Professionalism Week 2006

A Case for Education

January 27, 2006

Late one afternoon in the teaching hospital...

What happened?

Problem List

• Late day • Multidisciplinary Disorders• Demanding client • Whiny Attitudes• Tension and irritability• Blame

Problem #1: Late Case/Day“Differential diagnosis”

• Client got here late• Referring vet waited too long• The emergency service is slow• Medicine is always in rounds• Got stuck in “bottlenecks”• Hospital inefficiencies

Late Case/Day

• Busy day in a busy hospital• Sick animals can’t tell time

Problem #2: Multidisciplinary Case

• Let me know when you have a diagnosis

• Let me know if it needs to go to surgery• Not my table syndrome• They always go to medicine

Multidisciplinary Case

• Challenging case that requires teamwork and a “quarterback”

Problem #3: Demanding Client

• Just one of those *#&% types• Pathologically attached• Mentally ill• Other bias about individual• Entitled high maintenance client

Problem #3: Demanding Client

• Concerned and stressed pet owner

Problem #4: Whiny Attitudes • One of those days• Research grant/paper/presentation due• Problems at home?• She’s always like that• It’s those darn whiny students these

days

Whiny Attitudes

• Justified to make a point?• Emotions and reactions are high

Problem #5: Blame

• It must be someone’s fault..• “They never” syndrome• It’s harmless ribbing, get used to it• The RDVM should have known better

Problem #5: Blame

• Everyone is doing the best they can

Diagnostic Plan

• Reflect on problem list and look for common themes

• Reflect on situation• Determine action plan and prognosis

Ways of Thinking

Wow. That sounds like “cognitive restructuring”!

Dr. Strand

Cognitive Restructuring

• Three Rational Questions–Is my thinking based on fact?–Does my thinking help me achieve my

goals?–Does my thinking help me feel the

way I want to feel?

Pucci, 1999

Solution-Focused Problem Solving

• Identify a time in the recent past when this was not a problem?

• What was happening that worked well? • What would we see if we were watching

things go well on videotape?

Kim-berg, 2002

• So what does this have to do with professionalism?

Professionalism

• From “profess”: to make a vow, admission, claim, allegiance

• “The conduct, aims or qualities that mark a profession or professional person”

Professionalism

• A vocation or occupation requiring long period of intense study

• Performing specialized work for pay• “the following of a profession for gain or

livelihood”

Is it just a job?

Professionals Healers

Autonomy

Self-Regulation

Responsibility to Society

Teamwork

Competence

Commitment

Confidentiality

Altruism

Integrity

Ethics

Responsibility to Profession

Caring/Compassion

Insight

Openness

Respect for Healing

Respect for Patient

Presence

Steinart et al, McGill University

Professionals and Educators

• Recognize special responsibility • Encourage free spirit of learning• Foster honest academic conduct• Demonstrate respect for students• Recognize obligations in community of

scholars • Serve as responsible member of academic

institution• Maintain rights/obligations as citizen of

larger communityAmerican Association of University Professors, 1966/1987

Professionals and Educators• Diversity and Tolerance• Civility• Free Exchange of Ideas• Fairness• Integrity• Intellectual Standards of

Excellence• Autonomy

AAUP, American Council on Education; 2005

UTCVM Professional Behaviors

• Commitment to EXCELLENCE• High MORAL and ETHICAL Standards• Act with COMPASSION• PRIDE, DIGNITY, ALTRUISM• Treat others with RESPECT• Act with HONESTY and INTEGRITY• Be TRUSTWORTHY and PREPARED• Exhibit COLLEGIALITY• Act with CONFIDENTIALITY

Does it matter?

Does it matter?

Does professionalism matter?

• What’s your emotional bank account at the end of the day? Week? Year?– Surplus?– Deficit?

What’s the Evidence?

• Student behavior predictive of future disciplinary actions for physicians

• Particularly with 3 domains–Poor responsibility/reliability–Lack of self-improvement/adaptability–Poor initiative/motivation

Academic Medicine, 2004New England Journal of Medicine, 2005

What’s the Evidence?• Compared 5 yrs of student report data with

physician citations in state

• Most were breaches of integrity/ professionalism (75% of students, 79% of physician citations)

– Failure to meet requirements, attendance

– Abuses of privilege

– Substance abuse

• 16% for arrogance, abusive behavior, poor group interaction

Ainsworth et al, AAMC, 2005

What about the rest of us?

• Students observed and reported Operating Room behaviors

• Residents and anesthesiologists – good > bad

• Attendings and surgeons – bad > good

Curry, et al, AAMC, 2005

What about the rest of us?

• Most “bad” interactions in communication and respect

• More “bad” interactions with colleagues, co-workers than students or patients

Curry, et al, AAMC, 2005

What’s the Evidence?

• N= 281 veterinary students and 142 recent grads–Students who felt comfortable

discussing emotional veterinary issues with their professors also felt more confident and competent discussing and handling these issues with their clients

Tinga et al, 2001. JAVMA

What’s the Evidence?

• Malpractice–Virtually all malpractice claims are

associated with breakdown in communication within the veterinary team and between the team and the client.

Newman, Esq., 2004, NAVC Proceedings; Richardson, F. 2005

What’s the Evidence?

• Malpractice– Once a medical mistake has been made

these are the most common complaints against veterinarians:• Delay in informing the client

• Attempts to understate the problem

• Treatments to fix the problem without the client’s approval or knowledge

• Altered records

Can Professionalism be Taught?

Educating Professionals

• Late day • Multidisciplinary Disorders• Demanding client • Whining• Tension and irritability• Blame

Remember the Problem List

Educating Professionals

• Late day

• Multidisciplinary Disorders

• Demanding client

• Stress management Time mgmt Setting limits

• Conflict Resolution Teamwork

• Communication skills Cultural/diversity training

Educating Professionals

• Whiny Attitudes

• Tension and irritability

• Blame

• Self-awareness Professionalism

• Stress/coping skills Communication skills Cognitive restructuring

• Feedback skills, Conflict resolution

Naivete

Idealism

Years of Training

Student Mature Professional

Hilton, Clin Teach, 2004

Naivete

Idealism Cynicism

Wisdom

Years of Training

Student Mature Professional

Hilton, Clin Teach, 2004

Naivete

Idealism Cynicism

Wisdom

Years of Training

Student Mature Professional

Positive Experiences

Negative Experiences

Hilton, Clin Teach, 2004

Expectations for professionalism week

• Wide participation in dialogue• Time for reflection and personalization

of professionalism• Renewed “vows” toward

professionalism• New ideas and goals

Another day in the veterinary teaching hospital…

What happened this time?

Professionalism

• “A professional is one who can do his job well even when he doesn’t feel like it”

Acknowledgments

• Veterinary Social Work• Educational Enhancement Committee• Office of the Dean• UT Employee and Organizational

Development• Instructional Resources

Professionalism Week

• Departmental and Unit Workshops–Wednesday February 1, 8 – 10 am

• Building Trust within an Organization–Dr. Linda Francisco–Thursday, February 2, 3 pm–Followed by reception/social hour