ROLE MODELLING: Making the Implicit Explicit

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ROLE MODELLINGMaking the Implicit Explicit
Caroline Storr, Liliane Asseraf-Pasin, Andrea
Moreault
We would like to acknowledge the Faculty
Development Office Dr. Richard Cruess Dr.
Sylvia Cruess
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Reflection

• What is the most significant experience you have
  encountered within your professional training
  and/or career development?

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Individuals admired for their ways of being
and acting as professionals Côté Leclère
Academic Medicine, 2000

• WHO ARE ROLE MODELS?

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• Role Modelling is at the heart of character
  formation
• Knowledge and skills are essential, but
  putting them together in a competent and
  caring response to patients needs is learned
  in personal interaction and Role
  Modelling Kenny, N. Academic Medicine 2003

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Role Modelling

• Un modèle de rôle en médecine est un médecin
  qui, dans le contexte de son exercice
  professionnel, influence lapprentissage des
  externes et des résidents avec qui il est en
  contact. (Chamberland Hivon, 2005)
• The process whereby faculty members exhibit
  knowledge, attitudes, and skills, demonstrate and
  articulate expert thought processes, and manifest
  positive professional behaviours and
  characteristics (After Irby, J Med Ed, 1986)

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Pedagogical modalities specific to clinical
education
Clinical Teacher Patient Student
Supervision
Role modelling
Chamberland Hivon, 2005
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• Excellent role models will always inspire, teach
  by example, and excite admiration and emulation.
• PAICE, E. BMJ 2002
• being a role model is what happens when you are
  busy doing other things John Lennon

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• ACTION!!!

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• What are some of the differences between a Role
  Model and a Mentor?

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MENTORING

• Mentorship differs from role modelling in that
  the mentor is actively engaged in an explicit
  two-way relationship with a junior colleague-a
  relationship that evolves and develops over time
  and can be terminated by either party
• A good mentor is a coach asking questions more
  often than giving answers
• Mentors have an active role in guiding their
  junior colleagues PAICE, E. BMJ 2002

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• WHY DO ROLE MODELS MATTER?
• Major Influence in the Creation of a Health
  Professional
• Part of the formal informal curriculum
  (influenced by the hidden curriculum)
• Can affect career choice
• Significant influence on peers
• Negative role modeling is common and can be
  destructive

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• WHY DO ROLE MODELS MATTER?
• RESIDENTS Less than 50 of teaching physicians
  are good role models
• 
  (Wright et al NEJM, 1998)
• 
  

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Role Models

• Are often unaware of what they are demonstrating
• Model A BROAD RANGE OF ATTRIBUTES
• - expertise/clinical skills
• - humanism/self awareness,
  empathy, respect
• - communication/patient student
• - personal qualities/lifestyle
• - collaborative practice
• - advocacy

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Attributes
Competence Commitment Confidentiality Altruism Tru
stworthy Integrity / Honesty Codes of
ethics Morality / Ethical
Behavior Responsibility to profession
Caring/compassion Insight Openness/ transparency R
espect for the healing function Respect
patient dignity/autonomy Presence/Accompany
Autonomy Self-regulation Associations
Institutions Responsibility to society
Team work
Healer
Professional
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What Makes a Good Role Model?

• Competence
• TIME total hours of time spent teaching
• Being aware of being a role model
• Being explicit about what is being modeled and
  why
• Communicating enthusiasm
• (Generalist vs specialist)
• Wright et al NEJM,1998
• Côté Leclère Acad Med, 2000

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What Makes a Good Role Model?

• Demonstrating sensitivity to students needs
• Being aware of power difference
• Giving feedback
• Stressing importance of patient relationship
• Stressing psychosocial aspects of medicine
• Reflecting and encouraging reflection in students
• Institutional support
• Wright et al NEJM,1998
• Côté Leclère Acad Med, 2000

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What Makes a Poor Role Model?

• Disrespect- patients/students/team members
• Insensitivity- patients/students/team members
• Professional dissatisfaction
• Lack of collegiality
• Culture accepting of poor relationships
• Lack of institutional support

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Barriers to Good Role Modeling

• Time/overwork
• Impatience
• Overly opinionated
• Hostile attitude

• Lack of enthusiasm
• Poor interpersonal skills
• Impersonal approach
• Too reserved/quiet

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NO ONE IS A GOOD ROLE MODELALL OF THE TIME
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HEALTH PROFESSIONALS CAN IMPROVE AS ROLE
MODELSBehaviors Can Change Skeff
NEJM,1998
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CONCEPTUAL MODEL
Excellent Clinical Skills
High Order Clinical Skills
BARRIERS personal
Teaching Skills
BARRIERS institutional
Personal Qualities
Reflective Role modeling
Threshold Level
After Wright et al CMAJ, 2002
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1. Apprenticeship model

• Learning through participation in an environment,
  where  ways of being  are modeled.
• Allows one to observe
• How knowledge and skills are applied to real
  situations, unique to the profession.
• How behaviours and knowledge (as well as the
  consequences of these) are used in context.

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2. Situated learning

• Learning that occurs in the context of practice,
  including knowledge, skills, and social norms.
• Professionals learn from participating in, and
  gradually being absorbed into, communities of
  practice.
• Learn to talk from talk
• The process becomes an integral and inseparable
  aspect of social practice.

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3. Observational Learning (Bandura)

• Learning occurs in an environment of constant,
  dynamic, reciprocal interaction among people,
  their behaviour and the environment.
• Students learn behaviours and ways of being that
  look successful to them in light of their own
  goals and experience and the rewards they see
  present in the environment.

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4. Reflective practice (Schön)

• The process of intentionally turning thoughtful
  practice into a potential learning experience.
• Reflection helps the model to make explicit the
  moral and other judgmental standards by which
  they guide and judge their behaviour.

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4. Reflective practice (Schön) Reflection
and Role Modeling

• Reflection IN Action while performing an
  act/role, explain what is being done
• Reflection ON Action after Performing the
  act/role, reflect with the student(s) on the
  impact of the action on the patient, student, and
  self
• Reflection FOR Action discuss what has been
  learned for the future
• Lachman
  Pawlina Clin Anat, 2006

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5. Ethics Education

• The systematic reflection about what we do,
  believe, and value can contribute powerfully to
  understanding how we frame and resolve medical
  ethical dilemmas and how, in reality,
  professional character is formed.

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TAKE HOME MESSAGE

• Attention - to the patient
• - to the student
• Retention - use Socratic methods to involve the
  student and promote retention
• Production - getting the student to use knowledge
  in order to embed it
• Motivation - make the event enjoyable
• 
  (Bandura 1986)

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ALL TEACHERS ARE ALWAYS ROLE MODELS FOR
STUDENTS,GOOD, BAD, or INDIFFERENTALTHOUGH WE
CANT ALWAYS BE PERFECTTHE GOAL IS TO BE
CONSISTENTLY GOOD