Accountability, Initiative, Integrity & Trustworthiness SKILL-221 Professor Samy Azer & Professor Hanan Habib College of Medicine, King Saud University Saudi Arabia

Objectives Upon completion of this lecture, students should be able to: Understand the meaning & components of accountability. Understand why accountability is needed in the medical profession. Discuss the meaning of initiative, integrity & trustworthiness. Discuss some practical examples & case scenarios.

Definition of Accountability “…Procedures and processes by which one party justifies and takes responsibility for its activities” It comprises responsibilities to patients. It comprises patient-physician relationship. It comprises responsibilities to colleagues. It comprises responsibilities to the profession. It comprises responsibilities to the society and public.

Key components of accountability 1. Responsibility: that means to become responsible (accountable) to patients, their families, society & community. To become accountable for quality of care, resolving conflict, and upholding principles.

Key components of accountability 2. Self-regulation in activities: This means that physicians’ actions and behavior should reflect legal, good ethical conduct, and no financial conflict in their performance.

Key components of accountability 3. Standard setting for current and future members of the profession: Accountability is about our willingness to maintain these professional standards in our day-to-day practices.

Key components of accountability 4. Ability to resolve conflict: Conflict might be financial, pharmaceutical. There is a need to disclose any conflict that could damage doctor’s accountability.

Key components of accountability 5. Free acceptance of duty to serve public: A doctor is accountable for improving the standards of the health care of their community, their country and worldwide.

Key components of accountability 6. Explain and give reasons for actions that could have caused harm to the patient, colleagues, and community: A doctor is accountable for actions that could cause harm.

Responsible style Promise only what can be delivered Commitment,delivered on time, accountability Support the basic tents of the profession Develops a philosophy and sound rationale for professional practice Thinks before reacting Foresees possible outcomes of professional actions Evaluates his/her professional practice Confronts discrepancies between intentions and actions

Why accountability is important to learn by medical students? Accountability is not needed as a knowledge. Social accountability for medical students is needed as behavior and as a practice.

Social Accountability of Medical Students To enhance the health of people by educating physicians & medical students ; by conducting research in clinical and basic medical sciences. By promoting the skills and attitudes of lifelong learning. Preparation of future doctors to respond to population needs. Canadian Medical Association Journal,1997

Summary about accountability Accountability = Responsibility To be accountable you need to have self regulation in your day to day actions. Accountability requires that we maintain standard setting. Accountability requires that we resolve conflicts. Accountability requires that we accept duties for public. As a medical students we need to demonstrate accountability in our small group discussion, student led seminars, and when we are working with others in teams.

Initiative The action of creating or starting. To make a conscious effort to do things without being told to and to find alternatives if an option is not possible.

Characteristics of an Initiative People with initiative character are starters and self-motivators. Have the ability to begin or to follow energetically with a plan or task. Took the initiative in trying to solve the problem. Have the power to or right to introduce a new legislative measure.

Trustworthiness Deserving of trust or confidence. Synonyms: true, accurate, honest, faithful The corner stone of the practice of medicine The demonstration of compassion, service and altruism that earns the medicine profession the trust of the public.

Trustworthiness Trustworthy people keep their promise, are honest, reliable, principled and never inappropriately betray a confidence. It embodies FOUR ethical principles: a- Integrity c- Promise – Keeping b- Honesty d- Loyalty

Trustworthiness in medicine Physicians are expected to make patients’ needs the first priority. Physicians should consider their contributions to their individual patients, to their own practice, the community and the health care system.

Integrity The most important factor in trust. Integrity carries the sense of wholeness: a person of integrity like a whole number, is a whole person, undivided, complete. integrity is doing the right thing when no one is watching.

Person with integrity Listen to his consciences and live by his principles no matter what others say and no matter the personal cost. Is honorable and upright in all actions. Has the courage to do what is hard or costly or failure is probable. Build and guard his reputations. Don’t do any thing he feels is wrong. Don’t lose heart if he fails.

Honesty Being honest in our conduct means playing by the rules and being trustworthy of another’s property and belongs. Dishonest conduct by ways of cheating can come in many forms, such as trickery, fraud, misleading,deliberately violating the rules, and swindling. Two types: communication honesty & conduct honesty

Communication Honesty a-Being truthful in representing facts and intentions to the best of one’s knowledge. b- Sincerity and candor

Conduct Honesty Cheating 1.Using unauthorized materials to achieve better grade. 2.Falsification or invention of any information. 3.Attempting to help another person in an act of cheating. Plagiarism 1.Submitting an assignment as if it were one’s own work.

