1. Medical Professionalism: Treating Colleagues with Respect J Rush Pierce Jr, MD, MPH Bronwyn Wilson, MD Hospitalists Best Practices February 18, 2011

2. Agenda Why this talk? Defining medical professionalism What does the literature show? How do we teach professionalism? – Scenarios – Discussion 02/18/20112 Best Practices: Treating Colleagues with Respect

3. AAMC exit survey 02/18/20113 Best Practices: Treating Colleagues with Respect Have you been personally mistreated during medical school?

4. AAMC exit survey 02/18/20114 Best Practices: Treating Colleagues with Respect

5. AAMC exit survey 02/18/20115 Best Practices: Treating Colleagues with Respect

6. UNM Clerkship data, 2009 02/18/20116 Best Practices: Treating Colleagues with Respect

7. UNM Clerkship data, 2009 02/18/20117 Best Practices: Treating Colleagues with Respect

8. What else do medical students report? 02/18/20118 Best Practices: Treating Colleagues with Respect

9. Profession Relationship between group of practitioners and society that benefits both Developed in Middle Ages, formalized in 19th century Benefits to professionBenefits to society Monopoly over use of knowledgePractitioners expected to altruistic, honest Autonomy of practice, self regulationAssurance of competency Prestige, status, financial rewardsProfession devoted to public good 02/18/20119 Best Practices: Treating Colleagues with Respect

10. Definition of Medical Professionalism 1.Maintaining competence 2.Honesty with patients 3.Confidentiality 4.Maintaining appropriate relationships with pts 5.Improving quality of care 6.Improving access to care 7.Just distribution of resources 8.Increasing scientific knowledge 9.Managing conflicts of interest 10.Commitment to professional responsibilities 02/18/201110 Best Practices: Treating Colleagues with Respect ABIM, ACP-ASIM, European Federation of Internal Medicine. Medical Professionalism Project (Ann Internal Med 2002;136:243-6)

11. What does sociology say about medical professionalism in past century? Autonomy has decreased and accountability has increased Increased emphasis on (1) just distribution of resources and (2) importance of teamwork Importance of lifestyle has changed expectations for altruistic behavior Increasing emphasis to use educational techniques other than role modeling 02/18/201111 Best Practices: Treating Colleagues with Respect

12. Can professionalism be measured? Survey professionals about their own behavior Survey observers about the behavior of professionals Measure markers of poor professionalism (patient complaints, malpractice suits) Survey observers about professionalism environment 02/18/201112 Best Practices: Treating Colleagues with Respect

13. What does the medical literature say? 1.Physicians say they believe more than they act 2.Professionalism is associated with pt satisfaction, pt compliance, less malpractice, other measures of excellence in practice 3.Professional behavior is influenced by the clinical environment 4.Professional behavior can be taught 5.Role modeling may be the most important way to teach professionalism 02/18/201113 Best Practices: Treating Colleagues with Respect

14. Role Modeling 02/18/201114 Best Practices: Treating Colleagues with Respect

15. Commitment to professional responsibilities “As members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the process of self-regulation, including remediation and discipline of members who have failed to meet professional standards. The profession should also define and organize the educational and standard-setting process for current and future members. Physicians have both individual and collective obligations to participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all aspects of their professional performance.” 02/18/201115 Best Practices: Treating Colleagues with Respect

16. So, Back to the Wards…. The Hidden Curriculum – Taught by residents late at night – Informal rules taught through role modeling, telling stories about how to “survive” on clerkship Ways to offset this phenomenon – Clear expectations from attendings, professional behavior by all team members – Resident training and support – Practice of Reflection in Action 02/18/2011 Best Practices: Treating Colleagues with Respect 16

17. Challenging Situations 1.Case Manager makes a derogatory remark about a patient in front of team 2.Consultant insults a team member, or team leader while you are making rounds 3.You are angry with how something has been handled and “mouth off” about X service. 02/18/2011 Best Practices: Treating Colleagues with Respect 17

18. How do we respond? 1.Do nothing, change the subject, glare at the case manager, correct her in front of others 2.Yell back at consultant, fume to team, dismiss his/her recommendations 3.Push through rounds, grumble more, discuss how medicine is so much better than X anyway 02/18/2011 Best Practices: Treating Colleagues with Respect 18

19. What would be a more constructive approach? Divide into three groups – each group takes one of the scenarios and develops an alternative approach that demonstrates “Reflection in Action” Take 5 minutes and then we’ll reconvene and compare plans. 02/18/2011 Best Practices: Treating Colleagues with Respect 19

20. Tips for “Teachable Moments” on Professionalism Don’t do anything, just stand there. – Take time to think about how you react will affect your colleague, your team, and your patients Find a time as close to the incident to have team debrief what happened – Address feelings, what went well, what didn’t, what are our responsibilities as a team – Give follow up – often students don’t know if anything happens, and assume complacency 02/18/2011 Best Practices: Treating Colleagues with Respect 20

21. Tips for “Teachable Moments” on Professionalism Notice and applaud positive acts of professionalism Use “Parables” – stories of adversity & success – When I was an intern…. Notice attention to detail and hard work of residents & students – this correlates with level of professionalism in other areas Strive to create a kinder more supportive health systems environment 02/18/2011 Best Practices: Treating Colleagues with Respect 21