Professionalism A Core Competency

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Professionalism - A Core Competency

• Sanjay Akangire, MD, Zeeshan Tarique, MD,
• Baoping Qian, MD, Mubariz Naqvi, MD
• Texas Tech University Health Sciences Center,
  Amarillo Texas

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Core Competencies

• Medical Knowledge
• Patient Care
• Communication
• Practice Based Learning
• System Based Practice
• Professionalism

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Introduction

• Professionalism is the most important part of the
  clinical competencies.
• Lack of professional behavior is the single most
  common cause for disciplinary action against
  students, residents, fellows and practicing
  physicians.

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Introduction

• ACGME and ABP mandates that professionalism must
  be fostered and evaluated as a competency for
  medical students, residents and practicing
  physicians.

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Profession Definition

• An occupation whose core element is work based
  upon the mastery of a complex body of knowledge
  and skills.
• It is a vocation in which knowledge of some
  department of science or learning the practice of
  an art is used in the service of others.
• Its members are governed by code of ethics and
  profess a commitment to competence, integrity,
  morality, altruism and the promotion of the
  public good within their domain.

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Professionalism Guidelines of ABP

• Professional behavior is an integral and vital
  attribute of a competent pediatrician
• Professionalism can be taught and should be
  evaluated
• Patients interest should be above the
  physicians self interest
• Professionalism extends beyond interaction with
  patients and their families

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Professionalism Guidelines of ABP

• Professionalism also includes the relationship
  between the physicians and other health
  professionals, interaction between specialists
  and between professional organizations
• Implication for research activities and
  interaction with pharmaceutical companies
• Professionalism should pervade all our activities
  in medicine.

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Components of Professionalism ABP/PPD-1999

• Honesty and integrity
• Reliability/Responsibility
• Respect for others
• Compassion/Empathy
• Self improvement
• Self awareness/Knowledge of limits
• Communication/Collaboration
• Altruism/Advocacy

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Professionalism And Residency Education

• Professionalism should be enmeshed with residency
  education and training
• Commitment to professionalism should be an
  integral part of the professional life of all
  physicians
• Program directors are in a key position to
  inculcate appropriate aspects of professionalism
  in residents under training

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Professionalism And Residency Education

• Program directors and the mentors have the
  opportunity to guide the trainees in achieving a
  balance between professional and personal life
• The trainees should be guided to foster
  appropriate boundaries between physicians, other
  healthcare workers, students and the people they
  serve.

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Evaluation of Professionalism in Trainees

• Professionalism is one of the important
  components of competency that the ACGME mandates
  to be evaluated

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Evaluation of Professionalism in Trainees

• ABP requires that the program directors evaluate
  the professionalism competency of the trainees.
• The Verification of Clinical Competency form is
  required for board certification in pediatrics.
• A specific form has been developed by the ABP.

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Desirable Professional Attributes

• Humility
• Honesty
• Reliability
• Accountability
• Appropriate balance between commitment at work
  and at home

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Desirable Professional Attributes

• Appreciation of own physical, emotional and
  spiritual health
• One must care properly for family and self
• Physician Heal Thyself is essential so that one
  can take care of others to their best capacity

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Teaching Professionalism

• Most of the attributes are learned from parents
  and teachers during elementary school
• To transform the basic personality becomes
  difficult
• Behavior modification can lead to appropriate
  expectations
• ABIM and ABP developed charters of
  professionalism for their members

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Teaching Professionalism ACGME Mandate

• To foster professionalism in trainees we must
  cultivate
• Respect
• Compassion
• Integrity
• Responsiveness to patients needs and society
  should supersede self interest
• Accountability to patient, society and profession
• Commitment to excellence and ongoing professional
  development
• Commitment to ethical principles

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Teaching Professionalism ACGME Mandate

• Confidentiality of patient information
• Informed consent
• Business practices
• Sensitivity and responsiveness to each patients
  culture, religion, age, gender and disability

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Teaching Professionalism

• These charters should become the major focus of
  educational programs
• Professional behavior could be taught through
  formal lectures, small group discussions, and
  directed meetings
• Students and trainees emulate the attributes of
  role model physicians

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Teaching Professionalism

• For physicians and trainees who stray beyond
  acceptable bounds, one on one counseling and
  formal disciplinary action becomes necessary
• The most effective method of teaching
  professionalism is modeling of the appropriate
  behavior by faculty
• The trainees learn what they see.

