[الدكتور أحمد باذيب]

Setting Expectations

Remembering back to your own first day on the wards as a third-year medical student, you can probably still feel the anxiety and uncertainty. Each rotation brought a new set of rules, a new set of behavioral norms, and a new community of physicians and health care professionals with whom to engage. When is it appropriate for a medical student to disclose test results to patients? What should you do if you discover an error that did not change a clinical outcome? Can a resident leave the bedside of a critically ill patient because patients are waiting to be seen in the resident's continuity clinic?

Unfortunately, the rules were unwritten and often discovered only when you made a mistake. It makes more sense to set explicit goals and expectations for students; for the most motivated, this may be the only step necessary. Through initiatives like those supported by the Arnold P. Gold Foundation, medical schools have moved professional expectations to center stage. Students at most schools now begin their first year with a "white-coat" ceremony, in which they learn the meaning of the responsibility that comes with wearing a white coat, the expectations for humanism and professionalism. This is also often the occasion when they recite the Hippocratic Oath or a similar oath of professionalism.8 Orientation sessions for preclerkship and clerkship experiences often communicate explicit expectations for professional behavior. The Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education have explicit expectations for professionalism,9,10 including clear policies and procedures that define professionalism and delineate appropriate responses to unprofessional behavior. Continuing a public professing of principles11 into the years of residency and practice is unusual but important to ensure that physicians remain committed to a common set of expectations for the profession. The Code of Medical Ethics from the American Medical Association and the Charter on Medical Professionalism12 serve to advance these principles and expectations.