Giving Feedback on Professionalism with RESPECT Julie Crosson, MD Henri Lee, MD Robert Lowe, MD Craig Noronha, MD February 7, 2011

Resident and Faculty survey on Communication Skills and Professionalism Main points for today 1. Residents found role modeling the most effective teaching method 2. Residents wanted more feedback 3. Many attendings cited the need for faculty development in communication skills and professionalism.

Goals 1.Put giving feedback on professionalism more prominently on clinician-educators radar 2. Provide a tool with which to do it

Objectives by the end of the workshop participants will: Engage in reflection on their own successes/challenges in giving feedback on professionalism learn a tool to use in giving feedback on professionalism based on the RESPECT model have an opportunity to practice using the tool in a scenario most attendings would find challenging.

Unprofessional Behavior Treatment of patients – Derogatory comments – Jokes Treatment of colleagues Substandard medical care – Cutting corners – Discharge fever

Do we teach this well? Burack and Irby 1999 – 4 medical teams at an AMC – Observations and interviews over 2 weeks – Review of a vignette Unprofessional behaviors – Cutting corners – Referring to patients derogatively – Outright rudeness

Attending response Most common response = NOTHING Responses – Nonverbal Often unnoticed – Humor Was taken to be agreement by learner – Appealing to self-interest of learner Others might think this is unprofessional – Medicalization Being nice improves compliance

Why no response? Reluctance to criticize based on limited data Sympathy for the stress of residency The folly of youth Feedback is hard to give People cannot be changed Dont want to poison the work atmosphere

Opportunities Role-modeling works – People change – We need to model explicitly More direct observation of trainees Faculty development programs Discussing professionalism as a topic openly Treating our learners with respect

Why we actually DO want to give feedback on professionalism if we dont say anything residents think the attending is in agreement (Burak/Irby article) people who have professionalism issues in training- go on to have them in their career and are more frequently sued (Papadakis, NEJM) to avoid how did this person get to be a senior resident! and improve our program opportunity to point out blind spots, people might not realize how they come across to reinforce we want to see- positive feedback on exemplary behavior

Reflection Exercise Reflect on experiences you have with positive or negative professionalism cases -Why was this instance memorable? -What was feedback given? -What went well? What challenge did you overcome? What helped you get there?

The RESPECT MODEL Skills set for giving feedback R espect E xplanatory model S ocial context P ower E mpathy C oncerns T rust/ T herapeutic alliance Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson, Sandra Gordon, Sheila Chapman, Peter Gonzalez, Eric Hardt, Thea James, Michele David, JGIM (supplement 2):

RESPECT Self awareness: Be aware of our own hot buttons Model the parallel process: Treat the resident the way we want them to treat the patient Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Explanatory Model What do you think is behind the patients reaction/behavior? What do you think is behind your own reaction/behavior? Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Social Context Parallel process: respectful curiosity. Think about generalizations/stereotypes/ assumptions that are occurring. How do the values on which we are raised influence our clinical behavior? Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM ( supplement 2):

Power Non-verbals Ask their sense of power differential. Explicitly identify the role modeling – asking their point of view – listening without interrupting Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Empathy You seemed really frustrated… What comes up for you in this scenario from your personal experience? Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Concerns and Fears What are you worried about? What is the patient worried about? How can you know? Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Trust/Therapeutic Alliance Discuss the feedback What learning points would you like to work on? Lets talk about any ways that I could help you. Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training C Mostow, J Crosson et al. JGIM (supplement 2):

Skills Practice Participants play preceptor and resident role ( 15 min.) Identify which aspect of the RESPECT model you will utilize Workshop leaders- join you as coach and to voice 3 rd party concerns as needed Small group debrief after 15 minutes

Preparation for role play Reflection for Resident What are your motivations/ barriers? Which aspects of RESPECT are you least in touch with? Why? Reflection for the Preceptor What challenges you most in giving feedback? What will you do to help resident be open to hear What skills of RESPECT will you use?

Big Group debrief What worked? What are your still struggling with?

Take Home Points Feedback on professionalism is not happening (Burack/Irby article) Ways to make feedback easier – Set it up as an expectation – Give feedback on positive examples of professionalism (we dont do it enough!) – Use tools available to keep their ears open

Closing and Evaluations We are craving some feedback!