Module 1 Professional Identity: Physician, Teacher and Leader

1
Module 1Professional Identity Physician,
Teacher and Leader
Residents as Teachers Leaders

• Module Created by
• John Culberson, M.D., M.S.
• Assistant Professor of Medicine
• Charlene M. Dewey, M.D., M.Ed., FACP
• Associate Professor of Medicine
• Web Page and Module Formatting by
• Maria Victoria Tejada-Simon, Ph.D.
• Assistant Professor of Molecular Physiology and
  Biophysics

2
Welcome

• Welcome to Module 1 Physician Identity. You
  should have completed a pre-test for this module.
  Did you complete the honesty pledge question?
• In that pledge you agreed to take the pre-test
  first, then read the module and then take the
  post-test after reading the module. If you did
  not complete the pre-test, please exit the module
  now and complete it then return to the module.
  Your honesty is appreciated.

Click here if you completed the pretest.
Exit
3
Welcome

• Welcome to Module 1 Professional Identity
  Physician, Teacher and Leader. As a physician,
  you will interact with a wide variety of
  individuals patients, their family, nurses,
  medical students, peers and faculty.
• Your role as a resident physician will be
  enhanced by adopting appropriate teaching,
  leadership, and communication principles into
  your daily routine.

4
Welcome

• Module 1 focuses on professional identity. We
  estimate about 45-60 minutes to complete this
  module. Resources for this module can be found
  on the RATL resources web page.

5
Introduction

• What's also important to remember about being a
  professional is that you are building your
  reputation and you want always to protect that
  reputation and avoid any behaviors that will
  jeopardize your reputation.
• Developing, maintaining and protecting your
  reputation will take awareness and prevention on
  your part. You may also find that sometimes a
  colleague may need help before he/she jeopardizes
  their reputation.

6
Introduction

• Professionalism is defined in the dictionary as
• the conduct, aims, or qualities that
  characterize or mark a profession or a
  professional person.
• Reflect for a second on those qualities, aims or
  your conduct up to this point in your training.
  Are you ready to assume the higher standard of
  professionalism in medicine?

http//www.merriam-webster.com/dictionary/professi
onalism
7
Introduction

• Although professionalism has been incorporated
  into most medical schools across North America,
  it remains rather difficult to define because it
  carries many connotations and implied meanings.
  What is certain, however, is that medicine is a
  moral endeavor which demands integrity,
  competence, and high ethical standards among
  other key attributes. - University of Ottawa

http//intermed.med.uottawa.ca/students/md/profess
ionalism/eng/what_is_professionalism.html (With
permission)
8
Introduction

• Drs. Richard and Sylvia Cruess of McGill
  University have become leaders in the field of
  medical professionalism. They describe the role
  of the physician as overlapping between that of
  the healer and that of the professional.
• Within this model, both positions are necessary
  to appreciate key attributes of the physician.
  Although the primary role of the physician is
  undoubtedly that of the healer, one must
  simultaneously maintain professionalism in
  medical practice. The following diagram
  highlights this crucial balance

http//intermed.med.uottawa.ca/students/md/profess
ionalism/eng/what_is_professionalism.html (with
permission)
9
Introduction
http//intermed.med.uottawa.ca/students/md/profess
ionalism/eng/what_is_professionalism.html (with
permission)
10
Introduction

• "Develop the frame of mind that whatever you do,
  you are doing it as a professional and move up to
  professional standards in it.

Click on the box to watch the Photo Story on
professional identity. Click again to stop.
(Video is approx 8 minutes.)
http//www.tipsforsuccess.org/professionalism.htm
11
Goals

• The goals of this module are
• 1. To help you to develop your professional
  identity as a physician and leader and
  characterize the relationships that define the
  physician.
• 2. To reflect on characteristics of the
  professional physician and to review the key
  principles of leadership and effective
  communication.

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Objectives

• After completing this module, you will be capable
  of
• Identifying four (4) aspects of effective
  communication.
• Describing four (4) relationships that define the
  professional identity of physicians.
• Demonstrating an appreciation of the physician's
  role by being part of the solution, rather than
  part of the problem avoiding the hidden
  curriculum.
• Designing an approach to leadership that
  incorporates Coveys seven habits.
• Reflecting on your professional role as physician
  and leader in medical education.

