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Mapping Professionalism Milestones: I need a GPS!
Cindy Christy, Lynn C Garfunkel, April Buchanan, BreA Robbins,
Caren Gellin
ObjecFves of the workshop
• Know the 6 pediatric professionalism competencies
• Use and/or develop assessment tool(s) to map to an ACGME milestone levels of professionalism
• Map a course of professional development from medical school through residency
Agenda
• IntroducFons • Review Professionalism competencies: Cindy • SePng the stage: Video • Assessment tools: April • Mapping strategy: Lynn • Evaluate trustworthiness level using tools: Video #2 and 3
• Development and ReporFng: BreA and Caren • Wrap-‐up and online evaluaFon
– www.appd.org/amsurvey/
hAp://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-‐PR-‐FAQ-‐PIF/320_pediatrics_07012013.pdf
Professionalism: Program Requirements for Pediatric GME
• Must demonstrate a commitment to carrying out professional responsibili5es and an adherence to ethical principles. (Outcome)
– Demonstrate: compassion, integrity, and respect for others; (Outcome) – Responsiveness to pa5ent needs that supersedes self-‐ interest; (Outcome) – Respect for pa5ent privacy and autonomy; (Outcome) – Accountability to pa5ents, society and the profession; (Outcome) – Sensi5vity and responsiveness to a diverse pa5ent popula5on, including but not limited to
diversity in gender, age, culture, race, religion, disabili5es, and sexual orienta5on; and, (Outcome) – A commitment to engage in personal and professional development that will sustain them in
balancing a commitment to their profession with a healthy and produc5ve personal life, including: (Outcome)
• Self-‐awareness of one’s own knowledge, skill, and emo5onal limita5ons that leads to appropriate help-‐ seeking behaviors; (Outcome)
• Healthy responses to stressors; (Outcome) • Manage conflict between one’s personal and professional responsibili5es; (Outcome) • Flexibility and maturity in adjus5ng to change with the capacity to alter one’s own behaviors; (Outcome) • Trustworthiness that makes colleagues feel secure when one is responsible for the care of pa5ents;
(Outcome) • Leadership skills that enhance team func5on, the learning environment and/or the health care delivery
system/environment with the ul5mate intent of improving care of pa5ents; (Outcome) • Self-‐confidence that puts pa5ents, families, and members of the health care team at ease; and, (Outcome) • The capacity to accept that ambiguity is part of clinical medicine and to recognize the need for and to u5lize
appropriate resources in dealing with uncertainty. (Outcome)
IV.A.5.e), Page 15
The 6 Professionalism Competencies
• Humanism, compassion, respect for others • ProfessionalizaFon/sense of duty • Professional conduct -‐ high standards of ethical behavior
• Self awareness of one’s own limitaFons, seeks help
• Trustworthiness • Acceptance of ambiguity and uncertainty
Scenario #1
OpFons for Assessment of
Professionalism
Current State of Professionalism Assessment
• No single instrument
• Assessment of some elements should take place over Fme
• Carried out in as authenFc a sePng as possible
• Based on specific observaFons rather than recall • Reliability and validity must be ensured
• Improve reliability by ↑observaFons and observers
Assessment Methods -‐ ConsideraFons
WHO • Self • Peer
• Supervising physician
• Non-‐MD members of health care team
• PaFents
HOW
• Itemized checklists
• RaFng scales • NarraFve
comments
WHAT • General viewpoint • Response to vigneAe • Observed clinical
encounter (real or simulated)
• CriFcal incident
PotenFal Methods of Assessing Professionalism
• Faculty narraFves and raFng scales
• CriFcal incident reports • Student/Resident quesFonnaires • 360o MulF-‐rater evaluaFon
• ReflecFve WriFng • Porholios
Assessment Methods • Faculty narra5ves and ra5ng scales
– Based on pre-‐defined criteria, evaluators use descriptors and/or assign numerical raFngs to determine where students/residents fall on a conFnuum
– May be used as summaFve or during observed clinical encounter
• Cri5cal incident reports – Used to record an experience of professional or unprofessional behavior that students/residents idenFfy as “criFcal” incidents
– Used as a reporFng tool of unprofessional behavior
Assessment Methods, cont.
