teaching professionalism: critical conversations with our learners

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You are an organized physician and your patients appreciate and expect your promptness. Your start times for rounds and clinic have been reviewed on several occasions with Bill a third year student on his comprehensive community clerkship. Routinely Bill shows up late, unprepared in ripped jeans and a base ball cap. What strategies would you use in

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Page 1: Teaching Professionalism:  Critical Conversations  With Our Learners

You are an organized physician and your patients appreciate and expect your promptness. Your start times for rounds and clinic have been reviewed on several occasions with Bill a third year student on his comprehensive community clerkship. Routinely Bill shows up late, unprepared in ripped jeans and a base ball cap.

What strategies would you use in your discussions with Bill?

You are an organized physician and your patients appreciate and expect your promptness. Your start times for rounds and clinic have been reviewed on several occasions with Bill a third year student on his comprehensive community clerkship. Routinely Bill shows up late, unprepared in ripped jeans and a base ball cap.

What strategies would you use in your discussions with Bill?

Page 2: Teaching Professionalism:  Critical Conversations  With Our Learners

Teaching Professionalism:

Critical Conversations With Our Learners

Northern Constellations 2013

Sudbury, OntarioJanuary 19, 2013

Teaching Professionalism:

Critical Conversations With Our Learners

Northern Constellations 2013

Sudbury, OntarioJanuary 19, 2013

James Goertzen MD MClSc CCFPAssociate Professor , NOSM

Medical Director Faculty Development, NOSM

Laurel Snyder MD CCFP-EMAssociate Professor, NOSMKenora Site Director, NOSM

James Goertzen MD MClSc CCFPAssociate Professor , NOSM

Medical Director Faculty Development, NOSM

Laurel Snyder MD CCFP-EMAssociate Professor, NOSMKenora Site Director, NOSM

Page 3: Teaching Professionalism:  Critical Conversations  With Our Learners

Conflict Disclosure Information: No financial or industry relationships to disclose. Creative Commons AttributionNoncommercial/No Derivative Works Canada License

Page 4: Teaching Professionalism:  Critical Conversations  With Our Learners

Learning Objectives: Learning Objectives: Learning Objectives: Learning Objectives:

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

►Provide effective strategies for dealing with learner unprofessional behavior.

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

►Provide effective strategies for dealing with learner unprofessional behavior.

Page 5: Teaching Professionalism:  Critical Conversations  With Our Learners

Core CompetencyCore Competency

Professionalism is a core competency for students, residents and practicing

physicians. Preceptors have critical roles in assisting their learners in the development of

professionalism.

Professionalism is a core competency for students, residents and practicing

physicians. Preceptors have critical roles in assisting their learners in the development of

professionalism.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012.

Page 6: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ChallengesPreceptor Challenges

Though it is essential to provide feedback that addresses the

professional behavior of learners, preceptors tend to be

silent about professional expectations and rationalize

lapses in professionalism.

Though it is essential to provide feedback that addresses the

professional behavior of learners, preceptors tend to be

silent about professional expectations and rationalize

lapses in professionalism.

Goertzen J. Developing professionalism in our learners: Critical conversations. The Foundation for Medical Practice Education, 2011.

Page 7: Teaching Professionalism:  Critical Conversations  With Our Learners

Professionalism: Biased Perception

Professionalism: Biased Perception

• As physicians we accept that we all have limits to our medical knowledge & expertise.

• In contrast, physicians are less comfortable in acknowledging their professional failings, attitudes and behaviors.

• As physicians we accept that we all have limits to our medical knowledge & expertise.

• In contrast, physicians are less comfortable in acknowledging their professional failings, attitudes and behaviors.

Ladouceur R. Family physicians and professionalism. Can Fam Physician 2009;55:961.

Page 8: Teaching Professionalism:  Critical Conversations  With Our Learners

DefineDefineProfessionalism:Professionalism:

Page 9: Teaching Professionalism:  Critical Conversations  With Our Learners

Definition of ProfessionalismDefinition of Professionalism

• Adherence to ethical practice principles.