13
Agenda

• Physicians have several roles in health care. In
  this module we will emphasize the professional
  and leadership roles of the physician while the
  teacher role is
• emphasized in Module 2.
• We will also emphasize effective communication
  and its role in developing healthy relationships
  in the medical setting.

14
Agenda

• Module 1 will include the following topics
• Physician identity professionalism
• Relationships in medicine
• Effective communication
• Leadership identity
• Hidden curriculum
• Summary

15
Professional Identity

• Are you a professional? What makes you a
  professional? How is professionalism defined?
  What would our great forefathers of medicine say
  about professionalism?
• Some greats had much to say about the
  professional practice of medicine starting with
  Hippocrates.

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Physician Identity

• The Hippocratic work On the Physician recommends
  that physicians always be well-kempt, honest,
  calm, understanding, and serious. The Hippocratic
  physician paid careful attention to all aspects
  of his practice he followed detailed
  specifications for, "lighting, personnel,
  instruments, positioning of the patient, and
  techniques of bandaging and splinting" in the
  ancient operating room. He even kept his
  fingernails to a precise length.

http//en.wikipedia.org/wiki/Hippocrates
Highlights of Hippocratic oath only
More detail on Hippocrates
17
Physician Identity

• The original translation of the Hippocratic oath
• To consider dear to me, as my parents, him who
  taught me this art to live in common with him
  and, if necessary, to share my goods with him To
  look upon his children as my own brothers, to
  teach them this art.
• I will prescribe regimens for the good of my
  patients according to my ability and my judgment
  and never do harm to anyone.
• To please no one will I prescribe a deadly drug
  nor give advice which may cause his death.
• Nor will I give a woman a pessary to procure
  abortion.
• But I will preserve the purity of my life and my
  arts.
• I will not cut for stone, even for patients in
  whom the disease is manifest I will leave this
  operation to be performed by practitioners,
  specialists in this art.

http//en.wikipedia.org/wiki/Hippocratic_Oath
18
Physician Identity

• Continued
• In every house where I come I will enter only for
  the good of my patients, keeping myself far from
  all intentional ill-doing and all seduction and
  especially from the pleasures of love with women
  or with men, be they free or slaves.
• All that may come to my knowledge in the exercise
  of my profession or in daily commerce with men,
  which ought not to be spread abroad, I will keep
  secret and will never reveal.
• If I keep this oath faithfully, may I enjoy my
  life and practice my art, respected by all men
  and in all times but if I swerve from it or
  violate it, may the reverse be my lot.

http//en.wikipedia.org/wiki/Hippocratic_Oath
19
Physician Identity

• Highlights from that oath include
• Valuing in the highest regard those who teach you
  the art of medicine teachers, clinicians,
  patients.
• Do no harm according to your ability being
  humble and knowing when to ask for help.
• Preserve the purity of my life and my arts
  keeping the profession and your role in it in
  high esteem.
• Keeping myself far from all intentional ill-doing
  and all seduction understanding boundaries and
  illegal behaviors.

20
Physician Identity

• Highlights continued
• I will keep secret and will never reveal
  maintaining confidentiality.
• If I keep this oath faithfully, may I enjoy my
  life and practice my art, respected by all men
  and in all times but if I swerve from it or
  violate it, may the reverse be my lot
• This last point clearly identifies both the good
  outcomes of maintaining a professional and
  ethical practice of medicine and the negative
  consequences if you dont.

21
Physician Identity

• The Core Values of Professionalism include  
• Honesty and Integrity
• Altruism
• Respect
• Responsibility and Accountability
• Compassion and Empathy
• Dedication and Self-improvement

http//intermed.med.uottawa.ca/students/md/profess
ionalism/eng/index.html (with permission)
22
Physician Identity

• Reflection time think about who you are and who
  you want to be as a physician. Then answer the
  following questions.
• List some adjectives that describe who you are as
  a person.
• Would others use the same adjectives to describe
  your interpersonal skills and activities at work?
• What reputation do you want for yourself?
• Your identity is your reputation. How you shape
  that identity and reputation is up to you!

23
Physician Identity

• As a physician, you will need to diagnose and
  treat illness, however, your greatest challenge
  may lie in developing and maintaining
  relationships in an environment of time
  constraints and stress. These relationships will
  bond you with others in the care of your
  patients.

