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Module 1 Professional Identity: Physician, Teacher and Leader

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Title: 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 pretest for this module.
    Did you complete the honesty pledge question?
  • In that pledge you agreed to take the pretest
    first, then read the module and then take the
    post-test after reading the module. If you did
    not complete the pretest, 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 one 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 Photostory 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.

12
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.

16
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
28
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

29
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
  • AAMC Viewpoint Defusing Physician Burnout
  • http//www.aamc.org/newsroom/reporter/march03/view
    point.htm
  • 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 the
    4-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
VCIyzNISw1Q
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 singers, the
    back-up singers, the violinists, the cellists,
    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 hear 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. These habits are
    divided into Private Victories and Public
    Victories.
  • 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.
  • 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 have 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 web
    page. Thank you for participating!!!!!

109
PDF References
  • See RATL web page for pdf references.

110
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