1. PROFESSIONALISM & SUPERVISION
Carrie Tibbles, MD
Associate Director, GME
Beth Israel Deaconess Medical Center
GME Orientation 2009

2. Why study or teach professionalism ?
Is it inherent?
Can it be learned?
Wasn’t your mother really responsible for this stuff?

3. Boston Doctor abandons patient during spine surgery to cash check
The Boston Globe
August 18th, 2002
“THE DOCTOR IS OUT”
Boston Doctor abandons patient during spine surgery to cash check

4. Professionalism Altruism Accountability Excellence Duty Service
Responsive

5. Professionalism Punctual Cooperative Displays initiative
Provides effective leadership
Maintains timely records

10. Professionalism and clinical excellence
148 Internal medicine residents
Multiple evaluators over a year
High Professionalism scores predicts-
Better in-training exam scores
Higher Mini-CEX scores
Completion of Evaluations
Less likely to be on probation
Reed, D. JAMA 2008;300 (11).1326

11. Are Professional Values important? Surgery residency results
24 Residents tracked over 50 months Subjective and Objective measures
Rowley et al Clin Ortho & Related Research 2000;378:110

12. Professionalism & Performance Measures
Professional /Subjective
Ethical standards & reliability, Punctuality, Patient relations, Interpersonal skills with staff
Performance / Objective
Test scores, surgical skills, organization, teaching
Rowley et al Clin Ortho & Related Research 2000;378:110

13. Rowley et al Clin Ortho & Related Research 2000;378:110
Each resident received a scores in Professionalism (subjective) and Performance (objective) areas
All residents scoring below the mean in Professionalism scored lower (< 0.001) on all performance (objective) measures when compared to those with scores above the mean on the Professionalism measures
Rowley et al Clin Ortho & Related Research 2000;378:110

14. Unprofessional behaviors .. subsequent disciplinary actions
Does unprofessional behavior in residency predict future disciplinary action?
Over 66,000 internal medicine graduates
Measures included Resident Evaluations and ABIM Certification Exams
Papadakis et al 2008; Annals Internal Medicine148:

17. Supervision ….
“residents must be supervised by teaching staff in such a way that the residents assume progressively increasing levels of responsibility according to their level of education, ability and experience.”

18. It’s about the Patient Patient care should always come first
The patient deserves the appropriate level of care
Be willing to ask for help

19. Supervision Know who is supervising you Know who you are supervising
Check in on a regular basis
Know how to call for help
Stat
Page system

20. Some events require attending notification
The attending physician needs to be notified in certain circumstances
Variable across departments
Make sure you know – or ask

21. Problems arise
Not always clear who is responsible to notify the attending
Be explicit – ask the question – WHO ?
Follow through …

23. Not enough supervision or Too much supervision
Be specific –
What could have been different?
How is the supervision affecting your autonomy?
Talk to chief residents
Talk to attendings you know
Talk to the PD or Chief

24. Successful Supervision = win-win situation
Easy accessibility
Not punitive
Allows progressive assumption of increased responsibility / autonomy
Superior patient care

25. Francis W. Peabody The Care of the Patient JAMA 1927
On Professionalism
“To begin with, the fact must be accepted that one cannot expect to be a skilful practitioner of medicine in the 4 or 5 years allotted…. Medicine is not a trade to be learned but a profession to be entered. It is an ever widening field that requires the continued study and prolonged experience in close contact with the sick.”
Francis W. Peabody The Care of the Patient JAMA 1927