Teaching and Assessing Professionalism: Recommendations from the ACGME

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Teaching and Assessing ProfessionalismRecommenda
tions from the ACGME

• Margaret M. Grimes, M.D.
• Virginia Commonwealth University

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Definition

• Commitment to professional responsibilities
• Adherence to ethical principles
• Sensitivity to diverse patient population

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• Medical professionalism is the ability to meet
  the relationship-centered expectations required
  to practice medicine competently.
  (Kuczewski, Lynch, Surdyk)
• Physicians relationship to
• Patients - Physicians
• Community - Self
• Health care system

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• The consummate professional is a well-rounded
  individual who has good interpersonal skills, a
  penchant for continuous learning, and a deep
  understanding of the human condition.
• - D.R. Nahrwold, 2004

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Professionalism and the Patient-Physician
Relationship

• Patient satisfaction
• Compliance with Rx recommendations
• Patient loyalty
• Most complaints involve unprofessional behavior
  litigation
• ?Professionalism/excellence link

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Can professionalism be taught?

• With targeted, defined interventions, it is
  possible to change specific professional
  attitudes and beliefs, reasoning, and behaviors.

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Some Successful Tactics

• Multicultural track
• Communication skills training program
• Challenging case conferences
• Resident support group
• Mentoring program

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Expectations for Pathology Residents

• Respectful behavior, compassion, integrity
• Responsiveness that supercedes self-interest
• Accountability to patients, society, the
  profession
• Commitment to excellence and on-going
  professional development
• Consistent, dependable performance of duties
• Commitment to ethical principles
• Sensitivity to cultures, age, gender,
  disabilities

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Consider important expectations

• Is the resident thorough and careful in
  completing patient care tasks?
• Does the resident know the limits of his/her
  abilities and seek help when appropriate?
• Is the resident willing to help or fill in for
  others?
• Is the resident respectful in interactions?

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• Etiquette
• Communication skills/personal interactions
• Veracity
• Following protocols
• Self-directed learning
• Response to instruction
• Response to stress

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Making Professionalism Concretefor Trainees

• Describe professionalism in terms of specific
  behaviors
• written standards of behavior/explicit
  expectations
• Categorize levels of professionalism and describe
  examples for each level
• frequently fails to, consistently, frequently
  exceeds
• Review professionalism scenarios/prompt learner
  generation of other scenarios
• case vignettes

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Approaches to Teaching Professionalism

• Clinical/experiential
• Simulation
• Discussion/seminar
• Cooperative/team learning
• Lecture
• Independent learning

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Discussion/seminar

• Rotation orientation sessions/discussion groups
  specify expectations
• Case scenarios
• Potential sources
• Clin Lab Manage Rev
• Pathology-specific cases
• Reality ethics

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Cooperative/team learning

• Involve the residents in developing and
  implementing strategies for teaching and
  assessing professionalism

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Lecture

• Research/IRB
• Privacy/confidentiality
• Business ethics

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Independent learning

• Individual projects
• Web-based tutorials

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Dont forget the hidden curriculum

• Stern (1996) The educational environment,
  whether through formal or informal curricula,
  appears to influence learner attitudes and
  behavior.
• Brownell et al (2001) Residents reported
  learning most about professionalism from
  observing role models.

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• The best way to teach professionalism is to
  practice the highest order of professionalism
  ourselves.
• - D. H. Nahrwold, 2004

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Why assess professionalism?

• To gauge learner abilities/determine achievement
• To aid program and curriculum improvements

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What should be assessed?

• Important and representative expectations per
  developmental level
• Affective, cognitive, behavioral, environmental
  outcomes
• Five types of relationships
• - Patient - Health care system
• - Society - Self
• - Physician

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How to assess?

• Use methods that are congruent with objectives
• Use more than one method (e.g. 360 and vignettes)
• Use methods likely to yield valid and reliable
  data
• The best assessments are those that incorporate
  learning

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Who should assess?

• Different types of assessors (e.g. physicians,
  other health care professionals)
• Invested assessors who are willing to be trained
  or have relevant experience

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When to assess?

• Begin early
• Conduct frequently over the long-term
• Before and after teaching or improvement
  opportunities

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Where to assess?

• Multiple settings
• obtaining informed consent
• communicating intraoperative diagnosis
• transfusion reaction work-up
• presentation at tumor board
• overall performance

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Approaches to Assessment of Professionalism

• Records/permanent products
• individual or team projects
• Observation and recording
• with immediate feedback
• Cognitive test
• multiple choice or open-ended questions
• Survey/rating
• 360 evaluation environmental survey

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Teach/Assesssome possible applications

• Standards of behavior
• Mentoring/role models
• Case scenarios
• Lectures
• Web-based tutorial
• Team learning
• Observation with immediate feedback

• 360 evaluation
• 360/environmental survey
• MC questions/survey
• MC questions
• Pre-test/post-test
• Open ended questions
• Observer notes

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