Privilege Of Self-regulation Research Articles

Exploring the professionalization of respiratory therapy in Canada.

IntroductionA recurrent challenge facing respiratory therapists (RTs) is their legitimacy as professionals. RTs are often referred to as technologists, vocationalists, or technicians and must often justify their status as full professionals rather than “professional technicians”. There is currently little exploration of what it means to be a profession and the process of professionalization in respiratory therapy.ApproachDrawing from sociological theory, the purpose of this paper is to discuss the professionalization of respiratory therapy in Canada using Andrew Abbott’s theory, the “system of professions”. We will use this theory as a lens to propose areas of consideration for professional development regarding two pervasive themes in the respiratory therapy community, RTs’ specialized body of knowledge and professional autonomy.Findings knowledge is believed to be essential in the evolution from occupation to profession and is valuable to a profession in three ways: it can influence the profession’s legitimacy, it can be used for conducting research, and it promotes higher education. RTs possess jurisdictional professional autonomy within Canada. The privilege of self-regulation allows RTs to act according to their knowledge and judgement without direct oversight from other professions.ConclusionBased on Abbott’s theoretical position, RTs can rightly justify their position as professionals. However, RTs need to acknowledge that professionalization is a dynamic and continuous process that requires creative changes to innovate within the profession and support future efforts to reinforce their position as professionals. Throughout this paper, we offer suggestions for how RTs can contribute to the ongoing professionalization of respiratory therapy.

Professionalism, Communities of Practice, and Medicine's Social Contract.

While medicine's roots lie deep in antiquity, the modern professions only arose in the middle of the 19th century after which early social scientists examined the nature of professionalism. The relationship between medicine and society received less attention until profound changes occurred in the structure and financing of health care, leading to a perception that medicine's professionalism was being threatened. Starr in 1984 proposed that the relationship was contractual with expectations and obligations on both sides. Other observers refined the concept, believing that the historic term, "social contract," could be applied to the relationship, a concept with which many agree. There was general agreement that society used the concept of the profession to organize the delivery of essential services that it required, including health care. Under the terms of the contract, the medical profession was given financial and nonfinancial rewards, autonomy, and the privilege of self regulation on the understanding that it would be trustworthy, assure the competence of its members, and be devoted to the public good. In examining how the social contract is negotiated, it has been proposed that physicians belong to a "community of practice" that they voluntarily join during their education and training. In joining the community, they accept the norms and values of community members and acquire the identity prescribed by the community. The leaders of the community are responsible for negotiating the social contract on behalf of the medical profession. In so doing, they must ensure that they recognize the importance of devotion to the public good in the maintenance of medicine's professional status.

THE SOCIAL CONTRACT, PROFESSIONALISM, AND ITS ASSESSMENT: THE STRATEGY OF THE ABFM GOING FORWARD

> Society granted physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that physicians would be competent, altruistic, moral, and would address the health care needs of individual patients and society. This “arrangement”

A Tale of Three 'Professions': Search Engine Optimization, Lawyering & Law Teaching

The question has been posed: is legal practice today a profession? This leads, naturally enough, to another question: should society treat it as one? Using the concept of ‘profession’ in different ways, some argue that one thing modern legal practice needs is a good dose of “professionalism;” others argue that, whatever once might have been true, treating law practice as a ‘profession’ is a rum game best abandoned. These questions matter. Law enjoys special regulatory privileges and market protections that make little sense if law has become just another form of business – a specialized form of consulting, perhaps. At the same time, societies depend on professions to perform important public functions, and if a de-professionalized legal occupation either cannot or will not reliably perform those functions, new solutions must be sought. These questions matter particularly now, because technology now allows non-lawyers to offer personalized legal services that rival lawyers, but in the US such services are barred by the protective market shelter given lawyers.To date, the discussion has been hampered by loose – and often conflicting – uses of the terms profession and professional. To counter that, this article examines law practice and two similarly demanding occupations – teaching law and consulting on search engine optimization – through the lens of a fully developed model of professions developed by sociologist Eliot Freidson. By delving deeper into the aspects of an ideal form profession, with contrast to two somewhat similar occupations, the article provides a more nuanced look at law practice’s claims to professional status.The residual market protections given to lawyers are one reason to determine whether they still constitute a profession – if they are not able to deliver on the social bargain of protecting the justice system, there seems little reason to protect them from the full onset of the market or to allow them the privilege of self-regulation. Perhaps more importantly, the analysis raises the question of who, if anyone, is protecting the system of justice from naked market and bureaucratic forces if lawyers have abdicated or been driven from the role. In a world where law has been and can be used to oppress the powerless, and where legal claims have become a tradable asset class, it’s not a trivial question.

