Valoriser la vertu en médecine : un examen plus approfondi de CanMEDS

Auteurs-es

  • Saroj Jayasinghe University of Colombo

DOI :

https://doi.org/10.36834/cmej.79246

Résumé

Le cadre CanMEDS-2015 décrit sept rôles clés attendus des médecins en exercice : communicateur, collaborateur, gestionnaire, promoteur de la santé, érudit et professionnel. Des critiques ont exprimé leurs préoccupation quant à l'omission d'un huitième rôle proposé, « le médecin en tant que personne », qui concerne les qualités humaines et la résilience personnelle du médecin. Après une analyse plus approfondie, le cadre inclus plusieurs attributs vertueux dans les rôles du médecin, en tant que professionnel et communicateur. Toutefois, il n'aborde pas suffisamment certaines vertus, telles que la créativité, l'amour et la spiritualité. S'appuyant sur la littérature en psychologie positive, l'auteur propose un ensemble supplémentaire de vertus classées en six catégories : sagesse, courage, humanité, justice, tempérance et transcendance. Sur cette base, l'auteur dresse une liste de vertus et de concepts pertinents pour un « rôle vertueux » des médecins. Le cadre CanMEDS devrait intégrer ces vertus en tant que rôle fondamental ou primordial et s'inspirer de l'éthique de la vertu issu des traditions religieuses et philosophiques. Cette approche est opportune, compte tenu des efforts actuels de mise à jour et de développement de CanMEDS2025. En adoptant un rôle vertueux au sein du cadre CanMEDS, nous visons à former des médecins techniquement compétents et profondément humains, répondant ainsi aux attentes de la société en faveur de professionnels de santé compatissants et vertueux.

Références

Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. CanMEDS. History. Available at http://canmeds.royalcollege.ca/en/about/histor [Accessed on Mar 12, 2024].

Dagnone JD, Takahashi SG, Whitehead CR, Spadafora SM. Reclaiming physician identity: it's time to integrate 'Doctor as Person' into the CanMEDS framework. Can Med Educ J. 2020;11(4):e97-e99. https://doi.org/10.36834/cmej.69182 DOI: https://doi.org/10.36834/cmej.69182

Annas J. Intelligent Virtue. Oxford: Oxford University Press; 2011. https://doi.org/10.1093/acprof:oso/9780199228782.001.0001 DOI: https://doi.org/10.1093/acprof:oso/9780199228782.001.0001

Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. 2013. https://assets.publishing.service.gov.uk/media/5a7ba0faed915d13110607c8/0947.pdf [Accessed on Apr 1, 2024].

Parliamentary and Health Service Ombudsman. Dying without dignity. 2015. http://www.ombudsman.org.uk/reports-and-consultations/reports/health/dying-without-dignity. [Accessed on Feb 23, 2024].

American Medical Association. AMA Code of Medical Ethics. 2016. Available at https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-of-medical-ethics.pdf [Accessed on Mar 23, 2024].

World Medical Association. WMA International Code of Medical Ethics. 2018. Available at https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/.

World Health Organization. Global Competency and Outcomes Framework for Universal Health Coverage. Geneva: World Health Organization; 2022.

Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996-1009. https://doi.org/10.1097/ACM.0b013e318221e615 DOI: https://doi.org/10.1097/ACM.0b013e318221e615

Andersen FA, Johansen AB, Sondergaard J, Andersen CM, Hvidt EA. Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC Med Educ. 2020;20(1):52. https://doi.org/10.1186/s12909-020-1964-5 DOI: https://doi.org/10.1186/s12909-020-1964-5

Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182-91. https://doi.org/10.1097/ACM.0b013e3181b17e55 DOI: https://doi.org/10.1097/ACM.0b013e3181b17e55

Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med. 2020 Jun;95(6):911-918. https://doi.org/10.1097/ACM.0000000000003175 DOI: https://doi.org/10.1097/ACM.0000000000003175

Ponnamperuma G, Yeo SP, Samarasekera DD. Is empathy change in medical school geo-socioculturally influenced? Med Educ. 2019;53(7):655-65. https://doi.org/10.1111/medu.13819 DOI: https://doi.org/10.1111/medu.13819

Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011;84(3):269-76.

Peabody FW. The soul of the clinic. JAMA 1928;90:1193-1197. https://doi.org/10.1001/jama.1928.92690420002009 DOI: https://doi.org/10.1001/jama.1928.92690420002009

Peabody, FW. The care of the patient. JAMA. 1927;88:877-882. https://doi.org/10.1001/jama.1927.02680380001001 DOI: https://doi.org/10.1001/jama.1927.02680380001001

Nelson AR. Humanism and the art of medicine. JAMA. 1989; 262(9), 1228. https://doi.org/10.1001/jama.1989.03430090090040 DOI: https://doi.org/10.1001/jama.1989.03430090090040

Rabinowitz DG. On the arts and humanities in medical education. Philos Eth Human Med. 2021;16(1):4. https://doi.org/10.1186/s13010-021-00102-0 DOI: https://doi.org/10.1186/s13010-021-00102-0

Reports of the Institute on Human Values in Medicine. Available at https://files.eric.ed.gov/fulltext/ED107541.pdf. [Accessed on Mar 20, 2024].

