JointlySponsored by Albert Einstein College of Medicine and - PowerPoint PPT Presentation

Title: JointlySponsored by Albert Einstein College of Medicine and


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Professionalism I Know It When I Dont See It

• Discussion Notes From the 3 Workgroups
• Assessment
• Logistics
• Rewards Remediation
• Workshop Held On
• Friday, December 16, 2005

Jointly-Sponsored by Albert Einstein College of
Medicine and Associated Medical Schools of New
York.
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Logistics

• The Logistics Workgroups were to determine when,
  where
• and how professionalism education should be
  integrated
• into the UME curriculum.
• Professionalism What is it?
• Prior to determining when, where and how
  professionalism
• education is taught, the Logistics workgroups
  needed to
• agree upon what constitutes professional
  behavior.
• The discussion centered on the following topics
• Can the term ethics be substituted for
  professionalism, or is it a component of
  professionalism?
• Professionalism is broader than ethics, but the
  two topics are tied together in pre-existing
  courses
• What are the ideals that brought students into
  medicine and how are they continually instilled
  throughout the curriculum?
• Does the system support professional behavior, or
  does it contribute to the lack of
  professionalism?
• What are the basic components of professionalism?
• Altruism

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• What/How Should Professionalism Be Taught?
• The discussion revolved around the role of
  faculty in the teaching of professionalism
• Professionalism must be exemplified by faculty
• Teaching will be experiential and much of it
  will be done
• through modeling of appropriate behavior
• Feed back must be detailed and honest
• It must be possible for students to fail
• Faculty must also be held to standards of
  professionalism
• There must be ongoing accountability
• Faculty development sessions
• Work into specific courses, ie pre-clinical
  years, clinical

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ASSESSMENT
The Assessment Workgroups were to define methods
to assess and evaluate professional behavior.
Professionalism Standards The discussion
centered on the need for institutional standards
on professionalism, and the call for developing
an assessment tool. One group referenced
Measuring Medical Professionalism by David T
Stern, MD and the 12 items from the University
of Michigans Dept of Surgery evaluation form.
The discussion placed emphasis on barriers and
the need to identify barriers for the successful
implementation of assessment. Some barriers
included - Subjective parameters make people
uncomfortable and reluctant - Faculty
spend limited time with each student and are not
in a position to evaluate long parameters -
Lack of understanding about the difference
between EVALUATION (which is summative,
high-stakes, and can have an impact on
career) and FEEDBACK (which is periodic,
improvement-oriented, and low stakes) -
Institutional personalities/corporate cultures
that marginalizes these issues - The
HALO Effect preceptor who observes a few
behaviors and feels the trainee is a nice
person and then is tempted/pressured to
extrapolate to unobserved behaviors and
conversely The DARK SMUDGE Effect - where one
mistake is amplified into a bad reputation -
Resistance to documentation of incidents
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• Ideas shared on how to overcome these barriers
  included
• 360 degree evaluations
• Could model this after the current approach to
  medical error a systems approach is important to
  depersonalize the evaluation
• Place emphasis on feedback vs. evaluation
• Faculty development
• Professionalism and/or Humanism Portfolio that
  the student accrues over time and can be used as
  a reflection tool
• Private attending who teach in services should
  have development and training through continuing
  education
• Residents can learn skills through being asked to
  teach students
• Patients can be asked to evaluate trainees

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REWARDS REMEDIATION

• The Rewards Remediation Workgroups were to
  define remediation
• strategies that can be used to improve
  professional behaviors.
• Reward Professional Behavior
• Prior to determining how exemplary behavior would
  be recognized
• and rewarded, discussion centered on what is
  expected of the
• student, how to let the student know what is
  expected and how to
• avoid the hidden curriculum? Points Noted
  Included
• Performance expectations that relate to test
  taking vs. Performance expectations in clinical
  setting
• Student maturity level
• Student values
• What is expected of the student?
• Establish Policies and Guidelines that are
  explicit
• Create a Code of Behavior or Code of Conduct to
  serve as a tool
• Get students involved in creating the criteria
• How to let the student know what is expected?
• - Communication with the student

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• How to avoid the hidden curriculum?
• - Faculty have to learn to talk with students
• - Faculty Involvement
• Must have the culture amongst them which is also
  rewarded or penalize
• Demonstrate expected behavior for faculty
• Mentorship Programs
• - Institutional Commitment
• Faculty Training and Workshops
• Develop tools that will educate on personal self
  awareness
• Financial Support.MONEY!!!! (for training and
  workshops)
• Top Down RewardsBottom Up Teaching
• Quality Improvement to Review Curriculum in light
  of cases
• Thoughts on how to reward professional behavior
  included
• Awards Ceremonies (ie Gold Humanism Honor
  Society)
• Recognize the Active Learner
• Find Time Place to Reward Good Behavior
• Publicity about Outstanding Performance

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Barriers Identified Included- Faculty
Resistance to Training- Not Knowing when to
Stop RemediationWhen is Enough?- Need to
generate a mechanism which ensures that
remediation plans developed with due
process are carried out- Need for financial
support and funding to compensate faculty mentors
to increase their numbers and lower the
ratios- Create institutional acceptance for
students who select to leave medicine- Major
Obstacles are financial, emotional and legal
ramifications of dismissing students who
fail to remediate