Regulation of Medical Profession: The Current Scenario

Medical profession is essentially self-regulated, since historical times. The physicians convinced society that science-based medicine was superior to alternative therapies and that their profession represented a trustworthy moral enterprise. We constructed information from Pubmed/Medline, Google database and text books to provide an overview. Complexity of the knowledge base and skills required, especially as technology advanced, would make regulation by non-professionals difficult. The major obstacles for credible self-regulation are providing assurance that those in practice maintain their competence; taking appropriate action once a problem with an individual practitioner has been identified and regulating conflict of interest. Conflict is inherent in a profession in which individuals are expected to be altruistic, while, as human beings, still pursue their own interests. Self-regulation of the medical profession is complex, and involves multilaminar, clairvoyant oversight aimed at guaranteeing the competence of the practicing physician. The privilege of self-regulation of medical profession has gradually made way to establishment of licensing laws worldwide. Standards were considered to be weak, variable and inconsistently applied, and physicians were further accused of using collegiality as a means of shielding poorly performing peers. Identifying problem physicians and taking appropriate disciplinary action against them can be a complex situation and can tarnish the reputation of the entire medical profession. When the society becomes dissatisfied with the performance of the profession; changes the terms of the social contract and reclaim some of these powers, the medical profession's rights to self-regulation tends to decline. The principal regulatory body may have a majority of lay members, which would mean that the profession is no longer self-regulating. Profession must accept greater accountability and should not hesitate to act on professional misconduct. Self-regulation is a privilege that can be maintained only with public consent and trust. The present generation of doctors needs to adapt and accept the changing scenario and develop a scientific approach to achieve the lost glory.

ABR Examinations: The Why, What, and How

The American Board of Radiology (ABR) has provided certification for diagnostic radiologists and other specialists and subspecialists for more than 75 years. The Board certification process is a tangible expression of the social contract between the profession and the public by which the profession enjoys the privilege of self-regulation and the public is assured that it can expect medical professionals to put patients' interests first, guarantees the competence of practitioners, and guards the public health. A primary tool used by the ABR in fulfilling this responsibility is the secure proctored examination. This article sets forth seven standards based on authoritative sources in the field of psychometrics (the science of mental measurements), and explains in each case how the ABR implements that standard. Readers are encouraged to understand that, despite the multiple opinions that may be held, these standards developed over decades by experts using the scientific method should be the central feature in any discussion or critique of examinations given for the privilege of professional practice and for safeguarding the public well-being.

プロフェッショナリズムとは？

What is a profession? According to Cruess, it is an occupation whose core element is work that is based on the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning, or the practice of an art founded on it, is used in the service of others. Its members profess a commitment to competence, integrity, morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession autonomy in practice and the privilege of self-regulation. Although medical professionals share the role of healer, there are wide variations between individuals. Professionalism is the basis of medicine's contract with society. Public trust is essential to that contract, and public trust depends on the integrity of both individual professionals and the whole profession. The introduction to this important symposium includes definitions of professions and of medical professionalism. It also includes discussions of reciprocal altruism, conflicts of interest in medical societies, the theory of cognitive dissonance, and the moral foundations of professionalism.

Continuing professional development for general practitioners: supporting the development of professionalism

The profession of medicine has long been characterised by virtues such as authorisation, specialisation, autonomy, self-regulation and adherence to an ethical code of practice, and its complexity has granted it the privilege of self-regulation. Studies have shown continuing professional development (CPD) for general practitioners (GPs) to be most effective when it is set up within a multi-method design. This paper reports a research-based evaluation of a 2-year educational CPD project for 21 GPs. The project focused on the issue of 'children in need' and was delivered through group supervision, teaching days, an e-portfolio, literature, newsletters and a desk checklist. A mixed-methods evaluation design was used. The GPs demonstrated an overall preference for supervision as an authentic method for self-directed professional development because it facilitated the creation of a common platform for relevant and useful knowledge in the context of general practice. Other methods were perceived as less valuable for GPs' CPD. The results suggest that general practitioners need to establish a common platform of shared experiences before engaging in multi-professional CPD. Participation in the supervision allowed the three groups of GPs to develop their professional skills, but left them with a desire for more training in establishing cooperative practices with their partners in care. The professional challenges discussed during the supervision sessions were important elements of the national GP Curriculum, but not all elements of professionalism were covered.

