Experience is hard teacher because she gives the test first, then the lesson afterwards. – Vern Law
As a last year understudy remaining on the slope of meeting all requirements for a BSC in Physiotherapy, there are sure abilities which I have procured all through my experience which have helped my comprehension of the parts satisfied by morals and demonstrable skill in this calling. The capacity to quantify demonstrable skill and ethics inside any calling is not a simple idea given the scope and profundity of ideas related therewith. These concepts are loosely defined and can evolve over time, especially given the increased interaction of professional staff in the work environment coupled with the physiotherapist’s ability to adequately define valid and reliable measures which incorporate behavioural characteristics, values and attitudes.
The ability to measure professionalism and morals within any profession is not an easy concept given the latitude and depth of concepts associated therewith. In defining professionalism within the broader notion of physiotherapy, one should constantly demonstrate moral core values by applying principles of altruism, excellence, caring, ethics, respect, communication and accountability (“Professionalism“, 2016). This must be read in conjunction with the practical aspect of the profession, with emphasis on working together with other professionals so as to achieve optimal health and wellness in individuals and communities. (Irvine, 2006). As a result of professionalism and at the edge of my final year as a student, this essay seeks to reflect around challenges and successes I have had throughout the year, highlight aspects of growth and means of dealing with a situation.
Next year we will be in the “real world” hoping that all the facts we had to recall over the past four years would enable us to excel, not simply get by. Unfortunately, in the “real world” it is not all black and white like the theory we have been studying. There is a variety of skills and lessons to be learned; embedded in the various professional settings (Howe, 2002). You are required to be a professional with moral and ethical values that develop over time to become a professional. Therefore professional development skills are crucial for long term professional success (Howe, 2002). Having spent majority of the year in clinical settings, I have been exposed to various implicit lessons required to master on the road to becoming a professional. But have I grown as a professional? According to Howe (2002) acquisition of the required skills or values is irregular, so it is necessary to evaluate your professional development.
The concept of professionalism has a vast array of interpretations but can be narrowed down to a few parameters (Morrow, Burford, Rothwell, Carter, McClachlan, & Illing, 2014). These parameters are; adhering to a set of regulations or code, appropriate appearance which includes uniform, appropriate attitude, behaviour and communication for the setting, sound knowledge and clinical skills and keeping up to date with developments in the field (Morrow et al., 2014). I have always thought that the appropriate attitude which embodies morals, ethics and was of particular importance with regards to professionalism. There are the obvious attributes such as integrity, honesty, morals, ethics, empathy and a good work ethic which I feel are important, but the most significant attribute I feel is responsibility.
These two videos above, speak about professionalism around the healthcare place and how clinicians should uphold professional values accompanied with ethical principles when working with patients (“Why Does Professionalism Matter? (Part I)”, 2016) and (“Why Does Professionalism Matter? (Part II)”, 2016)
A crucial part of professionalism is responsibility for your learning, decisions, actions and patients which is necessary for a professional. Throughout the year I have been saying “I am a student”. This allows me to take responsibility in the classroom but not necessarily in the clinical setting. I have used this excuse a few times this year, especially with regards to attempts at juggling my private and academic life. But now it is the end of the year, following exams I am no longer a ‘student’. There is no switch I can flip that will automatically make me a professional. If professionalism is not a switch that I can simply turn on, how do I be a professional? Morrow et al. (2014) commented that professionalism could be a set of characteristics of the person, not something that you suddenly have once you are qualified.
Based on that premise, you can and should be professional when you are a student preparing for your respective field. As a student you should only be exempt from having all the knowledge needed for your profession. You should however, be punctual, have the correct uniform, treat others with respect and courtesy, and take responsibility for your actions not related to direct theory. When I started my first block of clinical practice, this was not a concept that I considered. I have neglected researching treatments for patients in favour of completing an assignment. At the time I felt it was necessary, completely justified and I would do it again. In retrospect, it was a poor decision. It made me realise that my time management skills are not as good as I originally thought, because I should be able to balance my assignment or varsity work and clinical work. It is a skill that will be practiced prospectively. Post University is another chapter with its own distractions and aspects which need my attention. I will be working and have my patients to deal with. I will have to keep up to date with advances in physiotherapy which entails me doing my own research, reading and attending courses. I will have a life outside of work and will have to attend to those needs as well. Being able to manage my time effectively is a skill which I need to master in order to achieve balance not just in clinical practice but in life. It has taught me that time management is a crucial part of professionalism and common courtesy, so as of next year I will be incorporating a diary that I can manage my time effectively.
