RESUMEN
In 2002, the American Board of Internal Medicine (ABIM) Foundation launched the Professionalism Charter Project (Putting the Charter into Practice), an effort to more broadly disseminate an international physician charter on professionalism developed in collaboration with the American College of Physicians (ACP) Foundation and the European Federation of Internal Medicine. The Professionalism Charter Project awarded grants to five academic health centers (AHCs) in support of campus initiatives aimed at implementing the charter's commitments to patient welfare, autonomy, and social justice. One of those centers, the University of Texas Medical Branch at Galveston (UTMB), was already deeply involved in a professionalism initiative under the leadership of university president Dr. John Stobo, who had led ABIM's Project Professionalism some years earlier. The authors describe the influence of that initiative on UTMB's professionalism journey, from Stobo's appointment in 1997 to the latest actions undertaken to extend the charter campus-wide, binding all members of the university community to its principles and commitments. They reiterate challenges to professionalism well known to readers of this journal (e.g., the insidious influence of the hidden curriculum) and detail programs undertaken to address those challenges, stressing UTMB's campus-wide approach to interdisciplinary collaboration. Assessment of, and accountability for, professional behavior are key features of UTMB's approach, and particular attention is given to the decisions, circumstances, and programs involved in making the charter relevant, not only to physicians, but to each member of the AHC community. Finally, the authors offer a list of lessons learned along the way.
Asunto(s)
Curriculum , Educación Médica/ética , Cultura Organizacional , Competencia Profesional , Valores Sociales , Códigos de Ética , Ética Médica , Humanos , Innovación Organizacional , Rol del Médico , TexasRESUMEN
One of the most important challenges in resident education is to train residents how to function in relation to managed care companies and systems so as to enhance the quality, accessibility, and efficiency of health care. Since 1996, The University of Texas Medical Branch in Galveston has presented an annual half-day seminar on managed care to new residents. The format involves training sessions and didactic presentations aimed at small groups (led by faculty physicians and nonphysicians from throughout the medical and managed care establishments). Problem-based learning sessions conducted in these groups focus on topics such as the organization of managed care systems, access, network, admit versus observation, inpatient status, denials, avoidable hospital days, concurrent reviews, gatekeepers, referrals, behavioral health, disease management programs, and financial considerations. Pretests and posttests are given to those participating to gauge the effectiveness of the program. In addition, participants complete evaluation forms that can be used by program coordinators to assess resident satisfaction with the learning format and to determine what improvements can be made in the process. For the 1999 and 2000 seminars, posttest results were significantly higher than pretest results for the new residents who participated in the seminar. Each year, seminar evaluations show that the small-group format is well received. We conclude that the small-group learning format is effective and enjoyable for the residents and their leaders. The format necessitates the training of 30 group leaders to increase their knowledge of managed care systems.