PROFESSIONALISM

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PROFESSIONALISM

• John A. Talbott, M.D.
• Professor of Psychiatry
• Project Director - HELPERS-PRO
• Course Director - Practice of Medicine

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PROFESSIONALISM

• What is Professionalism?
• How is it evaluated?
• Can we select students well?
• Can we teach Professionalism?
• Where do students learn unprofessional behavior?
• How about Exemplary Behavior?

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What is Professionalism?

• The wife of a very well-known local celebrity is
  seen in gynecology clinic. She is informed of the
  results of a recent mammogram, which confirms the
  diagnosis of breast cancer. 2 hours later, while
  out to lunch at the Penn Street Restaurant, the
  resident physician who worked up the patient
  discusses the patient's case, referring to her
  specifically by name, who her spouse is, and her
  diagnosis.

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What is Professionalism?

• Is this Professional behavior?
• How do you know?
• Your upbringing/experience?
• Your training?
• Your gut?
• What then is Professionalism?

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What is Professionalism?

• Humanism
• Ethics
• Life-long Learning
• Physicians subordinating themselves to
  their patients
• Ethical behavior
• Research subjects
• Sensitivity to age, culture,
  disability, diversity and gender
• Professionalism
• Respect for Patients, Families and Colleagues
• Other (Death and Dying, Impairment, Sexual
  and Aggressive Behavior, Physician/Industry
  relationships)

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How is it Evaluated

• I was mentioning to my mother that I thought
  that I had found a possible pediatrician for my
  new baby. It was a faculty member who I had
  shadowed for ICP. He was great! Good rapport
  with patients, knowledgeable, and caring. But
  there was this nagging in the back of my mind
  that something wasn't quite right. A fellow
  student pointed out the problem -- he never
  washed his hands in between patients. He went
  from one Strep patient, to a routine high school
  physical, from one sick baby exam, to a well baby
  exam. Yet neither of us had EVER seen him wash
  his hands. Regardless of his clinical skills,
  the thought of him touching my or any other child
  totally turned me off after thinking about his
  lack of good hygiene.

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How is it Evaluated?

• How do we pick this behavior up?
• Observation
• Periodic (end of course or rotation)
• PD
• OSCEs
• How is it reported
• Orally
• In writing - Professionalism Website has forms
  http//medschool.umaryland.edu/Professionalism/Eva
  luation.asp

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How is it Evaluated?

• Physical Examination- systematic approach and
  thoroughness skill level in applying fundamental
  techniques attention to parts of examination
  requiring emphasis use of special techniques to
  delineate abnormal findings.

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How is it Evaluated?(even issues like)

• Altruism- Demonstrates sensitivity to patients
  needs, takes time and effort to explain
  information to patients and comfort the sick
  patient, listens sympathetically to patients
  concerns, puts patients interests before his/her
  own, shows respect for patients confidentiality.

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How is it Evaluated?Another example

• A radiology resident read the films of a patient
  who is a faculty member here. The resident lives
  with a current student and came home and told the
  student about a life-threatening diagnosis for
  the faculty member made on the basis of the
  films.

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How is it Evaluated?Another example

• How is it reported
• Orally
• In writing - Professionalism Website has form -
  called the Sentinel Event Form
  http//medschool.umaryland.edu/Professionalism/Eva
  luation.asp

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How is it Evaluated?Another example

• Sentinel events"
• Referring to oneself as, or holding oneself to
  be, more qualified than one is
• Participating in a conflict of interest
• Theft of drugs
• Violation of the criminal code
• Failure to be available while on call
• Failure to respect patients' rights
• Breach of confidentiality
• Failure to provide transfer of responsibility
  for patient care

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How is it Evaluated?Another example

• Failure to meet academic codes of behavior (e.g.
  cheating on an examination)
• Being disrespectful to patients, colleagues and
  other professional staff
• Falsification of medical records or
  misrepresentation of a clinical situation
• Assaulting a patient, colleague or staff member
• Sexual impropriety with a patient or colleague
• Sexual harassment
• Threat or hate crime
• Being under the influence of alcohol or drugs
  while participating in patient care or on call
• Any other conduct unbecoming of a physician

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How is it Evaluated?Another example

• Who is in the best position to observe
  professional and unprofessional behavior?
• The Dean?
• The faculty?
• The residents?
• The students?
• So, how do we utilize that?

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How is it Evaluated? Who is in the best position?

• Student-Student Form (for display only to fill
  out go to Medscope)
• Microsoft Word Document
• Adobe Acrobat Format

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Can we select students well?