24
Physician Identity

• Which of the following relationships do you think
  is the most important to a physician?
• Doctor-Self
• Doctor-Colleagues (MD, RN, students)
• Doctor-Patient
• Doctor-Community

25
Physician Identity

• All relationships require the physician to
  maintain their physical and emotional health. The
  Doctor-Self relationship is, in fact, the most
  important and most often overlooked!
• Ensuring time for yourself, friends, and family
  is a professional obligation and you owe it to
  yourself!

26
Doctor-Self

• Efficiency and the ability to establish
  professional and personal boundaries are
  essential skills, however, this may require
  considerable practice for some.
• No amount of knowledge and skill can overcome the
  negative consequences of physician burnout.
  Self-awareness is the primary tool to help
  identify burnout. But what is burnout?

27
Doctor-Self

• Burnout Maslach Leither describe burnout as
  the index of the dislocation between what people
  are doing and what they are expected to do.
• Burnout represents a deterioration of values,
  dignity, spirit, and will. an erosion of the
  soul. Burnout spreads gradually and
  continuously over time, sending people into a
  downward spiral from which it is hard to recover.

Spickard, Gabbe Christensen. JAMA, September
2002288(12)1447-50
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Doctor-Self

• Which of the following are signs of physician
  burnout?
• Decreasing efficiency
• Outbursts of anger
• Feeling overwhelmed
• Insomnia
• All of the above
• None of the above

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Doctor-Self

• Decreasing efficiency, outbursts of anger,
• feeling overwhelmed, insomnia, and
• depression are all signs of physician burnout.
• This is an unhealthy mental and physical
• state that adversely effects your training,
• your relationships, and your ability to provide
• excellent patient care.

30
Doctor-Self

• While everyone feels the effects of stress during
  their residency training, understanding your own
  personal stressors and how to avoid them are
  important.
• Once one identifies that they are on the road to
  burnout, seeking help from others is a sign of
  effective self-monitoring and emotional maturity,
  not weakness! Burnout can be prevented and
  treated.

31
Doctor-Self
Ways to avoid burnout

• Personal
• Influence happiness through personal values and
  choices
• Spend time with family friends
• Engage in religious or spiritual activity
• Maintain self-care (nutrition exercise)
• Adapt a healthy philosophy/outlook
• A supportive spouse or partner

• Work
• Gain control over environment workload
• Find meaning in work
• Set limits and maintain balance
• Have a mentor
• Obtain adequate administrative support systems

Spickard, Gabbe Christensen. JAMA, September
2002288(12)1447-50
32
Doctor-Self

• If you were to experience signs of physician
• burnout, from whom would you seek help?
• A medical student
• An intern
• A resident
• A faculty member
• A confidential counseling service

33
Doctor-Self

• Often, a peer may seem to be the best option for
  confiding in and receiving support during
  burnout, however, specific solutions are usually
  best provided by individuals who have experience
  with issues that may arise during training.
• Chief residents, faculty, and/or counselors are
  better positioned to objectively identify both
  problems and solutions. Experienced individuals
  are more likely to assist with wisdom and
  confidentiality.

34
Doctor-Self

• There are several options for physicians
  experiencing burnout. Check with your residency
  office or specific institutional wellness program
  for assistance.
• Institutional programs are confidential services
  and provides counseling and other services
  free-of-charge to those seeking assistance. They
  are generally utilized frequently by physicians
  of all specialties.

35
Doctor-Self

• Some resources that can be of assistance include
• Vanderbilts Center for Professional Health
  Faculty Physician Wellness Program
• http//www.mc.vanderbilt.edu/root/vumc.php?sitecp
  h
• http//www.vanderbilt.edu/HRS/wellness/wlcfpwp.htm
  l
• Help guide to Workplace burnout
• http//www.helpguide.org/mental/burnout_signs_symp
  toms.htm

36
Doctor-Self

• Remember, if you are not able to function, you
  cannot be of assistance to your patients. The
  Doctor-Self relationship is the most critical
  relationship you have. Take care of yourself and
  nourish your inner being in ways that help you
  feel refreshed and ready to return to work each
  day.
• Now lets look at the doctor-colleague
  relationship. In this section, we will focus on
  teamwork and communication between colleagues on
  a healthcare team.

37
Doctor-Colleague

• While physicians are conditioned to feel as if
  self-reliance is a worthy goal to be achieved
  through rigorous training, excellent medical care
  requires the coordinated efforts of a team of
  professionals.
• Team-building is emphasized in the military,
  sports, major corporations, and classrooms.
• Even medical education and healthcare are now
  recognizing the role and value of effective
  teamwork in patient care.