• Effective interactions with patients and with people important to those patients.

• Reliability and accountability.

• Adherence to ethical practice principles.

• Effective interactions with patients and with people important to those patients.

• Reliability and accountability.

Wilkinson T, Wade W. A blueprint to asses professionalism: Results of a systematic review. Acad Med 2009;84:551-8.

Page 10: Teaching Professionalism:  Critical Conversations  With Our Learners

Definition of ProfessionalismDefinition of Professionalism

• Effective interactions with people working within the health care system.

• Commitment to maintenance and improvement of competence in self, others, and systems.

• Effective interactions with people working within the health care system.

• Commitment to maintenance and improvement of competence in self, others, and systems.

Wilkinson T, Wade W. A blueprint to assess professionalism: Results of a systematic review. Acad Med 2009;84:551-8.

Page 11: Teaching Professionalism:  Critical Conversations  With Our Learners

Definition of ProfessionalismDefinition of Professionalism

•Professionalism can be difficult to define since is not limited to a static set of traits or characteristics.

•Concepts of professionalism evolve with changes in social norms and patient expectations.

•Professionalism can be difficult to define since is not limited to a static set of traits or characteristics.

•Concepts of professionalism evolve with changes in social norms and patient expectations.

Goertzen J. Developing professionalism in our learners: Critical conversations. The Foundation for Medical Practice Education, 2011.

Page 12: Teaching Professionalism:  Critical Conversations  With Our Learners

Definition of ProfessionalismDefinition of Professionalism

Professionalism is largely contextual and best understood as a series of behaviors within a

clinical setting rather than a series of personal character

traits or attributes.

Professionalism is largely contextual and best understood as a series of behaviors within a

clinical setting rather than a series of personal character

traits or attributes.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 13: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ChallengesPreceptor Challenges

The challenge for preceptors is to provide relevance for their

learners to the seemingly abstract concepts of

professionalism within the clinical setting.

The challenge for preceptors is to provide relevance for their

learners to the seemingly abstract concepts of

professionalism within the clinical setting.

Goertzen J. Developing professionalism in our learners: Critical conversations. The Foundation for Medical Practice Education, 2011.

Page 14: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ChallengesPreceptor Challenges

Within the clinical setting, patient problems rarely have black and white solutions. Learners often struggle to

balance competing demands.

Within the clinical setting, patient problems rarely have black and white solutions. Learners often struggle to

balance competing demands.

Leong R. Do FP agree on what professionalism is? No. Can Fam Physician 2009;55:969-71.

Page 15: Teaching Professionalism:  Critical Conversations  With Our Learners

Role of PreceptorsRole of Preceptors

Preceptors can assist learners by linking the principles of professionalism to their

relationships with patients, with other physicians and health care professionals, with communities,

and with self.

Preceptors can assist learners by linking the principles of professionalism to their

relationships with patients, with other physicians and health care professionals, with communities,

and with self.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 16: Teaching Professionalism:  Critical Conversations  With Our Learners

Attaining CompetenceAttaining Competence

Development of professionalism follows a parallel process to

attaining clinical competence. Following the introduction of the

principles of professionalism, application with in the clinical setting leads to competence.

Development of professionalism follows a parallel process to

attaining clinical competence. Following the introduction of the

principles of professionalism, application with in the clinical setting leads to competence.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 17: Teaching Professionalism:  Critical Conversations  With Our Learners

Role ModelingRole Modeling

Within the clinical setting, as students and residents

internalize the concepts of professionalism, they are greatly

influenced through the role modeling of their preceptors and other health care professionals.

Within the clinical setting, as students and residents

internalize the concepts of professionalism, they are greatly

influenced through the role modeling of their preceptors and other health care professionals.

Cruess Rl, Cruess SR. Teaching professionalism: General principles. Med Teacher 2006;28(3):205-8

Page 18: Teaching Professionalism:  Critical Conversations  With Our Learners

Role ModelingRole Modeling

Effective preceptors exhibit the positive aspects of

professionalism articulating the rational for their behaviors. They provide clinical opportunities for learners to exhibit professional

behaviors along with time to reflect and discuss experiences.