• While I was on my 3rd year surgical rotation,
  one of the patients our team followed had an
  extremely foul smelling abdominal wound
  infection- so foul that it smelled up the entire
  floor. One day on rounds, the attending and
  fellow began making jokes about the
  stench...while in the patient's room as if he
  weren't even there. Tears welled up in the
  patient's eyes. The attending realized this,
  and told the patient flippantly, "Oh, we're
  sorry" and turned to the fellow and said, "look-
  we've made the poor man cry". They promptly left
  the room and went on to the next patient as if
  the whole thing had never happened.

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Can we select students well?

• Tough question
• But were now trying through
• Heightened awareness
• Questions on interview
• Word of mouth and internet

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Can we teach Professionalism?

• At 29 South Paca a resident discussed private
  information about one student she was seeing as a
  patient over the phone in front of another
  student she was teaching. The information was
  very sensitive in nature. The student who
  overheard the info told the resident that she
  knew the student involved, but the resident
  continued to make numerous phone calls to the
  same patient-student revealing further sensitive
  information over the next two weeks in front of
  the other student she was teaching.

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Can we teach Professionalism?

• Im not certain
• But I know we have to try
• There are models out there - e.g. McGill
• Our attempt will be called The Practice of
  Medicine

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Can we teach Professionalism?The Practice of
Medicine

• To include
• Human Behavior
• Introduction to Clinical Practice, especially its
  element on the History of Medicine
• Problem Based Learning
• Intimate Human Behavior
• Physical Diagnosis
• Parts of longitudinal ambulatory and AHEC
• Orientation to the 1st, 2nd and 3rd years
• New initiatives in professionalism
• New simulation/technology experiments - e.g.
  OSCEs
• Capstone week

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Can we teach Professionalism?The Practice of
Medicine

• How will it be different? By doing
• Grades
• Standardized patient exercises and OSCE part of
  new course
• PBL to be changed to Year I Jan to Year II Jan
• Writing curriculum so that ICP and Human Behavior
  support one another
• T/C Human Behavior/ICP components at beginning of
  Year I, Year II and Year III
• Look to add service learning
• Potentially shift some ethics/professionalism
  into time currently occupied by preventive health
  in Year III
• Anchor simulation exercises within this course
  tied to PD

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Can we teach Professionalism?The Practice of
Medicine

• How will it be different? By adding
• Medical ethics and ethical behavior
• Death and dying, pain and palliation, breaking
  bad news
• House staff treatment of students
• Communication, the doctor/patient relationship,
  boundaries
• Strains and stresses of becoming and being a
  physician
• Religion and spirituality
• Cultural, ethnic, gender, sexual and
  socioeconomic diversity
• Patient safety/medical errors
• Physician/Industry relationships and gifts from
  industry
• Impairment
• Treating the VIP, HIV patients, smokers, the
  mentally and physically handicapped
• Sexual harassment.
• The stresses and strains of medicine (e.g.
  substance abuse, divorce)

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How about Exemplary Behavior?

• Ms. X is the epitome of professionalism and
  ethics in a medical student, and is the type of
  individual that the UMB School of Medicine
  strives to cultivate as a future physician. I
  have personally witnessed countless instances of
  her example of integrity, morals, and respect for
  others, throughout the first 3 years of medical
  school. This sentiment is echoed by many of my
  fellow classmates, residents, and attending
  physicians, who have mentioned her
  professionalism and integrity several months
  after completing a rotation with her. To receive
  these sort of remarks well after the fact means
  that she has made a lasting impression in her
  profession and has achieved something very
  special in her personal encounters with others.
  Of utmost importance to her, however, is that she
  holds her patients in the highest regard, and
  displays an unwavering compassion, altruism, and
  empathy in her care of them. She also
  demonstrates a continuing commitment to
  excellence and exhibits a commitment to
  scholarship that is unrivaled amongst our fellow
  classmates. She is an inspiration to her fellow
  students, the physicians she works under, and
  especially to her patients.

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How about Exemplary Behavior?

• How do I report it?
• In a fellow student
• In a resident
• In a faculty member
• Anytime via the Website use the Exemplary
  Comment Form
• But there are special opportunities

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How about Exemplary Behavior? The special
opportunities

• For students
• At the end of each small group experience
• At the beginning of the 4th year for the 10 of
  the class for the Humanism Honor Society
• For residents
• When the 4th year Honor Society selects 6
• For faculty
• When the 4th year Honor Society class pick 1

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QUESTIONS?