38
Doctor-Colleague

• Team work is vital in medicine! The welfare of
  your patients require your best efforts in
  accurately communicating with members of your
  immediate team, the extended patient care team
  and with the patients and their families.

39
Doctor-Colleague

• The team that best cares for a patient, is a team
  that communicates well between its members.

40
Doctor-Colleague

• The efficient and effective patient care team
  includes a large group of individuals including
  nurses, consultants, social workers, physical
  therapists, nutritionists, and, of course, the
  patient and their family.
• Each of these team members has a relationship
  with the patient and one another. Good
  communication between all team members is
  essential.

41
Doctor-Colleague

• As a member of any team, you will have to
  communicate with other teams. Evidence now
  supports that the team approach to patient care
  can improve outcomes and prevent readmissions.
• Too many physicians try to practice medicine
  solely in their sub-specialty or department.

42
Doctor-Colleague

• Please reflect for a moment. Which of the
• following are important for Effective
• Communication?
• Good listening
• Providing concise and specific feedback
• Providing overview/concepts followed by facts
• Using appropriate level of language
• Displaying confidence

43
Doctor-Colleague

• Effective communication is characterized by all
  of these
• Good Listening
• Communicating on an appropriate level for the
  learner
• Providing overviews general concepts first
  then facts
• Providing appropriate praise
• Providing specific concise feedback
• Summarizing important points

44
Doctor-Colleague

• While confidence is important, it is a perception
  that is supported by effective communication.
• However, while all aspects are important, good
  listening is the key! It is sometimes difficult
  for busy, stressed physicians to listen well.

45
Doctor-Colleague

• The habits and behaviors you learned early in
  your training can be difficult to change later
  be a good listener to each member of your
  team early and build good habits of listening to
  your patients, colleagues, peers and others.

46
Doctor-Colleague

• The dictionary defines communication as a process
  by which information is exchanged between
  individuals through a common system of symbols,
  signs or behaviors.
• Much important information is conveyed to peers,
  students, and patients through non-verbal
  communication.

47
Doctor-Colleague

• Imagine a scenario in which a resident and
• student are seated at a nursing station
• Student This patient has an elevated blood
  sugar, I think he has diabetes.
• Resident (without looking up, and in a
  condescending voice) By now, every student
  should know that most overweight people have
  diabetes.

48
Doctor-Colleague

• In the picture that you formed in your mind, how
  do you think the student felt based upon the
  residents communication style?
• What opinion will the student form about the
  residents communication style?
• Will this student feel comfortable forming a
  relationship with this resident?
• What has the student learned about obese
  patients? Is there a hidden message?

49
Doctor-Colleague

• In the previous scenario, how would you
  communicate differently in order to help the
  student to both understand the relationship
  between diabetes and obesity and observe an
  excellent physician role model?
• In general, you want to be a part of the
  solution, not part of the problem. Avoid
  perpetuating bad habits. Practice what you might
  say to this student.

50
Doctor-Colleague

• To effectively communicate with this student,
  first the resident should stop what they are
  doing and make eye contact. This tells the
  student they are important. Then, clarify what
  their question is. This makes sure you are
  giving the needed information. Then answer the
  question providing your knowledge and insight
  into the situation. Then ask them if they
  understood it or if they have any other questions.

51
Doctor-Colleague

• If you do not have time to answer, again, look at
  the student and say something to affirm their
  question and give them some guidance on what to
  do. (E.G Thats a good question but we dont
  have time to explain it in detail. If you look
  it up tonight, we can discuss it tomorrow on
  rounds.)
• This helps residents when they are busy and dont
  have time to stop. But dont let this be your
  only answer to every question!

52
Doctor-Colleague

• Also, if you make one of these comments, realize
  it is good for students to self learn but do make
  sure to touch upon it during your patient care
  rounds the next day. If you fail to do so, your
  students will see you as someone who just blows
  them off and doesnt really care enough to follow
  up. This can backfire if used the wrong way.

53
Doctor-Colleague

• Back to teamwork - When the team functions as
  one, the patient will ultimately benefit, but
  each member of the team also benefits.
• Think about this A patient is admitted to your
  service with diabetes, uncontrolled hypertension,
  severe osteomyelitis of the right great toe and
  distal foot, chest pain and depression. Who are
  the members of the team that will care for this
  patient?