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Teaching Approaches to Promote Professionalism

• Enhance an understanding of patient and learners
  needs
• Promote respect for each other
• Model a commitment to excellence in practice
• Provide abundant opportunities to engage, discuss
  and demonstrate professionalism

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Top Ten Examples of Unprofessional Behavior

• Intellectual or personal dishonesty
• Arrogance and disrespectfulness
• Prejudice
• Abrasive interactions
• Lack of accountability

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Top Ten Examples of Unprofessional Behavior

• Fiscal irresponsibility
• Lack of sustained commitment to self learning
• Lack of due diligence
• Personal excesses
• Sexual misconduct

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Please Care Standards and Behaviors Mayo
Clinic Approach

• PLEASE
• Present Acknowledge the person, smile, make eye
  contact
• Listen Give each person undivided attention
• Empathize Express compassion, calm voice,
  personal connection
• Action Find the answer, follow through, offer
  assistance
• Summarize Restate key information, follow up
  questions
• Excite Exceed each persons expectations, Go the
  extra mile

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Please Care Standards and Behaviors Mayo
Clinic Approach

• CARE
• Confidentiality Protect patients and colleagues
  confidentiality
• Attitude Make a positive impression and
  demonstrate caring
• Respect Adapt to diverse cultures, languages,
  disabilities and value others time
• Emotional Intelligence Be sensitive, understand
  another's emotional state of mind

PLEASE CARE Mayo Clinics Core Value,
Institutional Culture and professional Covenant,
Nov 2007
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Summary

• In the present day climate of competition, the
  medical profession has been challenged by
  confrontational and self promotional approach
• The medical profession is in-undated by
  advertisement for discount surgery and wonder
  cure
• Promotions touting the greatness of one hospital
  or physician group over another
• Medicine should be a higher calling that imposes
  a moral obligation to put the interest and
  wellbeing of other above own

Patrick Duff MD, American College of Obstetrics
and Gynecologists, Dec 2004
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Summary

• Old fashioned values based on the Hippocrates
  oath do still matter
• The requirements of professional behavior in
  medicine are simple, we must be knowledgeable,
  diligent and responsible
• Professionalism is an attribute that can be both
  taught and fostered
• We must strive for excellence but recognize that
  absolute perfection is not possible

Patrick Duff MD, American College of Obstetrics
and Gynecologists, Dec 2004
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Summary

• We must embrace humility and seek balance in our
  lives
• We must treat others with respect and compassion
• We should maintain grace and dignity under fire
  and ultimately be decent people who
  conscientiously always Try To Do The Right Thing

Patrick Duff MD, American College of Obstetrics
and Gynecologists, Dec 2004
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Quotes on Professionalism

• Medical Professionalism lies at the heart of
  being a good doctor
• Royal College of Physicians, London, UK, 2005
• A physicians academic accomplishments and
  clinical skills are all the more impressive when
  they are cloaked with graciousness, humility and
  modesty
• Patrick Duff, MD, ACOG, 2004
• The higher the individual on the scale of power
  and prestige the more important it is for him or
  her to be considerate for others and to be
  respectful of their needs for attention,
  compassion and fair treatment
• Patrick Duff, MD, ACOG, 2004

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Bibliography

• ABIM Foundation medical profesisonalism in the
  new millennium A physican charter, Annals of
  Internal Medicine, 2002136243-246
• ABP Components of Professionalism, 2000
  http//www.abp.org/resident/profguid.htm
• Cruess RL, Cruess SR. Teaching Professionalism
  General principles. Medical Teacher 2006,
  203205-209
• Hatem C. Teaching approaches that reflect and
  promote Professionalism. Academic Medicine, 2003
  78, 7 709-713
• Swick H. Towards a normative definition of
  medical Professionalism. Academic Medicine, 2000
  75, 8612-616

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Bibliography

• Duff P. Teaching and Assessing Professionalism in
  medicine. Obstetrics and Gynecology, 2004 104,
  61362-1366
• Wright, Scott. Examining what residents look for
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  Cultivating Humanistic values and attitudes in
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  2141-149
• Viggiano T. Putting the needs of patient first,
  Mayo Clinic Core Value, Institutional culture and
  professional covenant. Academic Medicine, 2007
  82, 111089-1093
• Jone WS. An intentional modeling process to teach
  Professional behavior Students clincal
  observation of preceptors teaching and learning
  in medicine, 2004 16, 3264-269

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Bibliography

• Arnold E. Can Professionalism be measured The
  development of a scale for use in medical
  environment. Academic Medicine, 1998 73,
  101119-1121
• Stark P. Discovering Professionalism through
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• Davis R. Defining the core competencies of
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• Epstein R. Mindful practice journal, AMA, 1999
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Flamingo Dance

• It is said that when flamingos dance, they make
  a heart. In dealing with others we should listen
  to our hearts, thats where professionalism
  resides.

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