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Professionalism

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Title: Professionalism


1
Professionalism
2
Professionalism
  • Fiduciary duty
  • of, relating to, or involving a confidence or
    trust (Merriam-Webster)
  • A contract with society
  • Law, Medicine, Clergy

3
Spheres of Professional Responsibility
4
Medical Professionalism in the New Millennium A
Physicians' Charter1
The Medical Professionalism Project The 2005
RSNA Professionalism Committee
5
Commitment to . . .
  • Professional Competence
  • Honesty with Patients
  • Patients' Confidentiality
  • Maintaining Appropriate Relationships with
    Patients
  • Improving Quality of Care
  • Improving Access to Care
  • Just Distribution of Finite Resources
  • Scientific Knowledge
  • Maintaining Trust by Managing Conflicts of
    Interest
  • Professional Responsibilities

6
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7
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8
Traditional Topics
  • Conflicts of Interest
  • Confidentiality
  • Errors
  • Impaired Physicians
  • Incompetent Physicians
  • Boundary Issues

9
Professionalism Swick 2000
  • Physicians subordinate their own interests to the
    interests of others
  • Physicians adhere to high ethical and moral
    standards
  • Physicians respond to societal needs
  • Physicians evince core humanistic values
    including honesty, integrity, caring, compassion,
    altrusim, empathy, respect, trustworthiness

10
  • Physicians exercise accountability for themselves
    and for their colleagues
  • Physicians demonstrate a continuing commitment to
    excellence
  • Physicians exhibit a commitment to scholarship
    and to advancing their field
  • Physicians deal with high levels of complexity
    and uncertainty
  • Physicians reflect on their actions and decisions

11
Emerging Topics
  • Social Networking and Media
  • Diversity among Patients and Workplace
  • New attitudes toward communication with patients
  • Need for trainee codes of professionalism
  • Evolving Power-Distance

12
Case 1
  • Social Networking
  • John Brown, a 2nd year resident in Radiology has
    a Facebook persona with 93 friends posted on
    his wall are photos from his days as a college
    football star.
  • Issues are that he frequently complains about the
    residency program , faculty members, workload,
    and actively solicits comments from female
    friends, some of whom are fellow residents,
    technologists in the dept, and patients.
  • Do you believe this is appropriate behavior? Why?

13
Case 2
  • Communicating results
  • You have just completed an CT examination on a 5
    year old child and the family members waiting
    wish to discuss the preliminary results of the
    cranial study. The patient, who presented with a
    tremor has a large posterior fossa tumor. Her
    pediatrician is away at a meeting.
  • What will you discuss with the family? Why?

14
Case 2B
  • The training directors have decided to have the 9
    PGY 2 and 3 residents in the program learn to
    provide preliminary study results to patients.
  • Rate numerically from worst (1) to best (7) the
    following ways that they could learn to do this

15
Case 2 B Possibilities Rank 1-7
Worst-Best
  • 4. Have residents view a video on giving results
  • 5. Groups critique a video of a physician giving
    results to a patient.
  • 6. Write a 5 sentence short essay on giving
    results.
  • 7. Assemble the residents into a group to
    practice giving results to standardized patients.
  1. Observe a faculty member giving study results to
    a patient.
  2. Present a lecture on methods of communicating
    results to patients. Then test the learners.
  3. Hold the lecture followed by a resident
    Teach-Back

16
What is your picture of a classroom?
University of Missouri
17
What can be your picture of a classroom?
Apple, Inc.
18
Case 3
  • Concept of Power-distance
  • Joe Green (PGY5) and Mary Brown (PGY3) are on
    service together and asked by the pulmonary
    fellows to plan and present conference for
    pulmonarys 6 attendings and 3 fellows. They are
    excited and ask the radiology attending to help
    provide some cases, and for suggestions. The
    attending, an Associate professor, has a fit
    that he was not asked, although he would have
    given the duty to them, anyway.
  • What is the problem here? How could it be managed
    better?

19
Case 4
  • Residents are derogatory about Dr. Smith, a
    semiretired radiologist who has outdated
    knowledge of technology. However, he has sharp
    skills in film interpretation, in which he
    capably and enthusiastically instructs
    residents.
  • The problem residents have is that he does not
    recommend or utilize cross sectional imaging when
    indicated. As a resident, what should you say or
    do when you believe his recommendations are in
    error?
  • What and why?

20
Case 5
  • A 5 yo boy at play, accidentally sustained a head
    injury in which he reportedly lost consciousness
    for about 1 minute. In the ER he is alert and
    responsive and has a normal neurologic exam.
    Mother and the ER physician feel he should be
    discharged home and monitored by the mother. Dad,
    an Internist and divorced from the mother,
    believes the child should have a cranial CT scan
    to ensure there is no underlying injury.
  • How would you manage the situation? Why?

21
Case 6
  • Joe Green, is a PGY 5 resident with 3 great job
    offers. He encounters fellow resident, Sam, who
    says Dont forget our board review session
    today from 3 until 6! Joe replies Naw, I hate
    spending time on all that trivia, I prefer
    sitting in the reading room and listening to the
    radiologists consult, instead.
  • What do you know about Joe and Sam?
  • Who will do better on the Boards? In life?
  • Why?

22
Proficient
Competent
Advanced beginner
Novice
HL Dreyfus 1986
23
Wisdom
Insight
Knowledge
Meaning
Information
Data
Patrick Lambe
24
Competence, certification
Training
Performance
Learning Knowing Understanding Comprehension
Practice, sustainable abilities
Mastery
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