54
Doctor-Colleague
At minimum, this patient will require input and
care form the following teams

• Physical Medicine and Rehabilitation
• Endocrinology
• Cardiology
• Discharge services
• Social worker
• Nutrition
• Diabetes education
• Family members

• The patient
• Nurses on the unit
• Internal Medicine/Family Medicine
• Surgery vascular and perhaps cardiothoracic
• Anesthesia
• Psychiatry
• Blood technicians

55
Doctor-Colleague

• Thus to care for this patient, many individuals
  from various teams will need to communicate and
  work together efficiently.
• Your role as the resident, intern or student is
  to be a part of the service team and the whole
  patient care team. Lets look at an example of a
  team effort.

56
Doctor-Colleague

• Below is a link to an example of teamwork with
  effective communication between several members
  of a team. Click on the link below to watch at
  least 3m of the 5-minute video and reflect on the
  following questions
• Who are the team members?
• How are they communicating with each other?
• How is it their product turned out so great?
• Can you see the similarities in medicine?

Click on the link http//www.youtube.com/watch?v
IliwQImJrYE
57
Doctor-Colleague

• This team had a specific purposeto make
  beautiful music together.
• There are probably a hundred members on this team
  and they are all different but several are
  similar in their function the lead players, the
  back-up cello players, the violinists, the
  drummer, the lighting team, sound team, etc. are
  all smaller teams that work well together as a
  whole in order to produce this beautiful concert.

58
Doctor-Colleague

• This is no different in medicine where small
  teams work together as a whole to heal patients.
  They all used their skills to create the final
  product that is a masterpiece!
• Not any one individual could have created that
  masterpiece by themselves. This is an example of
  how a team effort can create a great outcome.

59
Doctor-Colleague

• The Institute of Medicine 2004
• It is therefore crucial that physicians know how
  to work effectively in the context of integrated
  teams. They must understand their roles as part
  of the team and why it is important to foster
  positive relationships with other team members.
• (Pg 73)

60
Doctor-Colleague

• Each of us can help improve communication across
  departments if we are willing to try. Thus, we
  can each be a part of the solution instead of
  being part of the problem. Therefore, your role
  as an effective communicator and team player is
  key!
• Now lets look at the DoctorPatient
  relationship. This relationship also needs good
  listening and communication skills.

61
Doctor-Patient

• The doctor-patient relationship may produce
  particularly challenging communication issues.
  Language, ethnicity, culture, and other issues
  will play a role in the doctor-patient
  relationship.
• Unfortunately, it is not uncommon for physicians
  to exhibit poor listening skills and use
  vocabulary that is not understood by the patient.

62
Doctor-Patient

• Patients often drop hints rather than communicate
  concretely about problems or concerns. This
  requires physicians to have astute listening
  skills while they calibrate their vocabulary to a
  level of the learner (the patient). You will
  also need to watch the patient closely for their
  use of non-verbal communication and frequently
  ask if they understand or test their
  understanding.
• This skill does not come naturally but can be
  developed with practice.

63
Doctor-Patient

• Developing good communication between the doctor
  and patient is important. Effective
  communication is an excellent opportunity to
  demonstrate trust, compassion, empathy and
  appreciation to your patients.

Doctor Says Patient hears
Fibroids of the uterus Fire balls of my ucerus
Cirrhosis of the liver Sir roaches of the liver
Spinal meningitis Smiling mighty Jesus
These are real examples I have heard over time!
64
Doctor-Patient

• Identify yourself as a leader and role model for
  patients, their families, students, peers, and
  other members of the medical care team by looking
  at the patient, being attentive while they are
  speaking and demonstrating your empathy.
• Training institutions often teach students to ask
  open-ended questions and listen to their
  patients stories as part of their history. This
  is the foundation of patient-centered care.

65
Doctor-Patient

• However, a lack of time often causes us to force
  patients into simple yes or no questions, leaving
  no time for patients to tell their stories. This
  makes us more doctor-centered.
• Effective communication requires both parties to
  explicitly define their own unique views of
  illness and align them toward a common
  therapeutic goal.

66
Doctor-Patient

• This may seem more time consuming but studies
  have demonstrated that patients will only talk
  for about 3 minutes to tell their story when
  asked using an open-ended question.
• You can be more directive with other parts of the
  history later. Allowing the patient to tell
  their story is a key issue for building
  relationships with them.

