PROFESSIONALISM

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PROFESSIONALISM

• John A. Talbott, M.D.
• Professor of Psychiatry
• Project Director - HELPERS-PRO
• Course Director - Practice of Medicine

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PROFESSIONALISM

• Why is this necessary?
• How does it work?

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PROFESSIONALISM Why is it necessary?

• The public
• through their actions, e.g. alternative medicine
• through the press, e.g. Geo Harrisons guitar
• through the courts, e.g. malpractice
• The profession, e.g. ASIM
• This faculty, preclinical years, for Deans
  letter
• Our residents, washouts
• Our medical students, Sara Fabers email

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PROFESSIONALISM How does it work?

• What is Professionalism?
• How is it evaluated?
• --------------------------------------------------
  
• Can we select students well?
• Can we teach Professionalism?
• Where do students learn unprofessional behavior?
• How about Exemplary Behavior?

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What is Professionalism?

• The wife of a very well-known local celebrity is
  seen in gynecology clinic. She is informed of the
  results of a recent mammogram, which confirms the
  diagnosis of breast cancer. 2 hours later, while
  out to lunch at the Penn Street Restaurant, the
  resident physician who worked up the patient
  discusses the patient's case, referring to her
  specifically by name, who her spouse is, and her
  diagnosis.

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What is Professionalism?

• After...I did work at NIH,...I presented a
  poster...ata meeting and then also during
  student research day. One of the judges (a
  professor and clinician in the school) walked up
  to my poster and after reading silently for about
  a minute told me that the abstract was too
  difficult to understand, that the color of the
  text made it hard to read and then proceeded to
  make fun of the gene names. He told me that a
  poster should stand alone without the help of the
  presenter, that mine did not do this, and that
  his judging would reflect this accordingly.
  Disappointed, I said that I would make it clearer
  in the future, but asked if I could explain it
  anyway, even if it would not count for the
  judging. At an increased volume, he told me that
  I could not and that he did not want to hear it.
  He then walked off.

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What is Professionalism?

• Is this Professional behavior?
• How do you know?
• Your upbringing/experience?
• Your training?
• Your gut?
• What then is Professionalism?

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What is Professionalism?

• Humanism
• Ethics
• Life-long Learning
• Physicians subordinating themselves to
  their patients
• Ethical behavior
• Research subjects
• Sensitivity to age, culture,
  disability, diversity and gender
• Professionalism
• Respect for Patients, Families and Colleagues
• Other (Death and Dying, Impairment, Sexual
  and Aggressive Behavior, Physician/Industry
  relationships)

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How is it Evaluated

• I was mentioning to my mother that I thought
  that I had found a possible pediatrician for my
  new baby. It was a faculty member who I had
  shadowed for ICP. He was great! Good rapport
  with patients, knowledgeable, and caring. But
  there was this nagging in the back of my mind
  that something wasn't quite right. A fellow
  student pointed out the problem -- he never
  washed his hands in between patients. He went
  from one Strep patient, to a routine high school
  physical, from one sick baby exam, to a well baby
  exam. Yet neither of us had EVER seen him wash
  his hands. Regardless of his clinical skills,
  the thought of him touching my or any other child
  totally turned me off after thinking about his
  lack of good hygiene.

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How is it Evaluated?

• How do we pick this behavior up?
• Observation, especially for students
• Periodic (end of course or rotation)
• PD
• OSCEs
• How is it reported, for everyone
• Orally
• In writing - Professionalism Website has forms
  http//medschool.umaryland.edu/Professionalism/Eva
  luation.asp

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How is it Evaluated?Sentinel Events, ie Serious

• Referring to oneself as, or holding oneself to
  be, more qualified than one is
• Participating in a conflict of interest
• Theft of drugs
• Violation of the criminal code
• Failure to be available while on call
• Failure to respect patients' rights
• Breach of confidentiality
• Failure to provide transfer of responsibility for
  patient care

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How is it Evaluated?Sentinel Events, Continued

• Failure to meet academic codes of behavior (e.g.
  cheating on an examination)
• Being disrespectful to patients, colleagues and
  other professional staff
• Falsification of medical records or
  misrepresentation of a clinical situation
• Assaulting a patient, colleague or staff member
• Sexual impropriety with a patient or colleague
• Sexual harassment
• Threat or hate crime
• Being under the influence of alcohol or drugs
  while participating in patient care or on call
• Any other conduct unbecoming of a physician

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How is it Evaluated?

• Who is in the best position to observe students
  professional and unprofessional behavior?
• The Dean?
• The faculty?
• The residents?
• The students?
• So, how do we utilize that?

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How is it Evaluated?

• Oral vs Written
• Anonymous vs Identified
• With whom and for what (advice vs action)
• the person(s), eg Sara Fabers email
• his/her superior
• your mentor/advisor/faculty friend
• course director
• Dean of Student Affairs
• Me

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How is it Evaluated? Who is in the best position?

• One aspect of the new Professionalism Project
  that has caused some concern among students is
  the new option on the Medscope evaluation page
  that allows you to evaluate the professionalism
  of your peers.

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How is it Evaluated? Who is in the best position?

• Student-Student Form (for display only to fill
  out go to Medscope)
• Microsoft Word Document
• Adobe Acrobat Format
• This is strictly student-student there is no
  record, no reporting to the faculty or Deans
  staff or me - Stacy Ijams notes level of activity
  only.

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QUESTIONS?