Even Get It: Professionalism in Residency and Beyond (sponsored by American Association of Colleges, Osteopathic Medicine (AACOM) with panelists:
Barbara E. Walker, DO, Director-at-large, FSMB Board of Directors
Ravi Nallamothu, MD, SFHM, Program Director, Southeast Health Transitional Residency Program
Praful Patel, MD, FACOG, OB/GYN and Elective Clerkship Director, Alabama College of Osteopathic Medicine
Kristal Pouching, Chief Resident, Department of Medicine, Maimonides Medical Center
Ashley Henderson, 4th year medical student, UT Health Houston McGovern Medical School could not make it
Amber Chen, 4th year medical student, UT Health Houston McGovern Medical School
How would you define professionalism?
· Amber: A school survey of the McGovern community defined professionalism as respect, integrity, compassion, collaboration, and self-improvement.
· Kristal: Professionalism speaks to putting the needs of my patients and the patient care team above my own.
· Praful: The first word that comes to mind when considering professionalism is "kindness." He advises students to consider whether important people in their life were watching their actions and whether they would be proud of their behavior.
· Ravi: Professionalism is a wide concept that includes using our clinical knowledge, technical skills, and communication skills for the community.
· Barbara: Uses the definition given from the American Board of Medical Specialties board that defines professionalism as a belief system and explains how medical care should be organized and delivered. The values in that belief system are really vital to improving patient outcomes and clinician well-being.
Which professional attributes are most important to you?
· Amber: Respect
· Kristal: Attributes that revolve around work ethic
· Praful: Kindness
· Ravi: Sensitivity to various cultural aspects, professional growth
· Barbara: 5C's competence, continuous improvement, communication, collaboration, critical thinking, and compassion
What are the biggest examples of unprofessional behavior?
· Amber: Sometimes behaviors come from the students, but frequently the behaviors are modeled by supervisors
· Kristal: Professionalism is a journey, and examples depend on where you are in your journey
· Praful: Students that may run into problems are unable to work in a group setting and not assuming a team member role
· Ravi: Maintaining patient confidentiality and claiming an experience that they have not had
· Barbara: Confidentiality and not remembering HIPAA, not communicating effectively and admitting not knowing something, a need to understand their public image
What have you learned in terms of social media and professionalism?
· Amber: The idea of professional identity vs. personal lives
· Kristal: The use of technology will only increase in the younger generations. Their social media avatar may be even more of who they really are than in real life
· Praful: It is difficult to have a personal life if you have any social media accounts, and the trouble you can get into when using social media accounts is if you have an online persona, it is likely your professional persona as well
· Ravi: The culture in social media is very casual, whereas in medicine is more formal, and the communication styles are different. The second is difficulty in managing emotion
· Barbara: Medical boards, deans, patients, and licensing boards all can see what you post on social media
Final thoughts or advice for students?
· Amber: Faculty should be aware of the behavior they are modeling
· Kristal: Figuring out what is professional or not can be confusing, daunting, and scary. Err on the side of caution and try to attach yourself to a mentor
· Praful: We are products of those who touch our lives, learn from positive and negative experiences, think twice before sending or posting
· Ravi: In medical school and beyond, we are held to a higher standard and consider behavior and attitude, especially under stress.; it is also important to practice self-care
· Barbara: Self-care is critical. Take care of your family, your patients like the idea that you are human
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