Effective preceptors exhibit the positive aspects of

professionalism articulating the rational for their behaviors. They provide clinical opportunities for learners to exhibit professional

behaviors along with time to reflect and discuss experiences.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 19: Teaching Professionalism:  Critical Conversations  With Our Learners

Purposeful PreceptoringPurposeful Preceptoring

Involving learners in common clinical scenarios can be purposeful when the encounter is used as a catalyst for discussion of potential patient physician conflict such as requests for diagnostic tests or negotiating

length of work absences.

Involving learners in common clinical scenarios can be purposeful when the encounter is used as a catalyst for discussion of potential patient physician conflict such as requests for diagnostic tests or negotiating

length of work absences.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 20: Teaching Professionalism:  Critical Conversations  With Our Learners

Program ExpectationsProgram Expectations

It is important that programs clarify professional values and expectations with all learners. These expectations can act as a

frame of reference by which lapses in professional behavior

can be measured.

It is important that programs clarify professional values and expectations with all learners. These expectations can act as a

frame of reference by which lapses in professional behavior

can be measured.

Larkin GL, Binder L, Houry D, Adams J. Defining and evaluating professionalism: A core competency for graduate emergency medical education. Acad Emer Med 2002;9(11):1249-

56.

Page 21: Teaching Professionalism:  Critical Conversations  With Our Learners

You are an organized physician and your patients appreciate and expect your promptness. Your start times for rounds and clinic have been reviewed on several occasions with Bill a third year student on his comprehensive community clerkship. Routinely Bill shows up late, unprepared in ripped jeans and a base ball cap.

You are an organized physician and your patients appreciate and expect your promptness. Your start times for rounds and clinic have been reviewed on several occasions with Bill a third year student on his comprehensive community clerkship. Routinely Bill shows up late, unprepared in ripped jeans and a base ball cap.

Page 22: Teaching Professionalism:  Critical Conversations  With Our Learners

DISCUSSION:1. How is Bill’s behavior unprofessional?

2. What strategies would you use when discussing your concerns with Bill?

DISCUSSION:1. How is Bill’s behavior unprofessional?

2. What strategies would you use when discussing your concerns with Bill?

Page 23: Teaching Professionalism:  Critical Conversations  With Our Learners

DISCUSSION:3.How would you respond to Bill’s concern that it is unfair that his day starts earlier than the other students and preceptors in your community?

DISCUSSION:3.How would you respond to Bill’s concern that it is unfair that his day starts earlier than the other students and preceptors in your community?

Page 24: Teaching Professionalism:  Critical Conversations  With Our Learners

DISCUSSION:4. Due to your responsibilities as Department Head for Family Medicine, you have been late for several of your clinics over the week. How would you respond to Bill’s comments that you are not always on time?

DISCUSSION:4. Due to your responsibilities as Department Head for Family Medicine, you have been late for several of your clinics over the week. How would you respond to Bill’s comments that you are not always on time?

Page 25: Teaching Professionalism:  Critical Conversations  With Our Learners

Learning Objectives: Learning Objectives: Learning Objectives: Learning Objectives:

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

Page 26: Teaching Professionalism:  Critical Conversations  With Our Learners
Page 27: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses in ProfessionalismLapses in Professionalism

Lapses in professional behavior by learners are common and to be expected. It is through the experience of learning within a supervised clinical setting that

the principles of professionalism can be truly integrated.

Lapses in professional behavior by learners are common and to be expected. It is through the experience of learning within a supervised clinical setting that

the principles of professionalism can be truly integrated.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 28: Teaching Professionalism:  Critical Conversations  With Our Learners

Learner DefensesLearner Defenses

Maladaptive defence mechanisms for unprofessional behavior:

•Denial It was really a lapse.•Discounting He did yell at the

nurse but she had it coming.•Distancing It was a mistake

but we are all human.

