Attitude and Personal Behaviour in Medical Education

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ATTITUDEATTITUDE

AND PERSONALITY ASPECTSAND PERSONALITY ASPECTS

IN MEDICAL EDUCATIONIN MEDICAL EDUCATION

Sylvia D. ElviraSylvia D. Elvira

Department of Psychiatry

Faculty of Medicine - University of Indonesia



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IntroductionIntroduction

If you are a patient, what wouldIf you are a patient, what wouldyou expect of the doctor’syou expect of the doctor’s

attitude andattitude and

behavior?behavior? That is how you shouldThat is how you should

envision yourself in being aenvision yourself in being adoctor!doctor!

People expect you to conductPeople expect you to conductyour professional dutyyour professional duty

compassionately. compassionately.



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IntroductionIntroduction (2)(2)

That implies aspects o !attit"#e$%That implies aspects o !attit"#e$%i.e. si&cere' (ith ho&esty'i.e. si&cere' (ith ho&esty'

empathetic' proessio&al' etc.empathetic' proessio&al' etc.




)eca"se (e are #eali&* (ith perso&al)eca"se (e are #eali&* (ith perso&alprivacy' co&i#e&tiality' tr"st' ethics a&#privacy' co&i#e&tiality' tr"st' ethics a&#le*al aspects'le*al aspects'

it +ecame so importa&tit +ecame so importa&t

i& me#ical practice. i& me#ical practice. Doctor,patie&t$s relatio&shipDoctor,patie&t$s relatio&ship

+ecome the+ecome the ce&tral iss"ece&tral iss"ei& me#ical practice.i& me#ical practice.



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More tha& -"st havi&*More tha& -"st havi&*the sill i& #ia*&osis a&#the sill i& #ia*&osis a&#

treatme&t o #iseases'treatme&t o #iseases'me#ical #octorsme#ical #octors

sho"l# have the a+ility orsho"l# have the a+ility orco&si#erateco&si#erate

i&terperso&al comm"&icatio&.i&terperso&al comm"&icatio&.




It sho"l# too i&to acco"&t'It sho"l# too i&to acco"&t'thethe sacre# missio&sacre# missio& i&i&

it$s o+-ectives.it$s o+-ectives.

ItIt #iers#iers romromother proessio&s i&other proessio&s i&

that #eals (iththat #eals (ith#elicate#elicate perso&al mattersperso&al matters..



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Attitude, behavior & personalityAttitude, behavior & personality

Attit"#eAttit"#e ::

– manner of carrying oneself; – manner of carrying oneself;

disposition (disposition (stood in a graceful attitudestood in a graceful attitude););

- a state of mind or feeling (- a state of mind or feeling (hostile attitudehostile attitude))

a functionala functional

expression of behavior.expression of behavior.



Attitude, behavior & personalityAttitude, behavior & personality

ehaviorehavior ––

the specified way tothe specified way to

conduct oneself to performconduct oneself to perform

– the actions or reactions of – the actions or reactions ofa person in response to externala person in response to external

or internal stimuli. or internal stimuli.

!!"ehavior# is a more general term – !"ehavior# is a more general term – !co&#"ctco&#"ct##

applies to actions considered from theapplies to actions considered from the

standpoint of morality and ethics.standpoint of morality and ethics.



Attitude, behavior & personaltyAttitude, behavior & personalty (2)(2)

"ehavior is a"ehavior is a functional manifestationfunctional manifestation of personality -of personality -a reflection of personality.a reflection of personality.

Perso&alityPerso&ality – the totality of $ualities and traits – the totality of $ualities and traits

collective character behavioral emotional andcollective character behavioral emotional andmental traits distinctive to a person.mental traits distinctive to a person.%eveloped throughout life and more or less too& it#s%eveloped throughout life and more or less too& it#sstable form during adolescence.stable form during adolescence.

