Professionalism Week 2006
A Case for Education
January 27, 2006
Late one afternoon in the teaching hospital...
What happened?
Problem List
• Late day • Multidisciplinary Disorders• Demanding client • Whiny Attitudes• Tension and irritability• Blame
Problem #1: Late Case/Day“Differential diagnosis”
• Client got here late• Referring vet waited too long• The emergency service is slow• Medicine is always in rounds• Got stuck in “bottlenecks”• Hospital inefficiencies
Late Case/Day
• Busy day in a busy hospital• Sick animals can’t tell time
Problem #2: Multidisciplinary Case
• Let me know when you have a diagnosis
• Let me know if it needs to go to surgery• Not my table syndrome• They always go to medicine
Multidisciplinary Case
• Challenging case that requires teamwork and a “quarterback”
Problem #3: Demanding Client
• Just one of those *#&% types• Pathologically attached• Mentally ill• Other bias about individual• Entitled high maintenance client
Problem #3: Demanding Client
• Concerned and stressed pet owner
Problem #4: Whiny Attitudes • One of those days• Research grant/paper/presentation due• Problems at home?• She’s always like that• It’s those darn whiny students these
days
Whiny Attitudes
• Justified to make a point?• Emotions and reactions are high
Problem #5: Blame
• It must be someone’s fault..• “They never” syndrome• It’s harmless ribbing, get used to it• The RDVM should have known better
Problem #5: Blame
• Everyone is doing the best they can
Diagnostic Plan
• Reflect on problem list and look for common themes
• Reflect on situation• Determine action plan and prognosis
Ways of Thinking
Wow. That sounds like “cognitive restructuring”!
Dr. Strand
Cognitive Restructuring
• Three Rational Questions–Is my thinking based on fact?–Does my thinking help me achieve my
goals?–Does my thinking help me feel the
way I want to feel?
Pucci, 1999
Solution-Focused Problem Solving
• Identify a time in the recent past when this was not a problem?
• What was happening that worked well? • What would we see if we were watching
things go well on videotape?
Kim-berg, 2002
• So what does this have to do with professionalism?
Professionalism
• From “profess”: to make a vow, admission, claim, allegiance
• “The conduct, aims or qualities that mark a profession or professional person”
Professionalism
• A vocation or occupation requiring long period of intense study
• Performing specialized work for pay• “the following of a profession for gain or
livelihood”
Is it just a job?
Professionals Healers
Autonomy
Self-Regulation
Responsibility to Society
Teamwork
Competence
Commitment
Confidentiality
Altruism
Integrity
Ethics
Responsibility to Profession
Caring/Compassion
Insight
Openness
Respect for Healing
Respect for Patient
Presence
Steinart et al, McGill University
Professionals and Educators
• Recognize special responsibility • Encourage free spirit of learning• Foster honest academic conduct• Demonstrate respect for students• Recognize obligations in community of
scholars • Serve as responsible member of academic
institution• Maintain rights/obligations as citizen of
larger communityAmerican Association of University Professors, 1966/1987
Professionals and Educators• Diversity and Tolerance• Civility• Free Exchange of Ideas• Fairness• Integrity• Intellectual Standards of
Excellence• Autonomy
AAUP, American Council on Education; 2005
UTCVM Professional Behaviors
• Commitment to EXCELLENCE• High MORAL and ETHICAL Standards• Act with COMPASSION• PRIDE, DIGNITY, ALTRUISM• Treat others with RESPECT• Act with HONESTY and INTEGRITY• Be TRUSTWORTHY and PREPARED• Exhibit COLLEGIALITY• Act with CONFIDENTIALITY
Does it matter?
Does it matter?
Does professionalism matter?
• What’s your emotional bank account at the end of the day? Week? Year?– Surplus?– Deficit?
What’s the Evidence?
• Student behavior predictive of future disciplinary actions for physicians
• Particularly with 3 domains–Poor responsibility/reliability–Lack of self-improvement/adaptability–Poor initiative/motivation
Academic Medicine, 2004New England Journal of Medicine, 2005
What’s the Evidence?• Compared 5 yrs of student report data with
physician citations in state
• Most were breaches of integrity/ professionalism (75% of students, 79% of physician citations)
– Failure to meet requirements, attendance
– Abuses of privilege
– Substance abuse
• 16% for arrogance, abusive behavior, poor group interaction
Ainsworth et al, AAMC, 2005
What about the rest of us?
• Students observed and reported Operating Room behaviors
• Residents and anesthesiologists – good > bad
• Attendings and surgeons – bad > good
Curry, et al, AAMC, 2005
What about the rest of us?
• Most “bad” interactions in communication and respect
• More “bad” interactions with colleagues, co-workers than students or patients
Curry, et al, AAMC, 2005
What’s the Evidence?
• N= 281 veterinary students and 142 recent grads–Students who felt comfortable
discussing emotional veterinary issues with their professors also felt more confident and competent discussing and handling these issues with their clients
Tinga et al, 2001. JAVMA
What’s the Evidence?
• Malpractice–Virtually all malpractice claims are
associated with breakdown in communication within the veterinary team and between the team and the client.
Newman, Esq., 2004, NAVC Proceedings; Richardson, F. 2005
What’s the Evidence?
• Malpractice– Once a medical mistake has been made
these are the most common complaints against veterinarians:• Delay in informing the client
• Attempts to understate the problem
• Treatments to fix the problem without the client’s approval or knowledge
• Altered records
Can Professionalism be Taught?
Educating Professionals
• Late day • Multidisciplinary Disorders• Demanding client • Whining• Tension and irritability• Blame
Remember the Problem List
Educating Professionals
• Late day
• Multidisciplinary Disorders
• Demanding client
• Stress management Time mgmt Setting limits
• Conflict Resolution Teamwork
• Communication skills Cultural/diversity training
Educating Professionals
• Whiny Attitudes
• Tension and irritability
• Blame
• Self-awareness Professionalism
• Stress/coping skills Communication skills Cognitive restructuring
• Feedback skills, Conflict resolution
Naivete
Idealism
Years of Training
Student Mature Professional
Hilton, Clin Teach, 2004
Naivete
Idealism Cynicism
Wisdom
Years of Training
Student Mature Professional
Hilton, Clin Teach, 2004
Naivete
Idealism Cynicism
Wisdom
Years of Training
Student Mature Professional
Positive Experiences
Negative Experiences
Hilton, Clin Teach, 2004
Expectations for professionalism week
• Wide participation in dialogue• Time for reflection and personalization
of professionalism• Renewed “vows” toward
professionalism• New ideas and goals
Another day in the veterinary teaching hospital…
What happened this time?
Professionalism
• “A professional is one who can do his job well even when he doesn’t feel like it”
Acknowledgments
• Veterinary Social Work• Educational Enhancement Committee• Office of the Dean• UT Employee and Organizational
Development• Instructional Resources
Professionalism Week
• Departmental and Unit Workshops–Wednesday February 1, 8 – 10 am
• Building Trust within an Organization–Dr. Linda Francisco–Thursday, February 2, 3 pm–Followed by reception/social hour