1	Teaching & Assessing professionalism Andrew G. Lee, MD Professor of Ophthalmology, Neurology, & Neurosurgery The H. Stanley Thompson Neuro-ophthalmology Clinic Associate Program Director Department of Ophthalmology Graduate Medical Education (GME) Director of New Educational Initiatives The University of Iowa Hospitals & Clinics
2	Objectives Define Professionalism List reasons to change Show examples of teaching & assessing professionalism Call you to action & move you out of your comfort zone
3	Professionalism Doing the right thing In the right way At the right time For the right person For the right reason(s)
4	Professionalism defined ACGME professionalism manifested via commitment To carrying out professional responsibilities Adherence to ethical principles Sensitivity to a diverse patient population Multidimensional construct Interpersonal (e.g., altruism, respect, integrity) Public (e.g., accountability, self-regulation, justice) Intrapersonal (e.g., lifelong learning, maturity, morality, humility)
5	ACGME: Residents expected to demonstrate… Respect, compassion, & integrity Respond to needs of patients/society over self-interest Accountable to patients, society, & profession Commit to ethical principles Provision or withholding of clinical care Confidentiality of patient information Informed consent Business practices (conflicts of interest) Sensitive/responsive to culture, age, gender, disability
6	Professionalism can be defined Old school: “I know it when I see it” (Justice Stewart) New school Professional behaviors codified Unprofessional behaviors defined Other specialties (ABIM) & medical schools have already done work! (i.e., we don’t need to reinvent the wheel)
7	Seven “deadly sins” of professionalism (ABIM) 1) Abuse of power 2) Arrogance 3) Greed 4) Conflict of interest 4) Misrepresentation 5) Impairment (drugs, alcohol) 6) Lack of conscientiousness Lust Anger (wrath) Greed Pride Envy Gluttony Sloth
8	We know what’s not professional (critical event) Intellectual/personal dishonesty (falsifying records) Arrogance & disrespectfulness Prejudice (gender, ethnicity, age) Abrasive interactions with patients or coworkers Lack of accountability (medical errors) Fiscal irresponsibility (conflicts of interest) Lack of sustained commitment to self-learning Lack of due diligence (carelessness, laziness) Personal excesses (substance use) Sexual misconduct
9	Professionalism can be taught & assessed Proto-professional period (residents) Formative period Role models influence behavior Hidden curriculum (learn what not to do!) Professional & ethical behaviors Modifiable Improvable Measurable
10	The hidden curriculum Do as we say (formal) & as we do (informal or hidden curriculum)! Professionalism & ethics are not acquired in didactics How do faculty treat patients? Treat residents? Treat each other? (role modeling) Treat staff?
11	Are we asking the right people to evaluate professionalism?—360 degree Individuals who identified the problem Chief residents (peers) 84% Attendings (via oral comments) 76% Program director 74% Other residents 49% Attendings (via written comments) 41% Nursing staff 31%
12	Processes that identified problem (potential tools) Direct observation (clinical setting) 82% Critical incident 59% Morning report performance 45% Neglecting patient care duties 33% Chart review/record audit 26% In-training exam 23% Mini-clinical exercise (CEX) 8%
13	Interventions that worked in remediation of problem resident More frequent feedback sessions 65% Assigned mentor 53% Probation 35% Psych counseling 32% Remedial didactics 28% Leave of absence 9% Formal learning assessments 7% Substance abuse program 7%
14	Assessment of Specific professional behaviors Global evaluation form Patient satisfaction surveys Learner surveys of educational environment Direct observation (real or simulated or standardized, videotaped or live) Structured professionalism checklist Critical incident techniques or sentinel event markers Portfolio (e.g., self assessment project, patient or staff citations) Resident as teacher programs Longitudinal tracking of residents for critical events
15	You don’t have to reinvent the wheel! http://www.medicalteacher.org/Lynch%20Table1a.pdf Resources available for you now Assessment Reliability & validity Description of tool
16	360 degree evaluation Faculty (beware Hawthorne effect) Peer review Patient satisfaction Nurses, staff, medical students Informed consent observation Residents as teachers
17	360 degree evaluation
18	Summary “You cant make someone “ethical” but you can teach & assess ethical & professional behavior Professionalism can be defined (ACGME) “We need to do this” “We should want to do this” “We can make time to do it right” (or you will have to make time to do it over) Align the “hidden” with formal curriculum
19	Thank you for your time and attention