Role Modeling & Professionalism Instructor Name

Goal Residents will learn the impact their behavior and conduct have on others as an instructor and throughout their careers.

Objectives At the end of the session, the learner will be able to: Define professionalism & its importance  Describe characteristics of a good & bad role modeling  Explain how to measure professionalism through evaluation

Reflection Have you personally observed or benefited from working with physicians who consistently demonstrated the best qualities of patient care, clinical judgment and professionalism?

ACGME Competencies Patient Care Medical Knowledge Interpersonal and Communication Skills Practice Based Learning & Improvement Systems Based Practice Professionalism

Defining Professionalism: ACGME Professionalism is commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Professionalism How to you demonstrate it? How do you measure it? Does it really matter? How do you teach it?

Measuring Professionalism w/ E-Value Demonstrates respect, compassion, integrity Responsive and accountable to needs of patients, society and the profession Committed to excellence Ethical in clinical care, patient confidentiality, informed consent, and business practices Sensitive to culture, age, gender, disabilities

Does it Matter? Medical School Behavior Disciplinary action by state medical board was strongly associated with unprofessional behavior in medical school. Strongest Associations Those described as irresponsible Those w/ diminished ability to improve their behavior Papadakis, et al, NEJM 353:

Does it Matter? What about Residency? Does performance during residency predict likelihood of future disciplinary actions against practicing physicians? Papadakis et al, Ann Intern Med 2008;148:869-76

Study Design  Retrospective cohort IM residents  Trained from 1990 to 2000  425 AGCME accredited programs  66, 171 residents  Compared ABIM certification evaluation by program directors (global form), 1-9 scale to future disciplinary action by state board  Unprofessional behavior (83%)  Incompetence (1%)

Disciplinary Actions by State Boards: Unprofessional Behavior Failure to meet CME 21% Fraud/billing (medicare/aid)*9% Controlled substance Rx violations8% Substance abuse (self)*6% Sexual misconduct*5% Professional conduct (pt safety)4.5% Negligence4% Convicted of a crime*4% Records (maintain, misrepresent)3% Fail to conform to minimal practice2% *most associated with loss of license

Results  Only 1% of diplomates were during the 17 year study interval  Median years to first action 11 yrs (3 – 16)  Number of disciplinary actions 4.1 (1 – 48)

Papadakis et al, Ann Intern Med 2008;148:869-76

Implications  Most physicians don’t get into trouble  Most residents with “issues” hopefully resolve them  Or not egregious enough?  Patient safety issues

What Makes a Role Model?

Positive Role Models Clinical Attributes Knowledgeable Skilled (technical and clinical reasoning) Personal Attributes Humble Approachable/Receptive Calm Attentive to patients and to students Caring/compassionate/empathetic Passionate about work

Strategies to Improve Role Modeling Cruess, S. R, Cruess, R. L, Steinert, Y. (2008). Role modelling--making the most of a powerful teaching strategy. BMJ 336:

Strategies Be aware of being a role model Demonstrate clinical competence Protect time for teaching Show a positive attitude for what you do Implement a student centered approach to teaching

Strategies con’t Facilitate reflection on clinical experiences and what has been modeled Encourage dialogue with colleagues Engage in pertinent staff development Work to improve the institutional culture Whenever possible be explicit about what you are modeling

What do your students think? UAB Medical Student Clerkship Evaluations

Intern Evaluation  Dr. Intern was an outstanding mentor in facilitating my medical education. I could not have asked for a more professional, devoted individual who always seemed to place the interests of the patients and his team members above those of his own.

Intern Evaluation  He is an excellent role model and is extremely helpful and approachable. He is always available for questions about any patient on the team. He takes time to teach. He made my experience on medicine very enjoyable.

Intern Evaluation  She is an excellent intern. She is very knowledgeable, approachable, and dedicated to teaching students. She takes the time to go over assessment and plans with students, and she allows students the opportunity to write admission and daily orders. One of the best interns I have seen.

Resident Evaluation  I loved working with Dr. X. She was very constructive with us and really helped me improve my differentials, my notes, and my thought process in working up patients. She interacts well with patients and shows genuine concern for them. She is an excellent role model.

Intern Evaluation Dr. X was always available for questions and concerns. He was a great individual to work with. He presented an image of what a medical student should strive towards.

Resident Evaluation  Dr. X. does an excellent job integrating all members of the team, including medical students, into roles that allow them to contribute to the whole. He is extremely patient with students when they express difficulty with a concept.

Things to Remember  The first steps to becoming a positive role model is recognize your behavioral habits.  A moment of lost composure that translates into snapping at a nurse or belittling a patient, reflects on you and, ultimately, may influence the practices and habits of your trainees.  Realize your habits can be habit-forming for others.

Conclusions  Professionalism is a require ACGME competency  Don’t underestimate your influence  Positive role model  Life long efforts to maintain our professionalism  Thank you for all you do

They may forget what you said, but they will never forget how you made them feel. -Carol Buchner

Questions???