Maladaptive defence mechanisms for unprofessional behavior:

•Denial It was really a lapse.•Discounting He did yell at the

nurse but she had it coming.•Distancing It was a mistake

but we are all human.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 29: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses in ProfessionalismLapses in Professionalism

A lapse in professional behavior can be transformed into a critical

learning scenario when we have a collegial conversation with our

learner and encourage reflection and assimilation of appropriate

professional behaviors.

A lapse in professional behavior can be transformed into a critical

learning scenario when we have a collegial conversation with our

learner and encourage reflection and assimilation of appropriate

professional behaviors.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 30: Teaching Professionalism:  Critical Conversations  With Our Learners

Collegial ConversationCollegial Conversation

Assuming each clinical situation has one right answer may

truncate dialogue, raising the likelihood that the learner will

become defensive and limit exploration of alternatives to

their behavior.

Assuming each clinical situation has one right answer may

truncate dialogue, raising the likelihood that the learner will

become defensive and limit exploration of alternatives to

their behavior.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 31: Teaching Professionalism:  Critical Conversations  With Our Learners

Collegial ConversationCollegial Conversation

Allow the learner to initially explain the clinical context and rational

for apparent unprofessional behavior. In many clinical

situations, conflict may result from two or more divergent

professional or personal values.

Allow the learner to initially explain the clinical context and rational

for apparent unprofessional behavior. In many clinical

situations, conflict may result from two or more divergent

professional or personal values.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 32: Teaching Professionalism:  Critical Conversations  With Our Learners

Context and ProcessContext and Process

When preceptors understand the clinical context and process used by the learner which resulted in

the lapse of professionalism, effective educational

interventions can be developed which are learner specific.

When preceptors understand the clinical context and process used by the learner which resulted in

the lapse of professionalism, effective educational

interventions can be developed which are learner specific.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 33: Teaching Professionalism:  Critical Conversations  With Our Learners

Context and ProcessContext and Process

Lapses in professionalism can be resolved when learners realize

the negative impact of their behavior with patients,

physician colleagues, other health care professionals, or the

profession.

Lapses in professionalism can be resolved when learners realize

the negative impact of their behavior with patients,

physician colleagues, other health care professionals, or the

profession.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 34: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses Occur on a ContinuumLapses Occur on a Continuum

Preceptors can address the majority of learner professional

lapses with a confidential collegial conversation linked to a learner commitment to a change in their professional behavior.

Preceptors can address the majority of learner professional

lapses with a confidential collegial conversation linked to a learner commitment to a change in their professional behavior.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 35: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses Occur on a ContinuumLapses Occur on a Continuum

Following the collegial conversation, it is essential for

the preceptor to provide the learner with further clinical

encounters to address the lapse along with specific feedback and

appropriate reinforcement.

Following the collegial conversation, it is essential for

the preceptor to provide the learner with further clinical

encounters to address the lapse along with specific feedback and

appropriate reinforcement.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 36: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses Occur on a ContinuumLapses Occur on a Continuum

Lapses of a more serious nature require a staged response:

collegial conversation, clarification of context and

process resulting in the lapse, learner reflection, and planning of future educational activities.

Lapses of a more serious nature require a staged response:

collegial conversation, clarification of context and

process resulting in the lapse, learner reflection, and planning of future educational activities.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 37: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses Occur on a ContinuumLapses Occur on a Continuum

Documentation of the lapse is important. Learners should be notified of the consequences of not improving their behavior.

Consult with your program director for support and to ensure you are following proper process.

Documentation of the lapse is important. Learners should be notified of the consequences of not improving their behavior.

Consult with your program director for support and to ensure you are following proper process.

Goertzen J. Teaching professionalism. In: Kelly L. Community-based Medical Education: a teacher’s handbook, 2012

Page 38: Teaching Professionalism:  Critical Conversations  With Our Learners

Your second year resident aspires to be an excellent physician. She is early at rounds & clinics along with reading around cases. She is always on her smart phone and you have received complaints from patients and nurses. When you observe a patient interview, she looks at her phone every time it buzzes with seemingly personal calls.

