Van Mook – who sits on the Committee on Professional Behaviour at the Faculty of Health, Medicine and Life Sciences – explains that organisations recruiting doctors for leadership positions tend to focus first on a candidate’s medical expertise, for example by looking at their publication record. But that tells you nothing about their leadership skills, their ability to train new doctors, or even whether they will be a good doctor in practice.
Those roles require different skills: reliability, the ability to listen, empathy, communication skills and the capacity for self-reflection – in short, professional conduct. “For a doctor to succeed in the labour market, these skills are just as important as their medical skills”, says Van Mook. “I’ve conducted research involving complaints committees and I sit on a regional medical disciplinary board. Formal complaints are almost always about non-medical aspects. Generally speaking, if you treat your patients, colleagues and other healthcare professionals well, you’re unlikely to receive a formal complaint.”
Role models
That is why Van Mook argues that candidates should also be selected on non-medical skills, often referred to as “generic competencies”. The same applies to department heads and instructors, who should serve as role models for the future specialists they’re training. “That includes admitting when you’ve made a mistake or wrong decision, or behaved unreasonably because you were running on four hours of sleep.”
But it may also apply to selecting medicine students and specialists in training. According to Van Mook, training posts are currently appointed largely based on candidates’ CVs, including their grades and work placements. Aspiring specialists are well aware of this and begin building their CVs early on, turning medical education into something of a rat race. “On top of that, they’re all highly competitive and often very perfectionistic”, says Van Mook. “That’s not a bad thing in itself, but always striving for the best can also lead to burnout-like symptoms. And we know from research that people with these symptoms are more likely to behave unprofessionally. Poor work-life balance will eventually affect your work. Perhaps – and I say this with caution – we should consider reintroducing the allocation of medical training posts by lottery. That might help address part of the problem, including in specialty training.”
Tool for reflection
The good news, according to Van Mook, is that the vast majority of people can develop professional conduct and generic competencies. At MUMC+, instructors receive mandatory training in this area, as do specialists in training. “We also offer coaching and peer feedback. In most departments, specialists in training are assigned a mentor they can easily approach with any problems. They’re also required to keep a portfolio, which is used as a tool for reflection in discussions with their instructors.”
What if problems do arise? “Most problems can be resolved through an informal conversation. Sometimes a formal process is needed. Unprofessional behaviour can usually be corrected.” Only in rare cases is this impossible. “At that point, you need to be clear. If someone repeatedly belittles others, behaves unprofessionally and is unwilling or unable to change, there must be consequences – even if it doesn’t directly affect patient care. In my view, such a person should not be able to build a career here. Unprofessional behaviour is not just disruptive; it also indirectly has a negative impact on the quality of care.”
Reluctance
One issue, he says, is that most people are reluctant to speak up and prefer to avoid conflict. “We all tend to give people the benefit of the doubt. But if you see a problem and don’t report it, patterns will never come to light. We know this from both research and practice, and it simply isn’t acceptable.”
What can the Faculty of Health, Medicine and Life Sciences (FHML) do? Should any changes be made to the medical curriculum? Not necessarily, Van Mook says. He explains that FHML has long paid close attention to professional behaviour: “Professional development is integrated throughout the curriculum. Students are made aware of its importance when it comes to social media use, privacy and integrity, for example. They learn about it and are given the opportunity to develop these skills. The faculty does this very well.”