Having good time management is not the only quality I have highlighted this year, especially with regards to role models. As mentioned earlier, I will be the clinician next year. I am forced to accept the responsibility of being a role model. Earlier this year, we spoke about what entails to be a good professional and to name but a few traits were; eager to learn; treating effectively and leading by example; showing an interest and eagerness for the field; willingness to teach and encourage growth; show empathy and dedication towards the patient which are all traits of an ideal clinician as well as a good role model (Jochemsen-van der Leeuw, van Dijk, Van Etten-Jamaludin and Wieringa-de Waard, 2013). I also wrote how I am conscientious and have grit which are traits linked to motivation and success (Komarraju, Karau & Schmeck, 2009; MacCann, Fogarty & Roberts, 2012).
However, how many of these traits do I truly embody? These are traits I should have been consciously working at improving throughout the year. Once again, there is no switch that gets flipped once I graduate transforming me into a professional and good role model. I have not explicitly worked on improving these qualities throughout the year. In terms of my progress towards embodying those traits, I am in the exact same position I was when I initially wrote about them. My focus has been on passing the year and I have neglected this part of my development. This has made me realise that if I want to learn or develop a part of me I need to make a conscious effort at doing so.
According to Epstein (1999) students and clinicians deviate from their professional knowledge and values because they try to be efficient, aspire to please supervisors, feel embarrassed about situations, and feel overwhelmed. In my desire for the aforementioned, I have neglected my professional growth and I am no where closer to acquiring the above mentioned traits of a good role model. I realise that I have not practiced reflecting effectively the way I initially thought. Epstein (1999) talks about how Mindful Practice can help us become more aware and not fall victim to our own prejudices, opinions, projections and expectations. Based on that premise, I have come to the realisation that I was not acting in a Mindful manner.
To add to this, morals and ethics will be faced in clinical practice once we are qualified and it’s up to us to choose the best decision based on the patient and not yourself. However we tend to use the title of a student as a scapegoat for not taking full responsibility for our actions. On the precipice of graduating, it is paramount that one ensures that he/she is fully equipped in dealing with situations that test your professionalism. This results in many ethically compromised situations.
One such situation which applies to me and most likely all other students is the simple fact that we have a responsibility toward our patients to give them the best possible treatment. However we also have a lot of other work for varsity apart from just learning at the hospital. This was noted in a piece I wrote about the treatment of prisoners and their absence of justice. In retrospect this is incredibly unfair for the patient as it is my duty to give this patient the most effective treatment possible (Health Professions Council of South Africa [HPCSA], 2008).
I would feel betrayed and objectified if I was the patient and knew that I am second best to a theoretical grade that my clinician would earn. Besides betraying the patient I am also betraying my colleagues. I am not working with them for the best interests and health care of the patient but in actual fact making their lives more difficult by slacking and not putting the patient above my morals and ethics (Health Professions Council of South Africa [HPCSA], 2008). This has taught me a great deal of dealing with a situation that is against everything I stand for. What I have learnt from this is that you need to put your emotions aside, which is an incredibly challenging thing to do and takes time to mould. The best thing I have taken out of this situation is that I have experienced what it feels like to come across this situation, so when being in a similar situation I am presented with one of two options: (1) Put my emotions aside and treat this patient as any other patient and (2) if I cannot deal with the situation, really this to head of physiotherapy department so that they can send another physiotherapists whose good at dealing with it.
Apart from improving my ethical values, there are various other characteristics I had previously spoken about which form part of my ideal clinician as well as meet the criteria set by the Health Professionals Council of South Africa (HPCSA) of a good professional. Such characteristics include honesty, integrity and all round good morals (Health Professions Council of South Africa [HPCSA], 2008). So lying to a patient does not fit this mould of a good clinician and does not fit the HPCSA Professional Code of Conduct regardless of whether the lie is to help the other person (Health Professions Council of South Africa [HPCSA], 2008).
I told a patient a white lie. I told her that I would speak to the nurses about medication to regulate bowel movements and more medication for pain in her back. She was my last patient before the end of day and I told her I would talk to the nurses so that she would continue with physiotherapy treatment for the day. Once we were done I was eager to get done and head home so I had forgotten I said I would talk to the nurses. Even though I had not intentionally lied to her and it was to her benefit (in terms of her physiotherapy progress) it is still a lie and may not have been completely beneficial to her and does not fit into the Beneficence principle of the Bioethical principles (Lawrence, 2007).