'al&ing about !attitude formation# is in essence tal&ing'al&ing about !attitude formation# is in essence tal&ingabout the whole process of personality development.about the whole process of personality development.



1!

octor"Patients’ #elationshipoctor"Patients’ #elationship

eywords:eywords: Acceptance - Empathy - Rapport Acceptance - Empathy - Rapport

Acceptance Acceptance:: unpretentious acceptance.unpretentious acceptance.

Empathy Empathy

:: the ability to comprehend and feelthe ability to comprehend and feel

(empathie) not *ust cognitive understanding but(empathie) not *ust cognitive understanding butinclusiveinclusive the affective $ualitythe affective $uality as part of theas part of theinterpersonal relation+communication.interpersonal relation+communication.

Rapport Rapport :: an established empathic interpersonalan established empathic interpersonalrelationship with the sense of trust andrelationship with the sense of trust andunderstanding. ,n established meaningfulunderstanding. ,n established meaningfulhumane $uality of communication.humane $uality of communication.



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(2)(2) ow could we attained such $ualificationow could we attained such $ualification

In fact not all /%s could perform suchIn fact not all /%s could perform such$ualification in interpersonal+doctor-patient$ualification in interpersonal+doctor-patient

relationshiprelationship It is not *ust a matter of intellectual +It is not *ust a matter of intellectual +

academic performance.academic performance.

ItIt depends much on the basic personalitydepends much on the basic personality

developmental and cultural bac&ground.developmental and cultural bac&ground.




Doctor-patient relationshipDoctor-patient relationship

is based on a sustained,is based on a sustained,

open, andopen, and

trusted dialogtrusted dialog

as well as on the sharing ofas well as on the sharing of

information and nowledgeinformation and nowledge

( (!oter, 2"""!oter, 2""")#)#

http://adr.sagepub.com/content/17/1/77.full






$ealth care has seemingly shifted from$ealth care has seemingly shifted from

placing the patient as a whole person atplacing the patient as a whole person at

the center of a therapeutic relationship tothe center of a therapeutic relationship to

looing almost e%clusively at thelooing almost e%clusively at thebiological (biological (i.e.i.e., molecular, chemical, and, molecular, chemical, and

physical) nature of the patient#physical) nature of the patient#

his change in focus has concerned many his change in focus has concerned many

patients and health-care providerspatients and health-care providers




A more current viewpoint incorporatesA more current viewpoint incorporates

the patient's perspective and includesthe patient's perspective and includes

the patient as athe patient as a collaborativecollaborative

partnerpartner with hisherwith hisher

doctordoctor((!oter, 2"""!oter, 2""" *urphy *urphy et al.et al., 2001, 2001)#)#

his collaboration is essential to his collaboration is essential to

aa high-+uality doctor-patient relationshiphigh-+uality doctor-patient relationship,,

which leads to +ualitywhich leads to +ualityhealth care and positivehealth care and positive

outcomesoutcomes















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/"ma& )ehavior /"ma& )ehavior

$ippocrates wrote$ippocrates wrote.t is more important to.t is more important to

nownow what sort ofwhat sort of

personperson has a diseasehas a diseasethan to nowthan to now what sort of diseasewhat sort of disease

a person has/ a person has/

'o understand attitude and personality we should'o understand attitude and personality we shouldunderstand the essential part of human behavior.understand the essential part of human behavior.



/"ma& )ehavior /"ma& )ehavior

0nli&e the more primitive species human0nli&e the more primitive species human

behavior isbehavior is aa lear&e# +ehavior lear&e# +ehavior (not much of an(not much of an

instinctual behavior).instinctual behavior).

uman instinct - as the basic driving power uman instinct - as the basic driving power

"iological constitution psycho-educational"iological constitution psycho-educational

process and socio-environmental experiencesprocess and socio-environmental experiences

(bio-psycho-social)(bio-psycho-social) constitute the basis forconstitute the basis forpersonality developmentpersonality development..