• Student ques5onnaires – A self-‐administered survey with quesFons that the student/resident answers in a set format
– Can be used to study aPtudes, beliefs, past behaviors
– Can be used to assess individuals or groups
• Reflec5ve wri5ng – Single or collected wriFngs from students/residents that describe experiences to examine their own aPtudes, beliefs and values
– Can contain assigned or open-‐ended content
Assessment Methods: overview
• 360o Mul5-‐rater evalua5on
– Obtaining raFngs from a full range of observers: aAending's, paFents, nurses, peers, self and others
– Provides a more comprehensive picture of performance; gives a window into otherwise hard to evaluate behaviors
• Por[olios – CollecFon of arFfacts that represent the learning or teaching experience over Fme
– Can be evaluated itself as a whole
University of Michigan – Surgery (Assessment by Faculty and Self)
• Punctuality • Appearance • Honesty/Accountability/Response to Error • Compulsiveness
• Responsibility/Sense of Duty • Response to CriFcism
• Confidence and Ability to Assess Oneself
University of Michigan -‐ Surgery
• Respect for Others • IniFaFve/Self-‐RegulaFon • Altruism • Doctor/PaFent or Doctor/Family RelaFonships • Interprofessional RelaFonships • Trustworthiness/ ConfidenFality • Moral and Ethical Standards • APtude Toward Medical Profession
Musick 360° University of Kentucky
University of Maryland School of Medicine
• hAp://medschool.umaryland.edu/professionalism/EvaluaFon.asp
• Student to Student • CriFcal incident • Forms for assessment of Students, Residents, and Faculty
Milestones Mapping
SelecFng a response box in the middle of a level implies milestone in that level and in lower levels have been substanFally demonstrated
SelecFng a box on the line between levels indicates that milestones in lower levels have been substanFally demonstrated as well as some milestones in higher level(s)
Mapping to Milestone
0-‐10 = 1 11-‐20 = Level 1.5 21-‐30 = Level 2 … >85 = Level 5
Scoring and the Level
Mapping to Milestones 1 Punctuality 2 Appearance 3 Honesty/Accountability/Response to Error 4 Compulsiveness 5 Responsibility/Sense of Duty 6 Response to CriFcism 7 Confidence and Ability to Assess Oneself 8 Respect for Others 9 IniFaFve/Self-‐RegulaFon 10 Altruism 11 Doctor/PaFent or Doctor/Family
RelaFonships 12 Interprofessional RelaFonships 13 Trustworthiness/ConfidenFality 14 Moral and Ethical Standards 15 APtude Toward Medical Profession
P1 Humanism, compassion, integrity, and respect for others; based on the characterisFcs of an empatheFc pracFFoner Humanism
P2 A sense of duty and accountability to paFents, society, and the profession ProfessionalizaFon
P3 High standards of ethical behavior which includes maintaining appropriate professional boundaries Professional Conduct
P4 Self-‐awareness of one’s own knowledge, skill, and emoFonal limitaFons that leads to appropriate help-‐seeking behaviors
P5 Trustworthiness that makes colleagues feel secure when one is responsible for the care of paFents
P6 The capacity to accept that ambiguity is part of clinical medicine and to recognize the need for and to uFlize appropriate resources in dealing with uncertainty
P1 Humanism: compassion, integrity, and respect for others; empatheFc pracFFoner P2 Professionaliza5on: A sense of duty and accountability to paFents, society, and profession
MulFple Tools mapping to a Milestone
Or will you use the Sub-‐competency Milestones as your tool?
PROF4. Demonstrates self-awareness of one’s knowledge, skill, and emotional limitations, which leads to appropriate help-seeking behavior*
Level 1 Level 2 Level 3 Level 4 Level 5 Demonstrates an inability to recognize and acknowledge limitations and need for help with unintended consequences.
Requests assistance in response to external prompts. Afraid to appear weak.
Recognizes limitations, but perceives the need for autonomy to super-cede help-seeking
Recognizes limitations and requests help when needed
Habitually engages in help-seeking behaviors and role models teamwork to others
*Brian Youth, Maine Medical Center
Trustworthiness – ACGME reporFng
Trustworthiness PROF5. Demonstrates trustworthiness, so that colleagues feel secure when one is responsible for care
Level 1 Level 2 Level 3 Level 4
Gathers information incompletely or gives misinformation Follow-through with tasks is inconsistent.