What strategies would you use in your discussions with Janice?

Your second year resident aspires to be an excellent physician. She is early at rounds & clinics along with reading around cases. She is always on her smart phone and you have received complaints from patients and nurses. When you observe a patient interview, she looks at her phone every time it buzzes with seemingly personal calls.

What strategies would you use in your discussions with Janice?

Page 39: Teaching Professionalism:  Critical Conversations  With Our Learners

DISCUSSION:1. How is Janice’s behavior unprofessional?

2. What strategies would you use when discussing your concerns with Janice?

DISCUSSION:1. How is Janice’s behavior unprofessional?

2. What strategies would you use when discussing your concerns with Janice?

Page 40: Teaching Professionalism:  Critical Conversations  With Our Learners

DISCUSSION:3.While discussing the impact of her phone use on patient care, Janice is searching for articles to prove that today’s youth are better multi-taskers than their older preceptors. You leave the meeting fuming and threatening to fail her.

What do you do next?

DISCUSSION:3.While discussing the impact of her phone use on patient care, Janice is searching for articles to prove that today’s youth are better multi-taskers than their older preceptors. You leave the meeting fuming and threatening to fail her.

What do you do next?

Page 41: Teaching Professionalism:  Critical Conversations  With Our Learners
Page 42: Teaching Professionalism:  Critical Conversations  With Our Learners

Lapses in ProfessionalismLapses in Professionalism

It is critical that preceptors address lapses of professionalism

during medical training since student unprofessional behavior

is associated with residency difficulties and disciplinary action by licensing bodies in practice.

It is critical that preceptors address lapses of professionalism

during medical training since student unprofessional behavior

is associated with residency difficulties and disciplinary action by licensing bodies in practice.

Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79(3):244-

9.

Page 43: Teaching Professionalism:  Critical Conversations  With Our Learners

UNPROFESSIONAL BEHAVIORUNPROFESSIONAL BEHAVIORPurpose: Determine if medical students who demonstrate

unprofessional behavior are more likely to have subsequent licensing board disciplinary action.

Method: Case control study of all California medical school graduates disciplined by the California Medical Board from 1990-2000 (68 graduates). Control graduates (196) were matched by medical school graduation year and specialty. Variables examined included gender, undergraduate GPA, MCAT scores, National Board Examination Part 1 scores, negative excerpts describing unprofessional behavior in rotation evaluations, Deans letters for residency placement, and administrative correspondence. Out come variable was state board disciplinary action.

Purpose: Determine if medical students who demonstrate unprofessional behavior are more likely to have subsequent licensing board disciplinary action.

Method: Case control study of all California medical school graduates disciplined by the California Medical Board from 1990-2000 (68 graduates). Control graduates (196) were matched by medical school graduation year and specialty. Variables examined included gender, undergraduate GPA, MCAT scores, National Board Examination Part 1 scores, negative excerpts describing unprofessional behavior in rotation evaluations, Deans letters for residency placement, and administrative correspondence. Out come variable was state board disciplinary action.

Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79(3):244-9.Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79(3):244-9.

Page 44: Teaching Professionalism:  Critical Conversations  With Our Learners

UNPROFESSIONAL BEHAVIORUNPROFESSIONAL BEHAVIOR

Results: Medical students graduated from 1943-89. 95% of disciplinary actions were for deficiencies in professionalism. Prevalence of negative excerpts in undergraduate evaluations was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have negative excerpts (Odds ratio 2.15; 95% CI 1.15-4.02;p = .02).

Conclusion: Problematic behaviour in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.

Results: Medical students graduated from 1943-89. 95% of disciplinary actions were for deficiencies in professionalism. Prevalence of negative excerpts in undergraduate evaluations was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have negative excerpts (Odds ratio 2.15; 95% CI 1.15-4.02;p = .02).

Conclusion: Problematic behaviour in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.

Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79(3):244-9.Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79(3):244-9.

Page 45: Teaching Professionalism:  Critical Conversations  With Our Learners

UNPROFESSIONAL BEHAVIORUNPROFESSIONAL BEHAVIOR

Purpose: Identify the domains of unprofessional behavior that in medical school that are linked to disciplinary outcomes in practice.