Bain LE. Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino. Philos Eth Human Med. 2018 ;13(1):4. https://doi.org/10.1186/s13010-018-0057-0. DOI: https://doi.org/10.1186/s13010-018-0057-0

Pellegrino ED. Professionalism, profession and the virtues of the good physician. Mt Sinai J Med. 2002;69(6):378-84.

Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011;84(3):269-76

Miles A. Mezzich JE. The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. Internat J Person-Centered Med. 2011;1:207-222. https://doi.org/10.5750/ijpcm.v1i2.61 DOI: https://doi.org/10.5750/ijpcm.v1i2.61

Evans HM, Greaves DA. Ten years of medical humanities: a decade in the life of a journal and a discipline. Med Humanit. 2010;36(2):66-8. https://doi.org/10.1136/jmh.2010.005603 DOI: https://doi.org/10.1136/jmh.2010.005603

Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: a mixed methods systematic review. Front Public Health. 2023;11:1133484. https://doi.org/10.3389/fpubh.2023.1133484 DOI: https://doi.org/10.3389/fpubh.2023.1133484

General Medical Council: Our strategy: 2021-25. In. Edited by Council GM. Manchester: General Medical Council; 2020.

Verstegen PMB, Kole JJJ, Groenewoud AS, van den Hoogen FJA. Virtues in competency-based assessment frameworks: a text analysis. Perspect Med Educ. 2023;12(1):418-426. https://doi.org/10.5334/pme.996 DOI: https://doi.org/10.5334/pme.996

Peterson C, Seligman MEP. Character strengths and virtues: a handbook and classification. Oxford University Press; American Psychological Association; 2004.

Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598-605. https://doi.org/10.1097/00001888-200106000-00008 DOI: https://doi.org/10.1097/00001888-200106000-00008

McKinnon, C. Character, virtue theories, and the vices. Orchard Park, NY: Broadview Press;1999.

Nissbaum M. Non-relative virtues: an Aristotelian approach. World institute for development economics research of the United Nations University. WP 32;1987. https://doi.org/10.1111/j.1475-4975.1988.tb00111.x DOI: https://doi.org/10.1111/j.1475-4975.1988.tb00111.x

Hursthouse R, Pettigrove G. Virtue ethics. The Stanford Encyclopedia of Philosophy. Winter 2018 Edition. Edward N. Zalta (ed.), Available at https://plato.stanford.edu/archives/win2018/entries/ethics-virtue/.

Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician humanism in CanMEDS 2025. Can Med Educ J. 2023;14(1):13-17. https://doi.org/10.36834/cmej.75536 DOI: https://doi.org/10.36834/cmej.75536

Dahlsgaard K, Peterson C, Seligman MEP. Shared virtue: the convergence of valued human strengths across culture and history. University of Pennsylvania Rev Gen Psychol. 2005;9 (3):203-213. https://doi.org/10.1037/1089-2680.9.3.203 DOI: https://doi.org/10.1037/1089-2680.9.3.203

Keown D. Buddhist ethics: a very short introduction. Oxford University Press; 1st edition; 2005. DOI: https://doi.org/10.1093/actrade/9780192804570.001.0001

Keown D. The nature of Buddhist ethics. Palgrave Macmillan London;1992 DOI: https://doi.org/10.1007/978-1-349-22092-2

Sen, A. The idea of justice. Cambridge, MA: Harvard University Press; 2009.

Sreekumar S. An analysis of consequentialism and deontology in the normative ethics of the "Bhagavadgītā". J Indian Phil. 2012; 40(3):277-315: https://doi.org/10.1007/s10781-012-9154-3 DOI: https://doi.org/10.1007/s10781-012-9154-3

Gupta B. "Bhagavad Gītā" as duty and virtue ethics: some reflections. J Relig Eth. 2006; 34(3):373-395: https://doi.org/10.1111/j.1467-9795.2006.00274.x DOI: https://doi.org/10.1111/j.1467-9795.2006.00274.x

Bhavna O a & Parmar N: Qualities of the Physician Mentioned in Brihattrayi -A Review. Intern Ayurvedic Med J.. 2017; 5(7). https://www.iamj.in/posts/images/upload/2635_2644_1.pdf

Krishnan G, Singh S, Pathania M, et al. Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm. Front Artif Intell. 2023;6:1227091. https://doi.org/10.3389/frai.2023.1227091 DOI: https://doi.org/10.3389/frai.2023.1227091

Téléchargements

Publié-e

2024-11-05

Comment citer

1.
Jayasinghe S. Valoriser la vertu en médecine : un examen plus approfondi de CanMEDS. Can. Med. Ed. J [Internet]. 5 nov. 2024 [cité 25 avr. 2025];16(1):106-14. Disponible à: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/79246

Numéro

Rubrique

Canadiana

Articles les plus lus du,de la,des même-s auteur-e-s

Attention : Ce plugiciel nécessite qu'au moins un plugiciel de statistiques/rapport soit activé. Si vos plugiciels de statistiques fournissent plus d'une mesure, veuillez également sélectionner une mesure principale sur la page des paramètres du site de l'administrateur et/ou sur les pages des paramètres du responsable de la publication.