Professionalism

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Professionalism
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Professionalism

• Fiduciary duty
• of, relating to, or involving a confidence or
  trust (Merriam-Webster)
• A contract with society
• Law, Medicine, Clergy

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Spheres of Professional Responsibility
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Medical Professionalism in the New Millennium A
Physicians' Charter1
The Medical Professionalism Project The 2005
RSNA Professionalism Committee
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Commitment to . . .

• Professional Competence
• Honesty with Patients
• Patients' Confidentiality
• Maintaining Appropriate Relationships with
  Patients
• Improving Quality of Care
• Improving Access to Care
• Just Distribution of Finite Resources
• Scientific Knowledge
• Maintaining Trust by Managing Conflicts of
  Interest
• Professional Responsibilities

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Traditional Topics

• Conflicts of Interest
• Confidentiality
• Errors
• Impaired Physicians
• Incompetent Physicians
• Boundary Issues

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Professionalism Swick 2000 Academic
Medicine

• Physicians subordinate their own interests to the
  interests of others
• Physicians adhere to high ethical and moral
  standards
• Physicians respond to societal needs
• Physicians evince core humanistic values
  including honesty, integrity, caring, compassion,
  altrusim, empathy, respect, trustworthiness

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• Physicians exercise accountability for themselves
  and for their colleagues
• Physicians demonstrate a continuing commitment to
  excellence
• Physicians exhibit a commitment to scholarship
  and to advancing their field
• Physicians deal with high levels of complexity
  and uncertainty
• Physicians reflect on their actions and decisions

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Emerging Topics 2010

• Social Networking and Media
• Diversity among Patients and Workplace
• New attitudes toward communication with patients
• Need for trainee codes of professionalism
• Evolving Power-Distance

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Case 1

• Social Networking
• John Brown, a 2nd year resident in Radiology has
  a Facebook persona with 143 friends posted on
  his wall are photos from his days as a college
  football star.
• Issues are that he frequently complains about the
  residency program , faculty members, workload,
  and actively solicits comments from female
  friends, some of whom are fellow residents,
  technologists in the dept, and patients.
• Do you believe this is appropriate behavior? Why?

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Case 2

• Communicating results
• You have just completed an imaging examination on
  a 5 year old child and the family members are
  waiting to discuss the preliminary results of the
  cranial study. The patient, who presented with a
  tremor has a large posterior fossa tumor. Her
  pediatrician is away at a meeting.
• What will you discuss with the family? Why?

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Case 2B

• The training directors have decided to have the 9
  PGY 2 and 3 residents in the program learn to
  provide preliminary study results to patients.
• Rate numerically from worst (1) to best (7) the
  following ways that they could learn to do this

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Case 2 B Possibilities Rank 1-7
Worst-Best

• 4. Have residents view a video on giving results
• 5. Groups critique a video of a physician giving
  results to a patient.
• 6. Write a 5 sentence short essay on giving
  results.
• 7. Assemble the residents into a group to
  practice giving results to standardized patients.

1. Observe a faculty member giving study results to
   a patient.
2. Present a lecture on methods of communicating
   results to patients. Then test the learners.
3. Hold the lecture followed by a resident
   Teach-Back

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What is your picture of a classroom?
University of Missouri
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What can be your picture of a classroom?
Apple, Inc.
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Case 3

• Concept of Power-distance
• Joe Green (PGY5) and Mary Brown (PGY3) are on
  service together and asked by the pulmonary
  fellows to plan and present a conference for
  pulmonarys 6 attendings and 3 fellows. They are
  excited and ask the radiology attending to help
  provide some cases, and for suggestions. The
  attending, an Associate professor, has a fit
  that he was not asked, although he would have
  given the duty to them, anyway.
• What is the problem here? How could it be managed
  better? Have you experienced Power-distance
  issues?

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Case 4

• Residents are derogatory about Dr. Smith, a
  semiretired physician who has outdated knowledge
  of technology. However, he has sharp skills in
  film interpretation, in which he capably and
  enthusiastically instructs residents.
• The problem residents have is that he does not
  recommend or utilize cross sectional imaging when
  indicated. As a resident, what should you say or
  do when you believe his recommendations are in
  error?
• What and why?

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Case 5

• A 6 yo boy at play, accidentally sustained a head
  injury in which he reportedly lost consciousness
  for about 1 minute. In the ER he is alert and
  responsive and has a normal neurologic exam.
  Mother and the ER physician feel he should be
  discharged home and monitored by the mother. Dad,
  an Internist and divorced from the mother,
  believes the child should have a cranial CT scan
  to ensure there is no underlying injury.
• How should you manage the situation? Why?

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Case 6

• Joe Green, is a PGY 5 resident with 3 great job
  offers. He encounters fellow resident, Sam, who
  says Dont forget our board review session
  today from 3 until 6! Joe replies Naw, I hate
  spending time on all that trivia, I prefer to
  learn by listening to the consults, instead.
• What do you know about Joe and Sam?
• Who will do better on the Boards? In life?
• Why?

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Proficient
Competent
Advanced beginner
Novice
HL Dreyfus 1986
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Wisdom
Insight
Knowledge
Meaning
Information
Data
Patrick Lambe
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Competence, certification
Training
Performance
Learning Knowing Understanding Comprehension
Practice, sustainable abilities
Mastery