67
Doctor-Patient

• Patients feel valued and heard when doctors spend
  the time to listen to them.
• Will you stop to listen to your patients or will
  you rush through while working on other tasks?

68
Doctor-Patient

• What percentage of your medical school
• clinical experience was consistent with a
• patient-centered model?
• Less than 25
• 26-50
• 51-75
• Greater than 75

69
Doctor-Patient

• The Institute of Medicine 2004
• Medical students who learn how to elicit
  information needed to understand biological,
  personal, and social factors in the onset and
  maintenance of illness will diagnose and treat
  their future patients more effectively. (Pg 75)
• This quote speaks for itself! Now lets look at
  Doctor-Community relationships where we will
  emphasize professionalism leadership skills.

70
Doctor-Community

• The physician also has a professional obligation
  to the community they serve. An obligation to
  represent themselves in a professional manner, to
  identify diseases that affect their communities
  and to preserve our vital resources in our health
  care system.
• A professional always strives to improve
  themselves and acts in a manner supportive of the
  greater good.

71
Physician Identity

• List the four (4) relationships in medicine.

Click here for the answer
72
Physician Identity

• Doctor-Self
• Doctor-Colleagues (MD, RN, students)
• Doctor-Patient
• Doctor-Community

73
Leadership Identity

• Physicians are recognized as the leaders of large
  interdisciplinary teams of healthcare providers.
  Leadership skills are emphasized in corporate
  America, however, are often overlooked in the
  medical education process.
• Even as an intern, you may find yourself in the
  unfamiliar territory of leadership. It is a myth
  that great leaders are born like teaching
  skills, leadership skills can both be learned and
  perfected.

74
Leadership Identity

• Stephen Covey has written The Seven Habits of
  Highly Effective People.
• Covey defines a habit as the intersection of
  knowledge, skill, and desire. He describes a
  pathway to develop the security to adapt to
  change and to take advantage of the opportunities
  that change creates.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
75
Leadership Identity

• The Seven Habits
• Be proactive
• Begin with the end in mind
• Put first things first
• Think win-win
• Seek first to understand, then be understood
• Synergize
• Sharpen the saw

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
76
Leadership Identity

• In his book, Covey provides a plan to use the
  Seven Habits as a step-by-step pathway for
  living with fairness, integrity, and honesty, the
  security to adapt to change, and the security to
  take advantage of the opportunities that change
  creates.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
77
Leadership Identity

• The Seven Habits are divided into private
  public victories
• Private Victories involve self-mastery and move
  the individual from dependence toward
  independence, and
• Public Victories involve teamwork, cooperation,
  and communication and bring about an
  interdependent outlook.
• Covey emphasizes that private victories always
  proceed public victories.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
78
Leadership Identity

• Private victories
• Be Proactive Take action! Leaders lead, dont
  wait for someone else to do it.
• Begin with the End in Mind Organize your actions
  based upon the desired end-point.
• Put First Things First Prioritize based on the
  big-picture.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
79
Leadership Identity

• Lets use a very common scenario for the hospital
  setting. Having a patient-family conference
  about prognosis and therapy for your patients
  new diagnosis. The patient went to radiology at
  100 and the conference is scheduled for 300.
  The nurse gives you a message that a key family
  member was unaware of the meeting. You also need
  to get to the bank before it closes.
• The next few slides list Coveys habits and what
  you might do for each to be a more effective
  leader.

80
Leadership Identity

1. Be Proactive Your patient is waiting in the
   radiology waiting area after their x-ray. Go get
   them or arrange for their return.
2. Begin with the End in Mind The goal is to have a
   patient-family conference. Make sure everyone is
   aware of the purpose and importance ahead of
   time.
3. Put First Things First Organize your day so you
   and team members are able to get to the
   patient-family meeting on time go to the bank
   before or after the conference-remember your
   balance is important too!