의사의 프로페셔널리즘과 진료자율권

Physicians' dual roles -healer and professional - are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical-with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Physician's professional autonomy in Korea has been threatened by several factors. The most important are the unreasonable national healthcare system and negligence of education of the professionalism in medical schools. It asserted that physicians exploited their monopoly to create a demand for services which they then satisfied. It identified serious failures in self-regulation, and abuse of collegiality to protect incompetent or unethical physicians. It criticised physicians for pursuing their own financial interests at the expense of both individual patients and society. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values. In this, they acquire responsibility for its integrity, for its proper application, and for its expansion, which, for medicine, means the support of science. Professions have an obligation to transmit their knowledge by teaching it to future practitioners, the general public, and their patients. Even if the medical profession itself carries out ethical value education, it is unlikely that the values cherished by physicians for centuries can be preserved unless their preservation is encouraged and supported by society through the structure of the healthcare system. Healthcare systems can actively promote desirable behaviour or they can encourage physicians to place their own interest first. Without question, the medical profession itself wishes to function within a system dominated by a healthy and flourishing professionalism. Both government and publics should wish for the same type of physician- competent, moral, idealistic, and altruistic. This is best guaranteed by a reasonable health care system.

"Profession": A Working Definition for Medical Educators

Purpose: To provide a working definition of professionalism for medical educators. Summary: Thus far, the literature has not provided a concise and inclusive definition of the word profession. There appears to be a need for one as a basis for teaching the cognitive aspects of the subject and for evaluating behaviors characteristic of professionals. Furthermore, a knowledge of the meaning of the word is important as it serves as the basis of the contract between medicine and society, and hence, of the obligations required of medicine to sustain the contract. A definition is proposed based on the Oxford English Dictionary and the literature on the subject. It is suggested that this can be useful to medical educators with responsibilities for teaching about the professions, professional responsibilities, and professional behavior. Conclusions: The proposed definition is as follows: Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.

Professionalism for medicine: opportunities and obligations.

Physicians' dual roles - as healer and professional - are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical - with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values.

The Quiet Demise of Deference to Custom: Policy Implications in an Era of Managed Care

The health care industry has changed fundamentally in the century that has passed since physicians were first delegated the unique power to establish their own legal standard of care. The turn-of-the century (and naive) paradigm of the independent physician driven only by fidelity to patient interests has given way to modern corporate medicine. Power in the health care industry is shifting away from physicians and toward a heavily concentrated group of for-profit health insurers. In an effort to keep costs down, these entities use a variety of strategies to influence the clinical practices of their participating physicians. Under these circumstances, tort law's complete faith in medical customs is arguably a quaint relic of a simpler time. Consequently, it is not surprising that many courts are abandoning their deference to medical customs and, instead, are empowering juries, with the help of experts, to decide what a reasonable physician would have done under the circumstances. However, the prospect of a wide-spread retreat from the custom-based standard of care has fundamental policy implications. On the one hand, abandonment of the custom-based standard will improve the ability of courts to police the practices of physicians toiling in the shadow of managed care. On the other hand, it may demand more of lay jurors than we can reasonably expect of them. It may also threaten efforts to make health care more affordable. This Article explores the policy issues raised by the choice between a custom-based standard of care and a jury-determined reasonability standard. The author examines not only traditional legal arguments but also the recent findings of cognitive psychology, jury performance studies, and health industry research. Not surprisingly, this analysis reveals that both options are imperfect. However, the author cautiously recommends the reasonable physician standard. The revolutionary transformation of the health care industry in last quarter of a century has transferred considerable power from physicians to the health insurance industry, an industry that has not yet earned the privilege of self-regulation. Unlike the custom-based standard, the reasonable care standard assigns the task of standard-setting to representatives of the community and not to the regulated industry. And because the reasonable physician standard precludes unilateral establishment of the standard of care by the health care industry, it is also more likely to force the health care industry to engage the community in a conversation about health care cost and quality. For these reasons, it worth taking the risk that juries will be more resistant to cost control measures than health policy analysts would recommend.

Academic medicine's changing covenant with society.

The traditional and mutually accepted covenant between academic medicine and society had its origin in trust and was based on the premise that academic medicine's programs and commitments were in society's best interests, thus justifying generous support and the privilege of self-regulation. In contemporary times, this mutually supportive covenant is encountering substantial distress. The most noteworthy threats to the traditional covenant are the changing values and erosion of trust emanating from the competition model of delivering and paying for medical services. A creditable response to society's needs and expectations can be best undertaken by establishing a national agenda in academic medicine that places a high priority on health services research and the scientific analysis of our entire health care system. What is needed now is the institutionalization of health services research through expansion of the cadre of health service researchers, while providing a broader emphasis on academic rewards and recognition for initiatives in this critically needed area of investigation.