Partially gathers essential information. Requires prompting to complete tasks.
Gathers complete information for most situations. Completes most tasks independently. Initiates secondary tasks with prompting.
Thoroughly gathers complete information consistently. Self-initiates follow-through, without direction, checks all data and assures all task completion. Initiates secondary tasks without prompting.
*Brian Youth, Maine Medical Center
Assess Trustworthiness
• 15 minutes using tool(s) on table to assess trustworthiness of learner
• 15 minutes to present advantages and disadvantages of assigned tool(s)
Handover Clip 2
In the NICU …
Assessing Trustworthiness
• 15 minutes for each group to assess trustworthiness; use assigned tools, then map to trustworthiness level
• 15 minutes to present advantages and disadvantages of assigned tool(s)
Professional Development
Professionalism
• A behavior to be demonstrated1 • A developmental process2
– recognize and resolve conflicts3 • Link between problems in training and eventual discipline by a medical board4
1 Stern DT, ed. Measuring Medical Professionalism, 2006 2 Forsythe GB et al. The Future of the Army Profession. NY, 2002
3 Ginsburg S et al. Context, conflict, and resolu2on: a new frame for evalua2ng professionalism. AcadMed, 2000 4 Papadakis et al. Disciplinary ac2on by medical boards and prior behavior in medical school. NEJM, 2005
Unprofessional …
• What is “not professional”? • When is it a ‘problem?’
– ConFnuum
– Lapses
When to Throw the Flag?
Concerning Behavior PaAern
Professionalism CommiAee
ProbaFon + RemediaFon
Corrected
Dismissal
RemediaFon Alone
Corrected
ProbaFon
Drug/Alcohol/Psych
State CommiAee on Physician
Health Follow Up
Medical School to Residency
• Deciding Body – Honor Board – lesser offenses that are remediable
• Not reported on Dean’s leAer – PromoFons and Review Board, acFons are reported on Dean’s LeAer • Decides on disciplinary acFons • Formalizes remediaFon plans • ExcepFon: Referrals to State CommiAee on Physician Health
• ReporFng Instrument is Dean’s LeAer
Dean’s LeAer
Residency to Independent PracFce
• Deciding Body – Clinical Competence CommiAee
• Many ReporFng instruments – American Board of Pediatrics Annual In-‐Training EvaluaFon
– VerificaFon of Training Forms • PotenFal employers
• GME office (insurance companies)
ReporFng to the ABP
B. Professionalism (mark one) SaFsfactory UnsaFsfactory
o Repeat Year of Training o Period of ObservaFon
ReporFng to PotenFal Employers
ReporFng to GME office
The ReporFng ExcepFon State CommiAee on Physician Health
• “The Physician Health Program for New York State The CommiAee for Physician Health, founded in 1974, is a division of the Medical Society of the State of New York. CPH provides non-‐disciplinary, confidenFal assistance to physicians, residents, medical students, and physician’s assistants experiencing problems from stress and difficult adjustment, emoFonal, substance abuse and other psychiatric disorders, including psychiatric problems that may arise as a result of medical illness. “
• “We recommend evaluaFon, treatment and/or other assistance to our parFcipants, and monitor for progress in recovery from illness. In this way, we can also provide strong advocacy on behalf of the parFcipant to conFnue their pracFce as a physician or physician-‐in-‐training.”
• Tennessee: “The mission of the Physician’s Health Program (PHP) is to protect paFents through idenFficaFon, intervenFon, rehabilitaFon, and the provision of advocacy for physicians impaired by addicFve disease, mental or emoFonal illness.”
Wrap up
• Challenging and there is a developmental progression
• Tools are available and can be used to map to milestone level
• Review of reporFng requirements for lapses
• Please fill out evaluaFons
Thank-‐you
Comments, QuesFons, Thoughts …..
Professionalism • Humanism • ProfessionalizaFon • Professional conduct • Cultural competence
Personal and Professional Development
• Self-‐awareness • Healthy coping mechanisms • Personal/professional conflicts • Flexibility and maturity • Trustworthiness • Leadership • Self-‐confidence to put others at
ease • Dealing with uncertainty
