Transcript Professionalism

Professionalism
Professionalism
Fiduciary duty
of, relating to, or involving a confidence or trust
(Merriam-Webster)
A contract with society
Law, Medicine, Clergy
Spheres of Professional Responsibility
Society
Patient
Co-workers
Self
Medical Professionalism in the New
Millennium: A Physicians' Charter1
Social
Justice
Primacy of
Patients'
Welfare
Patients'
Autonomy
The Medical Professionalism Project · The 2005 RSNA Professionalism Committee
Commitment to . . .
Professional Competence
Honesty with Patients
Patients' Confidentiality
Maintaining Appropriate Relationships with Patients
Improving Quality of Care
Improving Access to Care
Just Distribution of Finite Resources
Scientific Knowledge
Maintaining Trust by Managing Conflicts of Interest
Professional Responsibilities
Traditional Topics
Conflicts of Interest
Confidentiality
Errors
Impaired Physicians
Incompetent Physicians
Boundary Issues
Professionalism: Swick 2000 Academic
Medicine
Physicians subordinate their own interests to
the interests of others
Physicians adhere to high ethical and moral
standards
Physicians respond to societal needs
Physicians evince core humanistic values
including honesty, integrity, caring,
compassion, altrusim, empathy, respect,
trustworthiness
Physicians exercise accountability for themselves
and for their colleagues
Physicians demonstrate a continuing
commitment to excellence
Physicians exhibit a commitment to scholarship
and to advancing their field
Physicians deal with high levels of complexity
and uncertainty
Physicians reflect on their actions and decisions
Emerging Topics 2010
Social Networking and Media
Diversity among Patients and Workplace
New attitudes toward communication with
patients
Need for trainee codes of professionalism
Evolving Power-Distance
Case 1
Social Networking
John Brown, a 2nd year resident in Radiology has a
Facebook persona with 143 “friends”; posted on
his wall are photos from his days as a college
football star.
Issues are that he frequently complains about the
residency program , faculty members, workload,
and actively solicits comments from female
“friends”, some of whom are fellow residents,
technologists in the dept, and patients.
Do you believe this is appropriate behavior? Why?
Case 2
Communicating results
You have just completed an imaging
examination on a 5 year old child and the
family members are waiting to discuss the
preliminary results of the cranial study. The
patient, who presented with a tremor has a
large posterior fossa tumor. Her pediatrician is
away at a meeting.
What will you discuss with the family? Why?
Case 2B
The training directors have decided to have the
9 PGY 2 and 3 residents in the program learn
to provide preliminary study results to
patients.
Rate numerically from worst (1) to best (7) the
following ways that they could learn to do
this:
Case 2 B Possibilities Rank 1-7
Worst-Best
1. Observe a faculty
member giving study
results to a patient.
2. Present a lecture on
methods of
communicating results
to patients. Then test
the learners.
3. Hold the lecture
followed by a resident
‘Teach-Back’
4. Have residents view a
video on giving results
5. Groups critique a video of
a physician giving results
to a patient.
6. Write a 5 sentence short
essay on giving results.
7. Assemble the residents
into a group to practice
giving results to
standardized patients.
What is your picture of a
classroom?
Case 3
Concept of “Power-distance”
Joe Green (PGY5) and Mary Brown (PGY3) are on
service together and asked by the pulmonary
fellows to plan and present a conference for
pulmonary’s 6 attendings and 3 fellows. They are
excited and ask the radiology attending to help
provide some cases, and for suggestions. The
attending, an Associate professor, has a fit that
he was not asked, although he would have given
the duty to them, anyway.
What is the problem here? How could it be
managed better? Have you experienced Powerdistance issues?
Case 4
Residents are derogatory about Dr. Smith, a
semiretired physician who has outdated
knowledge of technology. However, he has
sharp skills in film interpretation, in which he
capably and enthusiastically instructs
residents.
The problem residents have is that he does not
recommend or utilize cross sectional imaging
when indicated. As a resident, what should
you say or do when you believe his
recommendations are in error?
What and why?
Case 5
A 6 yo boy at play, accidentally sustained a head injury
in which he reportedly lost consciousness for about
1 minute. In the ER he is alert and responsive and
has a normal neurologic exam. Mother and the ER
physician feel he should be discharged home and
monitored by the mother. Dad, an Internist and
divorced from the mother, believes the child should
have a cranial CT scan to ensure there is no
underlying injury.
How should you manage the situation? Why?
Case 6
Joe Green, is a PGY 5 resident with 3 great job
offers. He encounters fellow resident, Sam,
who says: “Don’t forget our board review
session today from 3 until 6!” Joe replies;
“Naw, I hate spending time on all that trivia, I
prefer to learn by listening to the consults,
instead.”
What do you know about Joe and Sam?
Who will do better on the Boards? In life?
Why?
Expert,
Proficient
Master
Competent
Advanced beginner
Novice
Competence:
What individuals know or are able to
do
knowledge, skills, attitudes.
HL Dreyfus
1986
Wisdom
Insight
Knowledge
Meaning
Information
Data
Patrick Lambe
Training
Competence,
certification
Performance
Practice, sustainable abilities
Mastery
Learning
Knowing
Understanding
Comprehension