1. Unprofessional Behavior: What Does Stress Look Like, and How Can Advisors Help? Kendalle Cobb, MD Cleveland Clinic Lerner College of Medicine. Fostering a passion for scientific inquiry, skills for critical thinking and a broad-based clinical expertise INTRODUCTION Hard to predict which applicants and students are more likely to exhibit unprofessional behavior (1, 2, 3, 4, 5, 6) Anyone can demonstrate unprofessional behavior (7) Students do not demonstrate unprofessional behavior consistently in all settings (5) People are more likely to behave unprofessionally when they have an internal conflict (7) Unprofessional behavior in medical school can be a predictor of unprofessional behavior later in student’s career (6, 8, 9) Faculty often resist intervening (10) Early intervention can alter a student’s course (11) Educators should avoid assuming that problematic behavior is unchangeable, due to a character flaw (7), personality disorder (7), or generational difference (12, 13, 14) Students can develop skills to demonstrate professional behavior (15) RESULTS—STRESSFUL TIMES Fourteen of 16 (87.5%) responded PREPARING STUDENTS FOR STRESS Directing Tell students where to study Tell students not to take master’s degree classes Guiding Review expectations Send reminder e-mails a few weeks before a deadline Provide students with information regarding available resources Explore what career choices might be good fit for students’ preferences Cheerleading Remind students that they will be great physician-investigators Remind students that feelings about upcoming event are understandable and normal Problem-solving Help students think of strategies to prepare for and to reduce stress RESPONDING TO STUDENT STRESS Reiterate expectations Request meeting if evidence suggests that student is having difficulty Help student strategize how to handle stress Contact student when something has been left undone Meet more frequently Ask questions to make sure that advisor understands the main problem Discuss situation at Physician Advisor Committee Meeting Meet with student and with Associate Dean of Student Affairs Refer for professional counseling or time management coaching EFFECTIVE ADVISOR STRATEGIES Anticipate stressful times Help students prepare for stress Meet with the dean Formally refer to counseling, time management, or writing assistance with reporting structure Review evidence in timely way for discussion with student Reinforce how well student is doing Caveat: Interventions not effective if students have ingrained work habits or behaviors INEFFECTIVE ADVISOR STRATEGIES Casually refer for counseling and psychiatric care Give directives, such as telling students where to study or not to take courses Wait to see if student will call if they are not doing well REFERENCES See handout METHODS Surveyed all current physician advisors—16 physician advisors Excluded: 5 former advisors, three of whom have moved to other institutions Rationale for exclusion criteria: might not be able to recall specifics of student stress and behavior Survey was distributed via the Cleveland Clinic online survey site Parts of the Curriculum Summer research Research year First clinical rotation Surgical rotation Stages of Training Preparing portfolios Applying for residencies Determining rank lists End of second year External factors Difficulty balancing school with: Family obligations Personal time Graduate studies Personal stressors: Family issues Illness, substance abuse Major life events: Marriage Birth Breakups Winter STUDY AIMS To identify times during which students exhibit more stress To identify unprofessional behaviors observed during such times To learn current practices of advisors in preparing students for stressful times and in response to stressful times To learn advisors’ perceptions of effective strategies in helping students through stressful times