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Attit"#e0)ehaviorAttit"#e0)ehaviora&# Perso&ality Cha&*ea&# Perso&ality Cha&*e

1ersonality is a uni$ue individual traits which1ersonality is a uni$ue individual traits which

reaches it#s stable form after adolescence.reaches it#s stable form after adolescence.

,ttitude+behavior is the ,ttitude+behavior is the reflection ofreflection ofpersonality.personality.

2ome of the personality traits2ome of the personality traits+profiles+profiles werewere

very rigid and difficult to change or modifiedvery rigid and difficult to change or modified ..

2uch as: the obsessive-compulsive personality antisocial2uch as: the obsessive-compulsive personality antisocial

personality schioid personality etc.personality schioid personality etc.



1"

Attit"#e0)ehaviorAttit"#e0)ehavior

a&# Perso&ality Cha&*ea&# Perso&ality Cha&*e

Every proessio&Every proessio&

(ith hi*h respo&si+ility(ith hi*h respo&si+ility

re1"ire# to +e s"pporte#re1"ire# to +e s"pporte#

+y those (ith+y those (ith

co&#"cive aspects oco&#"cive aspects o

perso&ality patter&. perso&ality patter&.





The same pri&cipleThe same pri&ciple

applie# to Me#ical proessio&.applie# to Me#ical proessio&.

Not all perso&ality patter&Not all perso&ality patter&

is s"ita+le oris s"ita+le orme#ical proessio&. me#ical proessio&.





Perso&ality isPerso&ality is

the +asic *ro"&# orthe +asic *ro"&# or

+ehavioral ma&iestatio&s+ehavioral ma&iestatio&s

a&# proessio&al co&#"cts. a&# proessio&al co&#"cts.



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Possi+ility o +ehavioral0perso&ality cha&*e%Possi+ility o +ehavioral0perso&ality cha&*e%

If the person isIf the person is well motivatedwell motivated

3 sustained by a3 sustained by a

favorable environmentfavorable environment(unfortunately it is not(unfortunately it is not

always onalways on

the positive direction). the positive direction).



1ossibility of behavioral+personality1ossibility of behavioral+personality

change:change: "ac&ed up by a"ac&ed up by a

conducive personality patternconducive personality pattern..

"ehavior and attitude"ehavior and attitude

are more susceptible for change. are more susceptible for change. 4ong enough to sustain4ong enough to sustain

a meaningfula meaningful

lasting behavioral change lasting behavioral change



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Attit"#e ormatio& is &ot as simple as +"il#i&*Attit"#e ormatio& is &ot as simple as +"il#i&*

perso&al characters +y *ivi&* a#vise or lect"re 2 itperso&al characters +y *ivi&* a#vise or lect"re 2 it

is ais a comple3 years o #evelopme&tal lear&i&*comple3 years o #evelopme&tal lear&i&*

process i&volvi&*process i&volvi&* vario"s actors.vario"s actors. Attit"#e a&# +ehavior areAttit"#e a&# +ehavior are the o+serva+lethe o+serva+le

ma&iestatio&sma&iestatio&s o perso&ality aspects i& socialo perso&ality aspects i& social

comm"&icatio& 2 i& &ormal as (ell as ill&ess.comm"&icatio& 2 i& &ormal as (ell as ill&ess.

Some co&#itio&s mi*ht &ee# special +ehaviorSome co&#itio&s mi*ht &ee# special +ehavior

mo#iicatio& tech&i1"es to cha&*e.mo#iicatio& tech&i1"es to cha&*e.



2#

Attit"#eAttit"#e

Is a part o the +ehavioral ma&iestatio&s%Is a part o the +ehavioral ma&iestatio&s% manner of carrying oneself in relation to others -manner of carrying oneself in relation to others -the way to tal& and express oneself a position ofthe way to tal& and express oneself a position of

the body a state of mind or feeling dispositionthe body a state of mind or feeling disposition.. Attit"#e ormatio& mi*ht +e a& artiicial a&#Attit"#e ormatio& mi*ht +e a& artiicial a&#

temporary o&etemporary o&e but if compatible it may also but if compatible it may alsoserve the personality or behavioral disposition in aserve the personality or behavioral disposition in a

more predictable pattern. 1eople could learn amore predictable pattern. 1eople could learn agenuine way of communication an artificial orgenuine way of communication an artificial orsymbolic way.symbolic way.



