Setting Expectations on Professionalism in Residency: Orientation Workshop on Common Professionalism Issues

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Setting Expectations on
Professionalism in ResidencyOrientation
Workshop on Common Professionalism Issues

• Jayne M. Peterson, MD
• Banner Good Samaritan Medical Center

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Professionalism in Residency

• One of 6 Core Competencies required for board
  certification by the ABIM
• Traditionally difficult to define, to measure
  and to teach
• Unwritten rules only discovered when you make
  a mistake
• References
• Medical Professionalism. Chicago ACGME, 2006
  (Accessed Jan. 8, 2007 at http//www.acgme.org/out
  come/implement/Profm_resource.pdf)
• Stern, D, Papadakis, M. The Developing Physician
  Becoming a Professional. NEJM 20063551794-9.

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Setting Expectations in Our Residency

• Resident Manual
• Orientation for PGY 1 prior to starting residency
  
• Workshop for PGY 2s prior to moving to
  supervisory role with follow up workshop in early
  PGY 3 year
• Monthly orientation to each new rotation
• Advisor Meetings twice per year

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Definitions of Professionalism

• Prokos Trust
• Respect - for patients families, peers, other
  healthcare team members
• Appropriate behavior polite, dedicated,
  compassionate, hardworking, timely, well groomed,
  honest, maintain confidentiality

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Unprofessional Behavior Examples Observed by
Attendings

• Not taking responsibility for errors,
  communicating with patients family members
• Not following pay back rules, leaving work
  undone or not insuring continuity of care during
  handoffs, not working as a team, falsely calling
  out sick
• Discussing patients in a nonprofessional manner
  in multidisciplinary meetings
• Being late for clinical duties without good
  reason
• Poor communication skills in difficult situations
• Poor appearance both in dress and
  attitude/interest
• Criticizing other staff colleagues in public

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Resident Observed Unprofessional Behavior

• Gossiping about other members of healthcare team
• Yelling at ancillary staff
• Talking about patients in elevator
• Residents shirking post call duties to interns,
  or not assisting in workload
• Bad attitudes getting hits or whining
• Asking for weekdays off so have less patients
  schedule squabbling
• Poor checkouts leaving early
• putting down students interns
• Poor conference attendance
• Calling in sick or not showing up for expected
  duties

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Why do you think this unprofessional behavior
occurred?

• Stress/time issues
• No consequences
• Fatigue/frustration
• People are not secure in who they are just
  their personality arrogance
• Clinical duties not well defined/uncomfortable
  with role in health team

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Personal Professionalism Plans

• Open your envelope from 2007
• Did you do what you said you would do?
• Do you have a way to measure your change?

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Professionalism Quality Improvement

• Identify Something you want to change
• Plan What are your opportunities barriers to
  change? How will I know that the change was
  effective?
• Do Try it
• Study Measure the change
• Act See if you can incorporate the change in
  your life. Start the cycle over again.

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Summary of PDSA Cycle
Plan
Act
Do
Study
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Example Jayne Peterson

• Opportunity Time Management I waste too much
  time looking for things on my desk
• Plan Organize my desk then deal with each
  item only once toss it, file it, or complete
  it.
• Do schedule clean up date, get a new on-desk
  file system
• Study In one month is my desk still clean and
  can I find what I need?
• Act If in one month it is working I will keep
  this system and move on to my book shelf.

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Resident Small Group Discussion

• How can we improve professionalism in our
  residency program?
• What do you think should be the consequence of
  unprofessional behavior?
• Does it matter what the behavior is?
• Share a personal professional plan for 2008-2009
  with your group and how you plan to measure it.