A Framework for Professionalism in Surgery: What is Important to Medical Students? Maura Sullivan, PhD, Janet Trial, EdD, Craig Baker, MD, Kenji Inaba, MD, Josette Etcheverry, MSN, Mary Nally FNP, Peter Crookes, MD

none Disclosures 2

History 3

Terms used to explain professionalism abstract Different groups use word differently Easy to recognize, hard to define Ways to best teach not well established Power of the “hidden curriculum” The Problem 4

Develop an institutional culture of professionalism Establish expectations regarding professional behavior Explicitly define professionalism Attributes and principles must be clearly defined and understood Our Goals 5

Develop a comprehensive definition (framework) of professionalism in surgery Determine which attributes are most valued by medical students Determine which attributes are most demonstrated by faculty and residents Purpose 6

Framework for Professionalism in Surgery Phase 1 Core group of educational leaders Brainstorming sessions Review of literature and resources List of all attributes Phase 2 Attributes grouped into similar concepts Served as foundation for attribute categories Final categories decided upon by expert consensus Methods 7

Professionalism Clinical Competence Technical skill Clinical reasoning Diagnostic ability Inquisitiveness Patient-centered care Diligence Cultural Competence Respect for diversity Works across language/cultures Understands how culture affects healthcare Altruism Non-judgmental Caring Civic-minded Dedicated Compassionate Integrity/honesty Patient advocate Education Responsibility to teach (patients, learners) Mentoring Leadership Inspires others Role modeling Understands role on team Appearance Ethics/Legal Maintains appropriate relationships (industry, patients, peers, subordinates) Manages conflicts of interest Practices beneficence Full disclosure Reports mistakes Follows institutional guidelines Research ethics Just distribution of resources Practice Improvement Self-awareness Self-reflection Recognizes limits manages emotions Admits mistakes Response to criticism Aware of biases Motivation to improve Commitment to LLL Respect Interdisciplinary Patient autonomy Patient confidentiality Allied health Colleagues Accountability Interpersonal Skills Effectively communicates (information gathers, effective listening, transmits key information, giving bad news) Works well within a team Fosters relationship development Approachable Framework for Professionalism USC Department of Surgery

All Year III students (N=168) Structured focus group Define professionalism List most important attributes Describe any witnessed unprofessional behavior Written questionnaire Recorded and transcribed verbatim Methods- cont 9

Coded by two independent raters Assigned an attribute category Iterative process of discussion, refinement of coding schema and consensus Achieved inter-rater agreement of 99% Comments assigned up to three attribute categories Coding 10

Belittling those below you on the hierarchical chain Respect and leadership Making negative comments about a very sick ICU patient Altruism and Respect Coding Example 11

AttributeMost DefinedMost Important Respect56%53% Altruism12%21% Practice-Based Improvement9%3% Clinical Competence7%6% Interpersonal Skills6%8% Accountability4% Ethics/legal3%Not mentioned Education2%1% Appearance1% *LeadershipNot mentioned3% *Cultural CompetenceNot mentioned Results – 82% Response Rate 12

Results – 82% Response Rate 13

53% witnessed unprofessional behavior by faculty Results - Cont 14

64% witnessed unprofessional behavior by residents/fellows Results - Cont 15

Framework for Professionalism in Surgery has been useful Clear definition Foundation for expected behaviors Conclusions 16

Conclusions - Cont 17 Respect most important attribute Most violated Rude or argumentive behavior Interlay between emotionally charged behavior and cognitive skills Rudeness may impair thinking skills and/or cause distraction Able to target faculty development program

Further explore the impact of rude behavior on performance Study of human behavior in high risk environments Safety studies in other disciplines Few in medicine Future Studies 18

19 Thank You