Setting Expectations on Professionalism in Residency: Orientation Workshop on Common Professionalism Issues Jayne M. Peterson, MD Banner Good Samaritan Medical Center

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 Stern, D, Papadakis, M. The Developing Physician – Becoming a Professional. NEJM 2006;355:

Setting Expectations in Our Residency Resident Manual Orientation for PGY 1 prior to starting residency Workshop for PGY 2’s 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

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

Unprofessional Behavior Examples Observed by Attendings Not taking responsibility for errors, communicating with patient’s 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

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

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

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?

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.

Summary of PDSA Cycle Plan Do Study Act

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.

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 with your group and how you plan to measure it.