Reflecting on the situation I certainly did her a disservice and was quite selfish by making my treatment and not the patient a priority. From the patient’s point of view, she is meant to fully trust me and know I have her overall wellbeing in mind. If she had found out that I told her a white lie that trust would be completely lost and her progress in physiotherapy would slow down or halt. There is no evidence showing a distinct contributory link between trust and clinical outcomes but trust has been proved to form part of relationships which deliver good health care (Pearson & Raeke, 2000). Apart from disrespecting the patient it is also a slap in the face to the other members of the multidisciplinary team. I did not make the patient’s holistic treatment a priority.
This situation has taught me that I should always try and view the patient holistically and remember I form part of a team in order to improve clinical outcome. Studies have shown that working in an Interdisciplinary team improves clinical outcome so I should do my best to add to the overall outcome (Mauk, 2012). This situation has also brought to my attention that I still at times look for the easy way out with the thought of only being a student in the back of my mind. I should take responsibility as a health care practitioner by keeping the patients best interests in mind and know that soon I will not be a student (Health Professions Council of South Africa [HPCSA], 2008).
In closing, my growth as a student has had a rollercoaster effect of ups and downs, twists and turns, but nonetheless has taught me that you are always learning and adapting as you move through your career. Part of being a student of the field includes developing professional skills in order to achieve success (Howe, 2002). However, this will not happen automatically. I need to consciously pay attention and make an effort at develop the skills necessary (Jochemsen-van der Leeuw, 2012). This is honestly the first time this year I feel I have used the tool of reflecting effectively. It has allowed me to realise and agree with Morrow et al. (2014) that professionalism is a part of you, not something that you suddenly have once you are qualified. This is reality and the real world. And in the real world you need to take responsibility and decide for yourself what will be as well as who you will be. I have decided I am a professional. In my next chapter, I am a clinician.
“BE THE CHANGE YOU WANT TO SEE IN THIS WORLD.”
Epstein, R. M. (1999). Mindful practice. Journal of the American Medical Association, 282(9), 833-839.
Health Professions Council of South Africa. (2008). Guidelines for good practice in the health care professions. Retrieved February 8, 2015 from http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/conduct_ethics/rules/generic_etethic_rules/booklet_1_guidelines_good_prac.pdf
Howe, A. (2002). Professional development in undergraduate medical curricula – the key to the door of a new culture?. Med Educ, 36(4), 353-359. http://dx.doi.org/10.1046/j.1365-2923.2002.01168.x
Irvine, D. (2006). Measuring Medical Professionalism; Understanding Doctors’ Performance. BMJ, 333(7557), 49.49. http://dx.doi.org/10.1136/bmj.333.7557.49
Jochemsen-van der Leeuw, H., van Dijk, N., van Etten-Jamaludin, F., & Wieringa-de Waard, M. (2013). The Attributes of the Clinical Trainer as a Role Model. Academic Medicine, 88(1), 26-34. doi:10.1097/acm.0b013e318276d070
Komarraju, M., Karau, S., & Schmeck, R. (2009). Role of the Big Five personality traits in predicting college students’ academic motivation and achievement. Learning And Individual Differences, 19(1), 47-52. doi:10.1016/j.lindif.2008.07.001
Lawrence, D. J. (2007). The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate. Journal of Chiropractic Humanities, 14, 34-40.
MacCann, C., Fogarty, G., & Roberts, R. (2012). Strategies for success in education: Time management is more important for part-time than full-time community college students. Learning And Individual Differences, 22(5), 618-623. doi:10.1016/j.lindif.2011.09.015
Mauk, K. (2012). Rehabilitation nursing. Sudbury, MA: Jones & Bartlett Learning
Morrow, G., Burford, B., Rothwell, C., Carter, M., McClachlan, G. & Illing, J. (2014). Professionalism in health care professionals. London: Health and professions care council.
Professionalism. (2016). Apta.org. Retrieved 6 r 2016, from http://www.apta.org/Professionalism/
Why Does Professionalism Matter? (Part I). (2016). YouTube. Retrieved 4 November 2016, from https://www.youtube.com/watch?v=2PIplMOIINg
Why Does Professionalism Matter? (Part II). (2016). YouTube. Retrieved 4 November 2016, from https://www.youtube.com/watch?v=G7A8Mu9-26Y