A hidden curriculum? Possible to teach?

In the literature, a physician:Subordinates her/her own interest to those of othersAdheres to high ethical and moral standardsResponds to societal needsDemonstrates humanistic values of honesty, integrity,

caring, compassion, altruism, empathy, respect for others and trustworthiness

Exercises accountability of self and colleaguesDemonstrates continued commitment to excellence and

scholarshipDeals with high levels of complexity and uncertaintyReflects on his/her actions and decisions.

Swick HM, Towards a normative definition of professionalism. Acad Med. 2000;75:612-616

Professionalism

An expanded definition for physicians includes the ability to cultivate a relationship with patients, to listen to them, and to commit to their needs as well as to the profession.Harris GD, Fam Med

2004;36(5):31 314-15

Learning to be a professional is part of learning to be a physician. Teaching

professionalism is part of a “hidden” but critical curriculum.

Definition: What do residents think defines a professional?

Honesty and integrity Reliability and responsibilityRespectfulness for others Compassion and empathySelf improvement Self awareness, know limitsCommunication Altruism and advocacyInsight RespectCollaboration AccountabilityResponsibility Interest in othersResponsive to feedback Timeliness

- a survey of St. Paul’s Site residents by Dr. Eva Knell

Role modelling is very important, especially after

correcting a lack of professionalism by a learner.

Role Modelling“We learn by practice and the best practice is to follow a model of the virtuous person.” Aristotle

1. CMA Code of Ethics, http://www.cma.ca/index.cfm/ci_id/43892/la_id/1.htm. This short document is also adopted by the BC Medical Association and the BC College of Physicians and Surgeons.

Teaching ProfessionalismThree steps to teaching professionalism

include:1/ Serve as a proficient role model2/ Create a positive working environment with an

efficient, pleasant office staff3/ Raise the expectations of the learner so he/she

modifies behaviour, corrects self-defeating thoughts and attitudes, and pursues excellence in all their learned or accomplished skills.

Harris GD, Fam Med 2004;36(6):390-2

How to teach professionalism: 1. Role Model, role model, role model 2. The “one minute preceptor”3. Discussion groups such as chart rounds

4. Journaling and other self reflective practices.

5. In clinical situations: use the opportunity

Putting the patient first

Confidentiality Discussing cases in a normal part of

medical practice and learning but when is it inappropriate?

A few more topics to considerDraping, patient privacy, sexual misconduct

ConsentIntegrity, honesty, commitment, behavior in public

Communication with team members, patients and colleagues

Right to refuse treatmentRight of resident to refuse to participate.

And more…………Other Boundary Issues: not loaning or borrowing

money, not hiring patients Professional responsibilities e.g. Follow up of

patient results, need to keep up to date, follow through and continuity of care, insurance reports, conflict of interest, attendance and being on time

Record keepingRespect of other health professionalsRespectful languageRespecting others time by being punctual and

organized Racism, sexism, ageism, etc CONSEQUENCES of unprofessional behavior, how

practices are monitored

Fallibility : Errors happenHow to deal with themReporting if needed and when to report

Self forgivenessMoving onHelping each other

Where can help be found? Physician Health Committee (BCMA)

ColleaguesCMPACollege of Physicians and SurgeonsDoctors who treat doctors Family, friends, outside interests, faith

ConsequencesHold the residents feet to the fire!!! Unprofessional behavior must be corrected.

There are consequences!If behavior does not change or if you do not feel comfortable, bring it to the attention of the Site Faculty and Site Director

EvaluationEvaluation forms ask for your assessment

of professionalism and ethical behaviorGive feedback EARLY and evaluate this

area as rigorously as knowledge and skills. Residents will be your colleagues some

day. Don’t wait until they have graduated from our program to discover they have professional issues that need improvement.

Would I like this person to treat me or my family?

Will they uphold the integrity of the profession?

Will my CMPA fees go up if this person graduates?

So, in clinical situations:Always consider professional issues

Recognize and compliment professional behavior

Recognize and correct unprofessional behavior

AND role model, role model, role model

Thank YouThis module was written as an aid to the

Preceptors in the Postgraduate Family Practice Program at the University of BC.Study credit is available to groups of

preceptors who complete the modulePlease give us your feedback on the module so

that we may improve it for others. Email you comments to Dr. Fraser Norrie, Faculty

Development, UBC Family Practice Fraser.Norrie@vch.ca