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Attit"#eAttit"#e

0ith regard to the ob1ectives of medical0ith regard to the ob1ectives of medical

education,education, assessment of the personalityassessment of the personality

and behavior of medical students areand behavior of medical students are

more meaningfulmore meaningful than assessment of thethan assessment of the

attitudes#attitudes#

bservation of 3attitudes' may serve asbservation of 3attitudes' may serve as

indicator for monitoring +uali4cation#indicator for monitoring +uali4cation#



2$

Attit"#eAttit"#e

5arious behavioral aspects relevant to5arious behavioral aspects relevant to

medical professionmedical profession

/oral/oral 5thics5thics

2ocial norms and values2ocial norms and values

ther aspect to be consideredther aspect to be considered 4egal aspect + conse$uences4egal aspect + conse$uences



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Moral' Ethics' Norms 4 5al"esMoral' Ethics' Norms 4 5al"es

,ttitude+behavioral guidance towards a more ,ttitude+behavioral guidance towards a moreorganied and civilied community-life.organied and civilied community-life.

,ssumed to aspire good reasons for a better ,ssumed to aspire good reasons for a bettersocial-life. 0nfortunately there are no infalliblesocial-life. 0nfortunately there are no infalliblestandard measures.standard measures.

5verything will revert to5verything will revert to co&scie&ceco&scie&ce- a sub*ective *udgmental con*unction with respects- a sub*ective *udgmental con*unction with respectsto humanitarian consideration.to humanitarian consideration.

6efer bac& to the baseline:6efer bac& to the baseline: perso&ality' +ehaviorperso&ality' +ehaviora&# attit"#ea&# attit"#e..



2"

Moral. Ethics' Norms 4 5al"esMoral. Ethics' Norms 4 5al"es (2)(2)

$oral$oral the $uality of behavior or attitudes asthe $uality of behavior or attitudes as

seen from the *udgmental presumption based onseen from the *udgmental presumption based on

social conformity of good 3 bad standards. Itsocial conformity of good 3 bad standards. It

depends much on the individual insight.depends much on the individual insight.

%thics%thics the philosophical revelation of moral inthe philosophical revelation of moral in

terms of rules or standards governing the conductterms of rules or standards governing the conduct

of members of a specific group or profession.of members of a specific group or profession.

%thic&%thic& a set of principles of right conducta set of principles of right conduct6)6)

6) American $eritage 7ollege Dictionary6) American $eritage 7ollege Dictionary



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Moral. Ethics' Norms 4 5al"esMoral. Ethics' Norms 4 5al"es (8)(8)

'ocial (orms ) *alues'ocial (orms ) *aluesan unwritten set of standards for behavioralan unwritten set of standards for behavioral

conduct, built up as part of social or cultural way ofconduct, built up as part of social or cultural way oflifelife the measuring codes ofthe measuring codes ofconduct in a particular social environment#conduct in a particular social environment#

Developed alongside history of the society by theDeveloped alongside history of the society by thein9uence of traditional, cultural and religious values#in9uence of traditional, cultural and religious values#

+odes or aphorism?+odes or aphorism? .n a chaotic community, these norms & values.n a chaotic community, these norms & values

became futile# .nconsistency, inconse+uence andbecame futile# .nconsistency, inconse+uence anddouble standards, became the guiding principles#double standards, became the guiding principles#



3!