Method: Case control study of all California medical school graduates disciplined by the California Medical Board from 1990-2000 (68 graduates). Control graduates (196) were matched by medical school graduation year and specialty. Negative excerpts describing

unprofessional behavior in rotation evaluations, Deans letters for residency placement, and administrative correspondence were extracted. Qualitative analysis was carried out to clarify domains of behaviors that had been indentified as unprofessional by faculty.

Purpose: Identify the domains of unprofessional behavior that in medical school that are linked to disciplinary outcomes in practice.

Method: Case control study of all California medical school graduates disciplined by the California Medical Board from 1990-2000 (68 graduates). Control graduates (196) were matched by medical school graduation year and specialty. Negative excerpts describing

unprofessional behavior in rotation evaluations, Deans letters for residency placement, and administrative correspondence were extracted. Qualitative analysis was carried out to clarify domains of behaviors that had been indentified as unprofessional by faculty.

Teherani A, Hodgson CS, Banach M, Papadakis MA. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Acad Med 2005;80(10):S17-20.

Teherani A, Hodgson CS, Banach M, Papadakis MA. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Acad Med 2005;80(10):S17-20.

Page 46: Teaching Professionalism:  Critical Conversations  With Our Learners

UNPROFESSIONAL BEHAVIORUNPROFESSIONAL BEHAVIOR

Results: Three domains of unprofessional behavior emerged that were significantly related to later disciplinary action: poor reliability and responsibility, lack of self-improvement and adaptability, poor initiative and motivation.Conclusion: Medical students experiencing difficulty in any

of the three identified domains of unprofessional behavior were more likely to be disciplined in future practice. Study findings suggest that faculty include assessment of these behaviors in their evaluation of medical students.

Results: Three domains of unprofessional behavior emerged that were significantly related to later disciplinary action: poor reliability and responsibility, lack of self-improvement and adaptability, poor initiative and motivation.Conclusion: Medical students experiencing difficulty in any

of the three identified domains of unprofessional behavior were more likely to be disciplined in future practice. Study findings suggest that faculty include assessment of these behaviors in their evaluation of medical students.

Teherani A, Hodgson CS, Banach M, Papadakis MA. Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Acad Med 2005;80(10):S17-20.

Page 47: Teaching Professionalism:  Critical Conversations  With Our Learners

Hidden Curriculum

Page 48: Teaching Professionalism:  Critical Conversations  With Our Learners

Hidden CurriculumHidden Curriculum

During medical training, learners must often grapple with the

dissonance between espoused virtues and professional

responsibilities and the actual behaviors exhibited by physicians

in every day clinical practice.

During medical training, learners must often grapple with the

dissonance between espoused virtues and professional

responsibilities and the actual behaviors exhibited by physicians

in every day clinical practice.

Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum; What can we learn from third-year medical student narrative reflections? Acad Med 2010;85(11):1709-16.

Page 49: Teaching Professionalism:  Critical Conversations  With Our Learners

DefineHidden Curriculum:

Page 50: Teaching Professionalism:  Critical Conversations  With Our Learners

Hidden CurriculumHidden CurriculumLearning that occurs through informal interactions among

students, faculty, and others and/or

Learning that occurs through organizational and cultural factors intrinsic to training

institutions.

Learning that occurs through informal interactions among

students, faculty, and others and/or

Learning that occurs through organizational and cultural factors intrinsic to training

institutions.

Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum; What can we learn from third-year medical student narrative reflections? Acad Med 2010;85(11):1709-16.

Page 51: Teaching Professionalism:  Critical Conversations  With Our Learners

Hidden CurriculumHidden Curriculum

Learners struggle to understand explicit professional values they

are taught and the implicit values of the hidden curriculum. Conflict invites compromise in

the area of professionalism along with disillusionment with the

practice of medicine.

Learners struggle to understand explicit professional values they

are taught and the implicit values of the hidden curriculum. Conflict invites compromise in

the area of professionalism along with disillusionment with the

practice of medicine.

