Professionalism

Fiduciary duty of, relating to, or involving a confidence or trust (Merriam-Webster) A contract with society Law, Medicine, Clergy

Spheres of Professional Responsibility Society Patient Co-workers Self

Medical Professionalism in the New Millennium: A Physicians' Charter 1 Primacy of Patients' Welfare Patients' Autonomy Social Justice The Medical Professionalism Project · The 2005 RSNA Professionalism Committee

Commitment to... Professional Competence Honesty with Patients Patients' Confidentiality Maintaining Appropriate Relationships with Patients Improving Quality of Care Improving Access to Care Just Distribution of Finite Resources Scientific Knowledge Maintaining Trust by Managing Conflicts of Interest Professional Responsibilities

Professionalism LawVirtue

Traditional Topics Conflicts of Interest Confidentiality Errors Impaired Physicians Incompetent Physicians Boundary Issues

Professionalism: Swick 2000 Academic Medicine Physicians subordinate their own interests to the interests of others Physicians adhere to high ethical and moral standards Physicians respond to societal needs Physicians evince core humanistic values including honesty, integrity, caring, compassion, altrusim, empathy, respect, trustworthiness

Physicians exercise accountability for themselves and for their colleagues Physicians demonstrate a continuing commitment to excellence Physicians exhibit a commitment to scholarship and to advancing their field Physicians deal with high levels of complexity and uncertainty Physicians reflect on their actions and decisions

Emerging Topics 2010 Social Networking and Media Diversity among Patients and Workplace New attitudes toward communication with patients Need for trainee codes of professionalism Evolving Power-Distance

Case 1 Social Networking John Brown, a 2 nd year resident in Radiology has a Facebook persona with 143 “friends”; posted on his wall are photos from his days as a college football star. Issues are that he frequently complains about the residency program, faculty members, workload, and actively solicits comments from female “friends”, some of whom are fellow residents, technologists in the dept, and patients. Do you believe this is appropriate behavior? Why?

Case 2 Communicating results You have just completed an imaging examination on a 5 year old child and the family members are waiting to discuss the preliminary results of the cranial study. The patient, who presented with a tremor has a large posterior fossa tumor. Her pediatrician is away at a meeting. What will you discuss with the family? Why?

Case 2B The training directors have decided to have the 9 PGY 2 and 3 residents in the program learn to provide preliminary study results to patients. Rate numerically from worst (1) to best (7) the following ways that they could learn to do this:

Case 2 B Possibilities Rank 1-7 Worst-Best 1.Observe a faculty member giving study results to a patient. 2.Present a lecture on methods of communicating results to patients. Then test the learners. 3.Hold the lecture followed by a resident ‘Teach-Back’ 4. Have residents view a video on giving results 5. Groups critique a video of a physician giving results to a patient. 6. Write a 5 sentence short essay on giving results. 7. Assemble the residents into a group to practice giving results to standardized patients.

What is your picture of a classroom? University of Missouri

What can be your ‘picture’ of a classroom? Apple, Inc.

Case 3 Concept of “Power-distance” Joe Green (PGY5) and Mary Brown (PGY3) are on service together and asked by the pulmonary fellows to plan and present a conference for pulmonary’s 6 attendings and 3 fellows. They are excited and ask the radiology attending to help provide some cases, and for suggestions. The attending, an Associate professor, has a fit that he was not asked, although he would have given the duty to them, anyway. What is the problem here? How could it be managed better? Have you experienced Power- distance issues?

Case 4 Residents are derogatory about Dr. Smith, a semiretired physician who has outdated knowledge of technology. However, he has sharp skills in film interpretation, in which he capably and enthusiastically instructs residents. The problem residents have is that he does not recommend or utilize cross sectional imaging when indicated. As a resident, what should you say or do when you believe his recommendations are in error? What and why?

Case 5 A 6 yo boy at play, accidentally sustained a head injury in which he reportedly lost consciousness for about 1 minute. In the ER he is alert and responsive and has a normal neurologic exam. Mother and the ER physician feel he should be discharged home and monitored by the mother. Dad, an Internist and divorced from the mother, believes the child should have a cranial CT scan to ensure there is no underlying injury. How should you manage the situation? Why?

Case 6 Joe Green, is a PGY 5 resident with 3 great job offers. He encounters fellow resident, Sam, who says: “Don’t forget our board review session today from 3 until 6!” Joe replies; “Naw, I hate spending time on all that trivia, I prefer to learn by listening to the consults, instead.” What do you know about Joe and Sam? Who will do better on the Boards? In life? Why?

Novice Advanced beginner Competent Proficient HL Dreyfus 1986 Expert, Master Competence: What individuals know or are able to do knowledge, skills, attitudes.

Data Information Meaning Knowledge Insight Wisdom Patrick Lambe

Training Performance Competence, certification Practice, sustainable abilities Learning Knowing Understanding Comprehension Mastery