Si*&iica&t Iss"esSi*&iica&t Iss"esReleva&t to Me#ical E#"catio&Releva&t to Me#ical E#"catio&

St"#e&t$s perspectives%St"#e&t$s perspectives% – personal+potential compatibility (cognitive+personal+potential compatibility (cognitive+

affective personality profile etc.)affective personality profile etc.)

– ad*ustment capability related to cultural andad*ustment capability related to cultural andeducational bac&ground (coping mechanism)educational bac&ground (coping mechanism)

– inherent ad*ustment problems attributed toinherent ad*ustment problems attributed to

philosophical+ historical bac&groundphilosophical+ historical bac&ground

– degree of insight in personality function anddegree of insight in personality function anddevelopment.development.



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Si*&iica&t Iss"esSi*&iica&t Iss"es

Releva&t to Me#ical E#"catio&Releva&t to Me#ical E#"catio&(7)(7)

Institutional perspectives&Institutional perspectives&

– 5nrollment screening re$uirements5nrollment screening re$uirements

– 8larity efficiency consistency and8larity efficiency consistency and

conse$uence in the institutional rulesconse$uence in the institutional rules

– 8larity in educational ob*ectives8larity in educational ob*ectives

– Institutional environment + identification figureInstitutional environment + identification figure – ,vailability of guidance 3 counseling service ,vailability of guidance 3 counseling service



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CLOSIN6 REMAR7SCLOSIN6 REMAR7S

8onducive personality and behavior are essential8onducive personality and behavior are essentialassets for medical students and+or medical doctors.assets for medical students and+or medical doctors.Its significance precedes attitude formationIts significance precedes attitude formation..

5ven though it#s difficult to assess (except on its5ven though it#s difficult to assess (except on its

extreme manifestations) it should be part ofextreme manifestations) it should be part of$ualification assessment$ualification assessment..

8omplex developmental bac&ground (bio-psycho-8omplex developmental bac&ground (bio-psycho-social) should be considered in the assessment.social) should be considered in the assessment.

/edical students should be &nowledgeable about/edical students should be &nowledgeable aboutpersonality and its developmental process.personality and its developmental process.



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CLOSIN6 REMAR7SCLOSIN6 REMAR7S (7)(7)

,ttitudes could be directed to a certain pattern ,ttitudes could be directed to a certain pattern

through learning process exercise experiencesthrough learning process exercise experiences

and other behavioral approach.and other behavioral approach.

8hange in attitude does not assure a long-lasting8hange in attitude does not assure a long-lastingbehavioral 3 personality change. 2ub*ect tobehavioral 3 personality change. 2ub*ect to

individual variation rooted in the basic personality.individual variation rooted in the basic personality.

9eeds enduring insight and strong motivation for9eeds enduring insight and strong motivation for

behavioral 3 personality change.behavioral 3 personality change.



3#

CLOSIN6 REMAR7SCLOSIN6 REMAR7S (8)(8)

'ry to be'ry to be open mindedopen minded andand understandingunderstanding in selfin self

assessment and criticism. "eassessment and criticism. "e receptivereceptive for possibilityfor possibility

of positive personality development.of positive personality development.

2ome personality traits are not amenable to2ome personality traits are not amenable tobehavioral change and in fact are not conducive forbehavioral change and in fact are not conducive for

medical education.medical education.

/oral ethics social norms 3 values legal aspects/oral ethics social norms 3 values legal aspects

etc. are only guidelines. 'he more importantetc. are only guidelines. 'he more importantindividual controlling power is theindividual controlling power is the co&scie&ce.co&scie&ce.

2 t l



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rgano-"iologic 1sycho-educative

2ocial environment

3 culture (includingbeliefs religion)

Nat"re 4

e&viro&me&t

2upernatural6eligiousness+2piritualism

8hat me#ical scie&ce

Lear&e# as Scie&tiic )ase

is i&#ee# o&ly a small part o

the )IO,PSYC/O,SOCIAL aspectsO the (hole &at"re

%asanto &i'isono( 12



3$

han you han you

Attitude and Personal Behaviour in Medical Education

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