New York University School of Medicine THE PROFESSIONALISM CURRICULUM AS A CULTURAL CHANGE AGENT IN SURGICAL RESIDENCY EDUCATION Mark S. Hochberg, M.D., Adina Kalet, M.D., Sondra Zabar, M.D., Colleen Gillespie, PhD., Russell S. Berman, M.D., H. Leon Pachter, M.D. and the SPICE Study Group Department of Surgery New York University School of Medicine

SPICE NATIONAL STUDY GROUP Surgical Professionalism and Interpersonal Communication Education Albert Einstein American College of Surgeons Association of American Medical Chiba University (Japan) Cleveland Clinic Columbia University-College of Physicians and Surgeons Cornell Creighton University Dartmouth Medical School Drexel Medical Emory University Florida International Florida State University Georgetown University Medical Gold Foundation Harvard/Beth Israel Harvard/Brigham and Hofstra University Medical King Saud University (Riyadh, Saudi Arabia) Johns Hopkins Loyola University Medical LSU Health Center Macy Foundation Maine Medical Center McGill University Medical College of Georgia Michigan State University Mount Sinai Medical Center National Board of Medical Examiners Northwestern University School of Medicine Ottawa Medical Center Rush University (Chicago) Southern Illinois University SUNY/Downstate Texas Tech Univ. Health Science Center Tufts Medical School/Baystate Tulane University United States University of Health Sciences University of Arizona University of British Columbia (Canada) University of California, Irvine University of California San Francisco-Fresno University of Florida School of Medicine University of Georgia University of Hawaii   University of Illinois-Chicago University of Illinois-Urbana University of Kansas University of Minnesota University of Missouri-Columbia University of Missouri-Kansas University of New Mexico University of North University of North Dakota University of Rochester University of South University of Southern California University of Tennessee/Knoxville University of Texas/San Antonio University of Utah University of Washington Medical School University of Western Ontario (Canada) Vanderbilt Medical School Virginia Commonwealth University Virginia Tech Medical School Washington University St. Louis Wayne State University

ACGME SIX CORE COMPETENCIES Patient care Medical knowledge Practice based learning and improvement Interpersonal and communication skills Professionalism Systems based practice CHALLENGE FOR SURGEONS: #4 AND #5

WHEN WAS THE PROFESSIONALISM COMPETENCY MANDATED BY THE ACGME/RRC? 1999 2002 2004 2006

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NYU PROFESSIONALISM SEMINAR TOPICS Advanced Communication Skills for Surgical Practice Admitting Mistakes - Ethical and Communication Issues Delivering Bad News – Your Chance to Become a Master Surgeon     Interdisciplinary Respect  -- Working as a Team   Working Across Language and Cultures: The Case for Informed Consent      Medical malpractice and the Surgeon Stress of Surgical Practice – The Life You Save May Be Your Own

OUR TWO QUESTIONS: Has professionalism education as mandated by the ACGME/RRC in 2002 taken hold? Is there any evidence that surgical residents’ professionalism skills have improved over time?

EVALUATION OF PROFESSIONALISM EDUCATION STUDY #1 Resident self-assessment of professionalism abilities – annually over four years STUDY #2 Objective metrics of resident performance during professionalism OSCEs as graded by standardized patients – annually over three years STUDY #3 SPICE Study Group national survey of 41 departments of surgery

STUDY #1 SUBJECTIVE METRICS

STUDY # 2 OBJECTIVE METRICS Studied one cohort of nine surgical residents over a three year period Each resident completed a six-station OSCE on professionalism each year The same set of OSCEs are administered as residents entered their PGY1, PGY2 and PGY3 years Standardized Patients varied over the years – all received similar training; rated each task as “well done”, “partially done” or “not done” by the resident 54 OSCEs per year; total 162 OSCEs over the three year study period

STUDY # 2 OBJECTIVE METRICS

STUDY #3 SPICE NATIONAL SURVEY

STUDY #3 SPICE NATIONAL SURVEY

STUDY #3 SPICE NATIONAL SURVEY

Let’s go to the videotape Ending Well 15

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FUNDING SUPPORT Josiah Macy, Jr. Foundation Arthur Vining Davis Foundations

THANK YOU! Adina Kalet, MD adina.kalet@nyumc.org Mark Hochberg, MD mark.hochberg@nyumc.org Sondra Zabar, MD sondra.zabar@nyumc.org

Mostly NOT Significant except Ethics: PGY 2 < 4 20