EDITORIAL

The educational challenge of The Good Physician housework

El reto educativo de El buen quehacer del médico

Albert Oriol-Bosch, Arcadi Gual

Correspondence

In March 2014 the General Council of Official Medical Associations (CGCOM) published a document entitled The Good Physician housework, which can be accessed at www.fundacioneducacionmedica.org. The document was drawn up by a small number of experts with the critical support of another 35 professionals and the Fundación Educación Médica (FEM), which assisted in the development of the idea, its execution, the drafting and revision of the document, and the consensus and eventual adoption by the medical profession within the CGCOM. The FEM is indebted to this institution, which has been the essential driving force allowing this task to be successfully completed.

As stated by Dr Rodríguez Sendín, president of the Spanish General Medical Council, this document, 'understood as a set of guidelines for good medical practice, establishes the behaviour and the attitude a doctor should follow and as such is therefore useful not only to professionals, but also very directly to professional organisations and the institutions responsible for the training of physicians'. It is therefore hardly surprising that the FEM has taken this document, now the property of the medical profession, and handed it over to the educational community to be included within its own pool of resources and to be used to guide its good educational practice. The fact is that the Bologna mandate currently in force, according to which the educational process should be oriented towards achieving the predefined competences, requires significant and necessary changes in the assessment methodology in order to determine the scope of the foreseeable achievements. And there is also a need for greater precision in the measurement of the level of competence reached, that is to say, of its application to professional practice. The Good Physician housework offers the conceptual frameworks required to implement the new essential evaluative procedures.

The document is structured in eight domains (professionalism, physician-patient relationship, professional competence, communication and collaboration, intra- and inter-personal relationships and teamwork, safety and quality, professional practice-learning relationship, and healthcare organisations and health systems), which show that the current architecture of the first two educational cycles (bachelor's degree and specialised training) does not match this at all.

The analysis of good practice for doctors basically deals with operational elements that correspond to what are known in educational jargon as 'cross-curricular competences'. Unfortunately, today, nobody takes responsibility for these competences or evaluates them in our teaching institutions. Since they are everyone's responsibility, in actual fact, nobody feels responsible for them. In this regard, it has been shown that when problems arise in clinical practice, what are at stake are generic or cross-curricular competences [1]. More interesting still is the work by Meng [2], who points out that success on the labour market is determined more by generic competences than by specific ones. As a result we have an unquestionable duty to improve, within the three periods of doctors' training, the development and learning of these 'disowned', that is to say, cross-curricular competences.

The eight domains developed in The Good Physician housework are not as amenable to a formal educational process (with formally organised contents, a specific teaching method and a curricular distribution) as they are to the setting in which the educational process is carried out. The educational climate within the faculties of medicine and the work climate in healthcare organisations, hospitals or primary care centres are probably the best resources available for instilling -or eradicating once and for all- attitudes that are appropriate to doctors' good practice. Fortunately, there are tried and tested resources for evaluating the educational climate both in faculties [3] and in healthcare institutions [4]. Yet, the educational climate is not an issue that, today, concerns those in charge of the respective institutions.

Highlighting the fact that the educational process must lead to the attainment of a product that is capable of acting in agreement with what is set out in The Good Physician housework will help those responsible for the institutions to take an interest in the educational and work climate in their organisations, while also helping to ensure that the decisions they make will be conducive to achieving the desired aims. Knowing the real situation of the institutional climate and the progress made in their respective institutions can be accomplished, as has been pointed out above, through the use of instruments that to date have been just as neglected as they are as available and valid.

This document calls for educational institutions to abandon the comfort zone of their own subject or specialty to take on joint challenges that affect the common domain where it becomes essential to share responsibility with all the others.

Correspondence:
Fundación Educación Médica.
Departamento de Ciencias Fisiológicas I.
Facultad de Medicina. Universitat de Barcelona.
Casanova, 143.
E-08036 Barcelona.
E-mail: agual@fundacioneducacionmedica.cat

References

1. Van der Vleuten CP, Schuwirth LW, Scheele F, Driessen EW, Hodges B. The assessment of professional competence: building blocks for theory development. Best Pract Res Clin Obstet Gynaecol 2010; 24: 703-19.         [ Links ]

2. Meng C. Discipline-specific or academic?; acquisition, role and value of higher education competencies. ROA Dissertation Series no. 8. Maastricht: Research Centre for Education and the Labour Market; 2006.         [ Links ]

3. Genn JM. Curriculum, environment, climate, quality and change in medical education -a unifying perspective. AMEE Medical Education Guide no. 23. Med Teach 2001; 23: 445-54.         [ Links ]

4. Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Med Teach 2005; 27: 326-31.         [ Links ]