Transcript Professionalism - University of Oklahoma

Summer Institute
July 2014
University of Oklahoma
School of Community Medicine
Jennifer K. Clark, MD
We are most fulfilled when the basic outer expressions of ourselves—
Work, Play, and Love—are developed in such a way….
WORK
Self
PLAY
LOVE
…that together they create one cohesive narrative.
(E. Erickson)
Your Why
Self
but what does this have to do with
Professionalism in Medicine??

Shifting context of medical practice
• Artisan/Vocational to Humanistic Professional

The concept of professionalism as an
expression of teachable behaviors rather
than character trait or virtue.
• What then is the expectation of having basic core
values to enter the profession?

Practice and teaching professionalism…
• The lynchpin of the hidden curriculum
4 CORE VALUES

Integrity

Respect

Compassion

Social Justice and
Excellence in Care
2 DOMAINS

Individual
interactions
• With patients/families
• With colleagues

Organizational
behaviors
• Healthcare settings
• Advocacy and
professional
organizations
Lesser et al., JAMA, 2010
“One way of defining
the character of
clinicians is to
examine their
moment-to-moment
actions…These small
actions, cumulatively,
describe the clinician
as a practitioner and
moral agent”
-Ron Epstein, MD
Professionalism:
it’s a relational thing
Professionalism: Behavioral skills developed from core values that are
Self-Community & Regulatory
Self-Organization
Self-Team
Self-Patient
Self-Personhood
demonstrated in the interactions between professionals as well as
between professionals and organizations.
Community
&
Regulatory
Organization
Crucial conversations and confrontations: the
demonstrable acts professionalism:
Team
Patient
Self
Advocacy: the intersect of work, play, and love
Practicing Professionalism
ADAPTIVE CAPACITY

Self-awareness

Interpersonal skills

Intention of healing
-Lesser et al
-Epstein et al
•
•
•
•
•
•
Recognize it’s an everyday thing
Self-reflect….explicitly
Offer your narratives
Practice mindfulness
Expose the hidden curriculum
Demonstrate intolerance to
unprofessionalism
 As
members of organizations, reflect on
your current environments…
• Are you engendering a system where you or
others are forced to be unprofessional?
Steve Hoppes, Ph.D.
“Mindfulness means moment-tomoment nonjudgmental
awareness.”
Jon Kabat-Zinn (2011, p. 231)
“Mindfulness
is the energy that
helps you be fully present with
whatever is there.”
Thich Nhat Hanh (2002, p. 51)
 Effective
in reducing anxiety, depression,
panic symptoms, mood disturbances,
chronic pain, and stress. (Brown & Ryan,
2003; Kabat-Zinn et al., 1992; Minor et al.,
2006; Teasdale, et al., 2000)
 Reductions
were maintained in 3-month &
3-year follow-ups. (Kabat-Zinn et al., 1992;
Miller et al, 1995.)
 Mindfulness
training resulted in improved
immune function, even in patients with HIV.
(Siegel, 2011)
 Mindfulness training resulted in enhanced selfcompassion. (Germer & Neff, 2013).
 Mindfulness has been shown to be effective in
treating conditions such as obsessivecompulsive disorder, borderline personality
disorder, and drug addiction. (Witkiewitz &
Bowen, 2010; Siegel, 2011)

“ … meditation can
produce increases in
relative left-sided
anterior activation that
are associated with
reductions in anxiety
and negative affect and
increases in positive
affect.” (Davidson, et al.,
2003)
http://www.youtube.com/wat
ch?v=gJ1_Bmx7QdY&featur
e=related
 302
Jefferson Medical College students.
 Over 10 weeks, students trained in mindfulness
experienced decreased Total Mood
Disturbances (TMD) (p=0.05), including
 Decreased anxiety (p=0.009), confusion
(p=0.009), and depression (p=0.09), while
increasing vigor (p=0.006).
• Control group: Increased TMD (p<0.0001), anxiety
(p<0.0001), confusion (p=0.02),, and
depression (p = 0.06),
while vigor (p<0.0001) decreased.

In a study of 30 primary care physicians, brief
mindfulness training was associated with
reductions in indicators of job burnout,
depression, anxiety, and stress (Fortney et al.,
2013).
 Presence
• “Our true home is not in the past. Our true home
is not in the future. Our true home is in the here
and now.” Thich Nhat Hanh
 Equanimity
 Open-heartedness
 Connectedness
• “We are here to awaken from our illusion of
separateness.” Thich Nhat Hanh
 "I
help people as a
way to work on
myself, and I work on
myself to help
people."

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



Brown, K.W., & Ryan, R.M. (2003). The benefits of being
present: Mindfulness and its role in psychological wellbeing. Journal of personality and social psychology, 84, 822-848.
Hanh, T.N. (2002). Be free where you are. Berkeley, CA: Parallax
Press.
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M. A.,
Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K.,
& Sheridan, J. F. (2003). Alterations in brain and immune function
produced by mindfulness meditation. Psychosomatic Medicine, 65,
564-570.
Fortney, L., et al. (2013). Abbreviated mindfulness intervention for
job satisfaction, quality of life, and compassion in primary care
clinicians: A pilot study. Annals of Family Medicine, 11, 412-420.
Germer, C. K., & Neff, K. D. (2013). Self‐compassion in clinical
practice. Journal Of Clinical Psychology, 69(8),
Kabat-Zinn, J. (2005). Coming to our senses. NY: Hyperion.



Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G.,
Fletcher, K.E., Pbert, L., Lenderking, W.R., & Santorelli, S.F.
(1992). Effectiveness of a meditation-based stress
reduction program in the treatment of anxiety disorders.
American Journal of Psychiatry, 149, 936–43.
Miller, J.J., Fletcher, K.E., and Kabat-Zinn, J. (1995). Threeyear follow-up and clinical implications of a mindfulness
meditation-based stress reduction intervention in the
treatment of anxiety disorders. General Hospital
Psychiatry, 17,192–200.
Rosenzweig, Reibel, Greeson, Brainard, & Hojat. (2003).
Mindfulness based stress reduction lowers psychological
distress in medical students. Teaching & Learning in
Medicine, 15, 88-92.
Siegel, D. (2011). The proven benefits of mindfulness.
In B. Boyce (Ed.), The Mindfulness Revolution, pp. 136139, Boston: Shambhala.
 Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway,
V., Soulsby, J., & Lau, M. (2000). Prevention of
relapse/recurrence in major depression by
mindfulness based cognitive therapy. Journal of
Consulting and Clinical Psychology, 68, 615-623.
 Witkiewitz, K., & Bowen, S. (2010). Depression,
craving, and substance use following a randomized
trial of mindfulness-based relapse prevention.
Journal of Consulting and Clinical Psychology, 78, 362374.
