Fostering a Culture of Accountability and Respect: Resident Leadership and

Development of a Professionalism Curriculum

Neha Sachdev, MD

Objectives

I. Background

II. Why Professionalism?

III. Research Methods

IV. Initial Results]

V. Interventions

VI. Timeline/Next Steps

Background• Northwestern McGaw Family Medicine Residency

• One of 11 original Teaching Health Center programs• Partnership with Erie Family Health Center (FQHC), Northwestern

McGaw Medical Center and Norwegian American Hospital (America’s Essential Hospital)

• Leadership Emphasis

and Culture

Why Study Professionalism?• ACGME Core Competency / Milestones• Central to formation of professional identity• Unprofessional conduct in learners

strongly correlates with future disciplinary actions• Residents identify importance of professionalism

education in training• Increasing demands on resident-time• Required for future leadership

Research Methods• Outcomes Measures

• Quantitative• Pre-post-post survey with PMEX• 24 residents, 6 fellows, 11 faculty members and residency coordinator

•Qualitative• Small group interviews with R1 and R2 classes

• Process Measures• Peer to peer formative feedback sessions• Longitudinal skill-building sessions• Longitudinal case-based sessions

PMEX Survey• Validated tool• Specific, observable behaviors• 9 questions in 4 major categories

• Doctor/Patient Skills• Time Management• Reflective Skills• Interpersonal Skills

Assessment- PMEX

Characteristics: 21 Respondents-Faculty & Residents, response rate of 62%

0

1

2

3

4

5

Highest Professionalism Scores

Admits errors/om-missions

Solicit feedback Accept feedback Address own gaps in knowledge and skills

1

2

3

4

5

Lowest Professionalism Scores

Pre Results

9

Key Findings = Lowest mean scores in Reflective skills, Highest

mean scores in Doctor-Patient Relationship skills

Interventions• Peer to peer feedback sessions on inpatient service• CCC formalization with resident presence• Formal feedback training- SBI method

Timeline• Winter/Spring 2014

• First Post PMEX Assessment collected• Small group interviews with PGY1 and PGY2 residents• 6 professional skill-building sessions held with PGY2/PGY3 residents

• Summer/Fall 2014• First Post PMEX analysis• Formal feedback sessions implemented in clinic, MCH service• 3 ‘On Doctoring’ sessions held with all residents and faculty• 4 ‘On Doctoring’ sessions held with PGY2/3 residents

• Winter 2015• Second Post PMEX Assessment collected• Follow-up small group interviews with PGY2/PGY3 residents

Focus Group Questions1) We are interested in understanding how residents learn about

professionalism. How would you define professionalism, what do you think it is?

2) We are interested in understanding your training and educationalexperiences in professionalism. Can you describe some of the ways that you have learned about professionalism? What has been the best educational experience? Why was this an effective method or approach? Can you describe some of the least effective ways to learn about professionalism? What made that educational experience ineffective?

3) What are some of the challenges to teaching professionalism in residency? What are your suggestions on how to teach professionalism effectively during residency?

4) Are there any other comments or experiences that you can share that would help us build an effective professionalism curriculum for residents?

Focus Group Themes Identified

Professionalism Definitions (positives and negatives) - Respect - Leadership - Patient care &

communication - Interprofessional

relationships - Learned vs. innate - Self-assessment - Behavior under stress &

fatigue

Methods of teaching/learning professionalism - Reflection - Didactic - Case-based/situational - Role-modeling/mentors - Code of

conduct/standards - Evaluations

(Individualized)

Difficulties with teaching/identifying professionalism - Skepticism - Blurring of roles

(peer vs friend vs colleague)

- Time/scheduling

Timeline/Next Steps• Winter/Spring 2014

• First Post PMEX Assessment collected• Small group interviews with PGY1 and PGY2 residents• 6 professional skill-building sessions held with PGY2/PGY3 residents

• Summer/Fall 2014• First Post PMEX analysis• Formal feedback sessions implemented in clinic, MCH service• 3 ‘On Doctoring’ sessions held with all residents and faculty• 4 ‘On Doctoring’ sessions held with PGY2/3 residents

• Winter 2015• Second Post Assessment collected• Follow-up small group interviews with PGY2/PGY3 residents

“On-Doctoring” Curriculum• Defining Values• The Impaired Physician• Finding Inspiration in Medicine• Leadership and Communication• Risk Management and Legal Basics• Balance and Wellness• Lapses in Professional Conduct

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