Brainard AH, Brislen HC. Viewpoint: Learning professionalism: A view from the trenches. Acad Med 2007;82(11):1010-14.

Page 52: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ResponsibilitiesPreceptor ResponsibilitiesPreceptors must lead by example

along with holding themselves accountable for unprofessional

behavior within their clinical settings. Programs should have

a zero-tolerance policy for unprofessional behavior of anyone in a teaching role.

Preceptors must lead by example along with holding themselves accountable for unprofessional

behavior within their clinical settings. Programs should have

a zero-tolerance policy for unprofessional behavior of anyone in a teaching role.

Brainard AH, Brislen HC. Viewpoint: Learning professionalism: A view from the trenches. Acad Med 2007;82(11):1010-14.

Page 53: Teaching Professionalism:  Critical Conversations  With Our Learners
Page 54: Teaching Professionalism:  Critical Conversations  With Our Learners

Online ProfessionalismOnline Professionalism

• Social media (Face book/Twitter) creates new hazards for medical professionalism.

• On the internet, physicians may leave behind a “footprint” that may have unintended negative consequences.

• Social media (Face book/Twitter) creates new hazards for medical professionalism.

• On the internet, physicians may leave behind a “footprint” that may have unintended negative consequences.

Greysen S, Kind T, Chretien K. Online professionalism and the mirror of social media. J Gen Intern Med 2010;25:1227-9.

Page 55: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ResponsibilitiesPreceptor Responsibilities

As medical trainees become more technologically savvy, it is the

responsibility of medical educators to familiarize

themselves not only with the advantages of the technology

but also with the negative effects of its misuse.

As medical trainees become more technologically savvy, it is the

responsibility of medical educators to familiarize

themselves not only with the advantages of the technology

but also with the negative effects of its misuse.

Farnan J, Paro J, Higa J, Reddy S, Humphrey H, Arora V. Commentary: The relationship status of digital media and professionalism: It’s complicated. Acad Med 2009;84(11):1479-81..

Page 56: Teaching Professionalism:  Critical Conversations  With Our Learners
Page 57: Teaching Professionalism:  Critical Conversations  With Our Learners

Physician Self-CarePhysician Self-Care

Professionalism includes physician self-care. Discussions about

coping strategies, help seeking behavior, personal physicians,

boundaries, and physician patients provide opportunities for learners to develop appropriate

self-care strategies.

Professionalism includes physician self-care. Discussions about

coping strategies, help seeking behavior, personal physicians,

boundaries, and physician patients provide opportunities for learners to develop appropriate

self-care strategies.

Spencer J. Physician, heal thyself but not on your own, please. Med Educ 2005;39(6):548-9.

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Learning Objectives: Learning Objectives: Learning Objectives: Learning Objectives:

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

►Provide effective strategies for dealing with learner unprofessional behavior.

►Review contextual nature of professional behavior.

►Review critical role of preceptors in development of professionalism among learners.

►Provide effective strategies for dealing with learner unprofessional behavior.

Page 59: Teaching Professionalism:  Critical Conversations  With Our Learners

Preceptor ResponsibilitiesPreceptor Responsibilities

Medical schools and residency programs begin the process of

the professional development of medical trainees. It is the community of practicing

physicians and preceptors who must accept responsibility for maintaining professionalism.

Medical schools and residency programs begin the process of

the professional development of medical trainees. It is the community of practicing

physicians and preceptors who must accept responsibility for maintaining professionalism.

Lucey C, Souba W. The problem with the problem of professionalism. Acad Med 2010;85:1018-24.

Page 60: Teaching Professionalism:  Critical Conversations  With Our Learners

PROFESSIONALISMPROFESSIONALISM PROFESSIONALISMPROFESSIONALISM

Learner lapses are expected

Preceptors have central role in modeling

Core competency

Lapses are invitation for collegial conversation

Understanding learner’s clinical context is essential

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QuestionsQuestions

Comments

Comments

ReflectionsReflections