By Uday Jain, MD
David Chestnut, MD, Professor of Anesthesiology and Chief of Obstetric Anesthesiology at Vanderbilt University Medical Center, presented the Emery A. Rovenstine Memorial Lecture at ANESTHESIOLOGY 2016 in Chicago. His talk, titled “On the Road to Professionalism”, focused on the concepts of character and virtue, which Dr. Chestnut views as critical to success in life and in the profession of medicine.
Dr. Chestnut stated that virtues can be classified in two ways: as the attributes that are often listed in a resume, and as the higher moral qualities that are often praised in a eulogy. During his lecture, he focused on detailed discussion of the latter as he believes they are the bedrock of professionalism. Dr. Chestnut is concerned that there has been a decline over time in writing about character and virtue.
The core competencies for physicians, Dr. Chestnut said, are the following:
- Patient care and procedural skills
- Medical knowledge
- Practice-based learning and improvement
- Systems-based practice
- interpersonal and communication skills
Professionalism requires character, life-long learning, unwavering commitment, and ongoing practice, Dr. Chestnut said. Humility, emotional intelligence, self-awareness, honesty, integrity, kindness, and altruism are components of professionalism. Professionalism is a commitment to skill and competence that requires refinement over a lifetime of practice.
Professionalism is not something that we learn once, Dr. Chestnut emphasized, noting that it is important for a physician to be responsible, accountable, and have concern for patient safety and the wellbeing of all. As professionalism is intangible, it is difficult to measure it in the same manner as cognition or skill.
We must regulate ourselves, Dr. Chestnut said. As none of us is perfect, lapses of professionalism occur regularly. To minimize this, we should seek out people who constructively make us aware of our shortcomings and show us the right approach. Dr. Chestnut stressed the importance of humility, which requires accepting criticism graciously and gratefully. We should apologize when an apology is needed. We should be modest, and focus on the organization rather than ourselves. We should recognize the contributions of others.
We should foster trust and confidence among all, Dr. Chestnut said. By displaying professionalism, we will earn respect, which is not our entitlement. To be leaders of the perioperative team, we should foster a collegial, mutually respectful, and supportive work environment. Dr. Chestnut noted that over the course of his career, he has come to recognize the major importance of kindness.
As an example of professionalism, Dr. Chestnut discussed the issue of proscribing participation by physician anesthesiologists in executions by lethal injection of anesthesia drugs. Both ASA and ABA strongly discourage taking part in an execution as not consistent with the professional ethics of anesthesiology.
Further information from ASA about the Rovenstine lecture is available at http://asa-365.ascendeventmedia.com/anesthesiology-2016-daily/rovenstine-lecture-professionalism-requires-a-lifetime-commitment. Videos of slides and audio tracks of lectures at ANESTHESIOLOGY 2016, including Dr. Chestnut’s lecture, may be purchased from ANESTHESIOLOGY Annual Meeting OnDemand at http://asa.ondemand.org/.