1. University of DundeeSchool of Medicine Feedback Improvement Tool A system to support regulation and quality improvement in health and social care Dr Douglas Murphy Clinical Academic University of Dundee d.y.murphy@dundee.ac.uk

2. Outline Personal take on ‘professionalism’ Share a concept designed for generic work-role applicability Current applications Worked examples Future plans

3. Professionalism

4. Improving Professional Regulation in Health and Social Care Professionalism and inter-disciplinary insights: Common Challenges Different Contexts Individuals Teams Quality Improvement and Continuous Professional Development Re-licensing and Revalidation Identifying Concerns Remediation

5. Bringing It All Together

6. Hub - Cycle of Insightful Practice Murphy D, Guthrie B, Sullivan F, Mercer S, Russell A, Bruce D. Insightful Practice: a reliable measure for medical revalidation. BMJ Qual Saf 2012;21:649-656.

7. Professionalism

8. Staying Professional – The Career Roundabout P u b l i c T h e P r o t e c t i n g

9. Research to Date General Practice Medical Students Health and Social Care Teams

10. Application of System to Date It has supported GP revalidation in Tayside Remediation in medical students at the University of Dundee with identified lapses in professionalism. Supporting the development of professionalism in all medical students. Testing application with teams (planned)

11. A worked Example Remediation with Medical Students

12. Lapses in Professionalism (LiP) Lateness Signing on behalf of someone else Drink driving

13. Take two students……..

14. Student 1

15. Student 1 (Drink Driving) Feedback Improvement Tool Step 1 Time to Reflect on Your LiP The purpose of this form is to capture your opinion of this exercise in helping engage, show insight and act on the data provided. Please rate your level of agreement using the rating scale 1-7 along with free text comments against each question: Question 1 Strongly Disagree 2 3 Disagree 4 5 Agree 6 7 Strongly Agree a. This LiP highlighted important issues ● Example Drink driving is a criminal offence. I have placed my professional career and the safety of others at risk. I understand drink driving is a recognised flag for alcohol problems. I was minimally over the limit after a 21 st the night before. b. This LiP highlighted concern in my performance ● Example I fully understand that this is a professional concern given the above. I take full accountability and responsibly for my behaviour. c. This LiP highlighted planned change ● Example I have discussed with: My personal tutor My undergraduate dean My General Practitioner. I will continue to liaise with the University and other authorities as needed. While I have no other record of problem drinking I will alter my lifestyle appropriately and report any future health difficulty. d. This LiP was valuable ● Example This LiP was valuable. I am extremely embarrassed by this significant life event. I recognise its importance and this opportunity to change my behaviour at this early point in my professional career.

16. Student 1 (Drink Driving) Step 2 Now set your objectives for improvement Set your SMART objectives based on your suite of feedback. We suggest that each objective is best completed as: S pecific, M easurable, A chievable, R elevant to your work and to a T imeline. Match your objectives to the GMC Tomorrow’s Doctors Outcomes Key: 1. The doctor as a scholar and a scientist 2. The doctor as a practitioner. 3. The doctor as a professional. 1. I will engage with any required monitoring processes. I will meet my tutor to discuss progress 2014/15. GMC Outcome 2. I will ensure that I never place myself or others at any future risk by avoiding drinking and driving. GMC Outcome 3. GMC Outcome 4. GMC Outcome 5. GMC Outcome 3 3

17. Student 1 (Drink Driving) Step 3 Reflect on your Insightful Practice Insightful Practice is defined as your engagement with, insight into and appropriate action for quality improvement following reflection on credible and independent feedback. To ensure that you have made best use of feedback, in order to continue to improve, you should ask the following questions and rate their response: Please rate your level of agreement using the rating scale 1-7 along with free text comments against each question: Question 1 Strongly Disagree 2 3 Disagree 4 5 Agree 6 7 Strongly Agree a. Have you engaged with all of the feedback ● Example: I have discussed this with the University and I believe I have shown personal accountability and taken responsibility for my behaviour. b. Have you shown insight into the messages contained within the feedback ● Description: I believe I have shown insight. I recognise that it is only through the passage of time that I can give confidence to having achieved a change in my behaviour. c. Have you taken appropriate action and set any necessary objectives for improvement ● Description: I believe that I have taken appropriate action and I am reassured by the University's support with this.

18. Student 2

19. Student 2 (Drink Driving) Feedback Improvement Tool Step 1 Time to Reflect on Your LiP The purpose of this form is to capture your opinion of this exercise in helping engage, show insight and act on the data provided. Please rate your level of agreement using the rating scale 1-7 along with free text comments against each question: Question 1 Strongly Disagree 2 3 Disagree 4 5 Agree 6 7 Strongly Agree a. This LiP highlighted important issues ● Example This is a storm in a teacup. I was at a 21 st the previous night, I was not drunk, I just got caught out after a minor bump. b. This LiP highlighted concern in my performance ● Example I have an exemplary record as a student and there is no concern in my performance. c. This LiP highlighted planned change ● Example None required. d. This LiP was valuable ● Example This LiP was unnecessary.

20. Student 2 (Drink Driving) Step 2 Now set your objectives for improvement Set your SMART objectives based on your suite of feedback. We suggest that each objective is best completed as: S pecific, M easurable, A chievable, R elevant to your work and to a T imeline. Match your objectives to the GMC Tomorrow’s Doctors Outcomes Key: 1. The doctor as a scholar and a scientist 2. The doctor as a practitioner. 3. The doctor as a professional. 1. N/A GMC Outcome 2. GMC Outcome 3. GMC Outcome 4. GMC Outcome 5. GMC Outcome

21. Student 2 (Drink Driving) Step 3 Reflect on your Insightful Practice Insightful Practice is defined as your engagement with, insight into and appropriate action for quality improvement following reflection on credible and independent feedback. To ensure that you have made best use of feedback, in order to continue to improve, you should ask the following questions and rate their response: Please rate your level of agreement using the rating scale 1-7 along with free text comments against each question: Question 1 Strongly Disagree 2 3 Disagree 4 5 Agree 6 7 Strongly Agree a. Have you engaged with all of the feedback ● Example: b. Have you shown insight into the messages contained within the feedback ● Description: c. Have you taken appropriate action and set any necessary objectives for improvement ● Description:

22. Step 4 Professional Regulation: Independent Review 1 Strongly Disagree 2 3 Disagree 4 5 Agree 6 7 Strongly Agree a. Has the student engaged b. Has the student shown insight c. Has the student taken appropriate action

23. Step 5 What level of confidence do you have in the professionalism of this practitioner without further measures and/or monitoring?

24. Can this system be adapted to fit your context? Improving Professional Regulation in Health and Social Care

25. Thank-you Future Partnerships? d.y.murphy@dundee.ac.uk d.y.murphy@dundee.ac.uk References available on request