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
81
Leadership Identity

• You have just handled this situation in a
  positive way thus making you a highly functional
  team member and personally victorious.
• Once you have achieved the personal habits of a
  leader, these habits must be combined with the
  habits of successful leadership in relationships
  with others. This task requires excellent
  communication skills.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
82
Leadership Identity

1. Think Win-Win Negotiate so that the
   circumstances are improved for both parties the
   patient and family should certainly win but
   that win may mean you need to educate them so
   they better understand what the best win is.
2. Seek First to Understand Listen and empathize
   with the families point-of-view and understand
   your own passion or drive toward one side or the
   other. Then help them understand your position.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
83
Leadership Identity

• Synergize Create new alternatives together that
  both parties are happy with. Decide what are the
  most important pieces to continue working on.
  Assure the patient and family you will work to
  obtain the goals of everyone - create new
  alternatives if needed.
• Example Demonstration What does this leader
  need to learn about leadership and communication?
  How did others react based on his actions?
  http//www.youtube.com/watch?voQBNMT9318A (If
  needed, click to start or select USS Montana)

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
84
Leadership Identity

• Keep in mind patients and most family members do
  not have significant understanding of medical
  terminology, our ways of doing things,
  treatments, options for treatment or withholding
  treatment. It is your job to help them
  understand this is also providing informed
  consent.

85
Leadership Identity

• Public victories are instrumental in providing
• team-based medical care. How might you apply
  Coveys habits as the leader of a medical care
  team for these situations?
• The patient is refusing a diagnostic test.
• The nurse is overwhelmed and has not given the
  patients antibiotics yet.
• The psychiatry resident must cover several
  hospitals when on call and your patient is not in
  their room.

86
Leadership Identity

• In each circumstance, the interests of both the
  health care providers and patient are best
  served through the demonstration of excellent
  professional and leadership skills.
• Your identity as a physician and colleague is
• based upon the consistent use of simple
  principles outlined by Covey.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
87
Leadership Identity

• Covey emphasizes, above all else, that taking
  care of personal needs is an important habit of
  effective leaders. He refers to his seventh habit
  as Sharpening the Saw.
• Covey states that to function optimally, one must
  learn to renew four dimensions of their nature.

(Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989)
88
Leadership Identity

• Habit 7. Balanced Self-Renewal
• Physical
• Mental
• Social/Emotional
• Spiritual
• This habit emphasizes the concept of personal
  leadership and was covered previously in our
  discussion of the Doctor-Self relationship.

89
Leadership Identity

• To begin with the end in mind means to start
  with a clear understanding of your destination.
  It means to know where youre going so that you
  better understand where you are now so that the
  steps you take are always in the right
  direction. pg 98.

Covey SR, The Seven Habits of Highly Successful
People, Fireside, 1989
90
Leadership Identity

• What is Coveys 7th habit that pertains to the
  individual?

Click here for the answer
91
Leadership identity

• Sharpen the saw! Balanced Self-Renewal
• Physical
• Mental
• Social/Emotional
• Spiritual

92
Hidden Curriculum

• Now lets look at how you affect learners when
  you dont even realize youre doing it.
• Its called the hidden curriculum of medicine
  because its that part of medicine that students
  learn without being taught. It is a dark side of
  medical education that can be undone with effort
  on your part.

93
Hidden Curriculum

• Each interaction in the medical environment is
  observed by someone students, nurses,
  technicians, colleagues, etc.
• As the observer, students especially, will learn
  the culture of their environment. They are
  learning how to act and what is/is not acceptable
  in their medical school, clinic, inpatient team
  or hospital.

94
Hidden Curriculum

• The authors propose that the chief barrier to
  medical professionalism education is
  unprofessional conduct by medical educators,
  which is protected by an established hierarchy of
  academic authority. Students feel no such
  protection, and the current structure of
  professionalism education and evaluation does
  more to harm students' virtue, confidence, and
  ethics than is generally acknowledged..

Brainbard AH, Brislen HC. Learning
Professionalism A View from the Trenches. Acad
Med 200782(11)1010-14.
95
Hidden Curriculum

• The authors maintain that deficiencies in the
  learning environment, combined with the
  subjective nature of professionalism evaluation,
  can leave students feeling persecuted, unfairly
  judged, and genuinely and tragically confused.
  They recommend that administrators, medical
  educators, residents, and students alike must
  show a personal commitment to the explicit
  professionalism curriculum and address the hidden
  curriculum openly and proactively.

Brainbard AH, Brislen HC. Learning
Professionalism A View from the Trenches. Acad
Med 200782(11)1010-14.
96
Hidden Curriculum

• Your verbal and non-verbal behavior becomes part
  of your teaching identity. Students witness your
  behaviors and can incorporate them into their
  view of patients, doctors, hospitals, and medical
  schools.
• The authors of the article clearly encourage and
  emphasize everyone taking a role to undo this
  darker side of medicine.

