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 cant 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? Shes always like that Its those darn whiny students these days

Whiny Attitudes Justified to make a point? Emotions and reactions are high

Problem #5: Blame It must be someones fault.. They never syndrome Its 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 community American 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 professionalism matter? Whats your emotional bank account at the end of the day? Week? Year? –Surplus? –Deficit?

Whats 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, 2004 New England Journal of Medicine, 2005

Whats 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

Whats 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, JAVMA

Whats 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

Whats 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 clients 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 StudentMature Professional Hilton, Clin Teach, 2004

Naivete IdealismCynicism Wisdom Years of Training StudentMature Professional Hilton, Clin Teach, 2004

Naivete IdealismCynicism Wisdom Years of Training StudentMature 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 doesnt 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