Conduct Honesty- Plagirism 1.Submitting a work that is purchased or obtained from internet source. 2.Incorporating a word or ideas of an author into one’s paper without giving the author due credit.

Promise Keeping A vital moral aspect of reliability. Promise is a vow, pledge, a declaration assuring that one will or will not do something. Two areas of promise keeping: a- Good work habit: complete our job /task b-Reliability: being dependable eg. return what you borrow, pay your debts, show up on time, and be prepared.

Loyalty This could be loyalty to an oath, one’s family, and our country. It implies the unfailing fulfillment to one’s duties and obligations and strict adherence to vow or promise.

Physician should : Demonstrate professional competence Be aware of their deficiencies. Obtain help when needed. Be honest and communicate information in complete confidence. In communications with the community, physicians must ensure that representations they make are to the best of their knowledge and truthful.

Practical Example 1 Dr Jamal Ahmad is a known urology surgeon working in one of the Ministry of Health hospitals. One of his patients has a chronic renal failure and is recommended for a kidney transplantation. Dr Jamal agrees to conduct the operation. Over the next four weeks he works on preparing the patient for the operation. Two days before the operation, Dr Jamal’s nurse rang the family and inform them that Dr Jamal is travelling overseas and the operation will be postponed. They will be informed about the time of the operation when Dr Jamal is back in two months. Questions: - What do you think about Dr Jamal attitude? Explain your views. - What would you do differently if you were doctor Jamal?

Practical Example 2 Dr Hamdy is a known surgeon. One of his patients has undergone an abdominal operation. Although the operation was successful several complications occurred postoperatively. Dr Hamdy became unhappy with these outcomes. Instead of helping the patient to recover, he blamed his registrar and the nursing staff for the patient’s problems. He became unable to resolve the conflict with the patient. The patient’s family also was not happy with these outcomes. Questions: What do you think about Dr Hamdy attitude? What would you do if you were in Dr Hamdy situation? Explain why

Practical example 3 Three resident doctors working in the surgical ward have been asked by hospital administration to go to a rural area 300 km from where they live to do surgeries on patients as part of university service. Two of them refused to go and requested to be paid for the service. Question: Which one of the following best describes the two residents ‘attitude’? A- Altruism B- Not interested about work in rural areas C- Lack social accountability.

Practical example 4 Nahid is a graduate of medical school. She has just moved to a non-English speaking country for post- graduate study. It was hard for her to fit in,understand the language and make friends and concentrate in the class. She is taking a basic science exam, which turned to be harder than she thought it would be. The answers has to be marked on a separate computer sheet. Nahid could not answer most of the MCQs. She handed her answer sheet and sits down at her desk await the end on the class.

To her right, Samar is working on her exam sheet and seems to have no trouble in answering. Glancing at Samar answer sheet, Nahid sees that she marked several answers differently. Nahid asked the invigilator to get back her answer sheet, saying that she just remembered she did not correctly put her ID number.

She quickly erased and changed some answers to reflect what she saw on Samar’s paper and hands back it again. Sometime later, the instructor inform Nahid that the invigilator saw her change her answers. She is going to be given an ‘F’ for the test. Nahid thinks her action do not constitute plagiarism or academic dishonesty,and the sanction is too harsh especially after she describes about her situation.

Questions: Is Nahid right in her behaviors ? What do you think about what she has done ? Does Nahid have to accept the instructor’s sanction ? Do you have any idea about better ways for Nahid to handle her problem in the future. If you were in the exam and saw a student behaving similar to Nahid what do you do ?

Quotes If you have made mistakes, even serious ones, there is always another chance for you. What we call failure is not the failing down, but the staying down. Mary Pickford Integrity without knowledge is weak and useless, and knowledge without integrity is dangerous and dreadful. Samule Johnson

Books for reading Feldman MD, Christensen JF (2007). Behavioural medicine. A guide for clinical practice. McGraw Hill Lang, UK. Stern DT (2005). Measuring medical professionalism. Oxford University Press,UK. Spandorfer J,Pohl CA, Rattner SL, Nasca TJ (2010).Professionalism in medicine. A case – based guide for medical students. Cambridge university press, UK.