97
Hidden Curriculum

• The Hidden Curriculum is often observed in the
  clinical arena. Picture in your mind some actual
  behaviors sometimes observed by students in the
  clinical setting
• Pimping students to the point of embarrassment.
• Frequently interrupting patients.
• Using social stigmas in your conversation.
• Yelling at learners about their incompetence in
  front of others.

98
Hidden Curriculum

• This is in contrast to the concepts of patient-
• centered medical care and professional
• behavior that students are taught as
• paramount to the Doctor-Patient and Doctor-
• Colleague relationships.
• These contradictions create inner conflict in
• students, diminish the credibility of medical
• teachers, undermine ethics, and create cynicism
  as highlighted by the authors.

99
Hidden Curriculum

• Remember, the Hidden Curriculum is
• conveyed through both verbal, non-verbal, and
  para-verbal behaviors. That means you can say
  something, do something or emphasize something
  the wrong way and you just contributed to the
  hidden curriculum.
• Lets look at some examples so you can stay clear
  of them in the future.

100
Hidden Curriculum
Here are examples of behaviors that teach a
negative lesson through the hidden curriculum.
Action Lesson Learned
Consistently arriving five minutes late to a team meeting. Its ok to be disrespectful to colleagues and students arent worth your time.
Throwing a clamp back onto the tray and yelling at the nurse, Thats not what I asked for. Yelling is ok treating subordinates rudely is acceptable when they make mistakes even if honest ones
101
Hidden Curriculum
Action Lesson learned
Stating, If you didnt have so many kids, you could take better care of your patients. Family life should be sacrificed if you want to be a great physician.
Informing the student that surgery residents are notorious for not answering pages. Bashing colleagues and maintaining stereotypes is ok regardless of what that surgeon was doing at the time.
Telling a story about how you had a sexual relationship with a nurse colleague. There are no sexual boundaries in medicine. Have sex with anyone you want, after all you are a doctor.
102
Hidden Curriculum

• These are all examples of the hidden curriculum
  and avoiding them can be challenging, but is not
  impossible. It starts with being aware of the
  problem and choosing to be different.
• Thus, you want to be part of the solution, not
  part of the problem. Through practice and
  self-identifying you will be able to prevent or
  change such behaviors, and in doing so, will be
  achieving both private/public victories while
  reducing the effects of the hidden curriculum!

103
Hidden Curriculum

• If a teacher havesic any opinion which he
  wishes to conceal, his pupils will become as
  fully indoctrinated into that as into any which
  he publishes.
• - Ralph Waldo Emerson
• Clearly this takes understanding of the issues
  and attempts to prevent the problems in the
  future. What will you chose?

104
Summary

• Physicians learn much of their professional
  identity as physicians, teachers and leaders by
  interacting with others in the clinical
  environment. As a student or resident you will
  have the opportunity to contribute significantly
  to the learning environment of your team.

105
Summary

• Students, patients, peers, and other members of
  the interdisciplinary team will benefit from your
  understanding of your professional role and the
  value of effective communication, relationships
  in medicine, leadership skills and how to avoid
  being part of the negative effects of the hidden
  curriculum.

106
Take Home Points

1. There are four types of relationships in
   medicine Doctor-Self is the most important!
2. Communication is your most powerful tool to build
   relationships, teach learners and lead
   effectively.
3. Leadership is not just a higher rank, but it is
   the effort to serve, understand and advance the
   team as a whole.
4. Where possible, dont be part of the problem, be
   part of the solution-avoid contributing to the
   hidden curriculum!

107
Conclusion

• It is our hope that each of you will respect each
  others chosen profession and that with practice
  and mutual respect you will join together to
  serve your patients and become the next
  generation of physician leaders.
• We hope this module helped you identify yourself
  as physician and leader. Module 2 will focus on
  your identity as a teacher and introductory
  teaching skills.

108
Closing Instructions

• You have now successfully completed
• Module 1 Professional identity. Please take the
  post-test for this module immediately upon
  completion.
• The evaluation form and other learning materials
  for module 1 can be found on the main RATL page
  in Moodle. Thank you for participating!!!!!

109
PDF References

• See RATL web page for pdf references.

110
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