Louise Arnold, Ph'D' CGEA

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Responding to Unprofessional Behaviorof
Students, Residents, and Physicians in Practice
Louise Arnold, Ph.D. CGEA March, 2004
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Scenarios

• Ms. Ann Martin, Medical Student
• Dr. Wayne Rudd, Resident
• Dr. Allen Morris, Professor

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Responding to Unprofessional Behavior

• Response patterns
• Factors in responding
• Approaches to remediation
• Prevention
• Environmental support

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Response Patterns

• Address professional lapse
• Do not address lapse
• Dont notice it
• Notice it but
• Ignore
• Rationalize
• Lament

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Factors in Responding Deterrents

• Prevailing culture
• Values of helping professions
• Organization of health care delivery
• Educational process
• Structure of curricular experiences
• Assessment
• Individual concerns

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Factors in Responding Promoters

• Values of medicine
• Health care delivery organizations
• Educational process
• Programs on professionalism
• Assessment

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Factors in Responding Assessment

• Accreditation Standards
• MSPE
• Longitudinal Assessment
• UNM
• USCF
• UTMB

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Factors in Responding Assessment

• Longitudinal Assessment
• UMKC
• Overseas
• Search for tools
• Validity

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Factors in Responding Individual Concerns

• Litigation
• Remediation

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Approaches to Remediation

• Process
• Characterizing the problem
• Therapy
• Techniques
• Programs
• Efficacy

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Prospects for Remediation

• Better if client
• Embraces professionalism
• Has insight
• Is willing to change
• Expresses feelings
• Values relationships

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Prospects for Remediation

• Depend on
• Individual client
• Problem
• Match between problem therapy
• Skill of therapist
• Match between therapist client

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Guides to Remediation/Rehabilitation

• Tailor to individual
• Here and now therapies

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Prevention

• Implement medical education as moral education
• Clarify professionalism
• Adopt charter
• Adopt policy
• Educate

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Prevention

• Assess
• Formative
• Has consequences
• Relate assessment to professionalism
• Promote well being

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Prevention

• Improve supervision
• Commit resources
• Delineate costs of unprofessional behavior
• Increase environmental support

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Institutional efforts

• Reading programs
• Appreciative inquiry
• Training for explicit role modeling
• Training for contemporary practice
• Comprehensive initiative

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Responding to Unprofessional Behavior

• Response patterns
• Factors in responding
• Approaches to remediation
• Prevention
• Environmental support