1. Building a Medical Professionalism Curriculum: Beyond Role Modeling Heather O’Mara, DO Dawn Sloan, MD

2. Disclosures The opinions expressed herein are those of the authors and are not necessarily representative of those of the U.S. Army or Department of Defense.

3. Objectives Define medical professionalism. Critically discuss how to teach and evaluate ACGME Family Medicine Milestones for professionalism. Participate in one method of teaching medical professionalism

4. IMPORTANCE OF PROFESSIONALISM

6. Professionalism in the Literature Smith LG. Medical professionalism and the generation gap. AM J Med. 2005; 118:440

7. Poor Professionalism Lapses lead to more state licensing board actions than lack of medical knowledge Unprofessional behavior in medical school predicts: –Poor performance in residency –Adverse actions by licensing board Unprofessional behavior associated with patient complaints and litigation Learner burnout and depression

8. High Professionalism Linked to improved patient outcomes Higher resident in-service training exams More likely to complete administrative tasks Less likely to receive official “warnings” or “probationary status” during formal training Relationship between “physician excellence” and professionalism (medical knowledge, skills, conscientious behaviors)

9. DEFINING PROFESSIONALISM

10. Stern Model Mueller, PS. Teaching and assessing professionalism in medical learners and practicing physicians. Rambam Maimonides Med J 2015; 6 (2):e0011.

11. ACGME: FM Milestones PROF-1: Completes a process of professionalization PROF-2: Demonstrates professional conduct and accountability PROF-3: Demonstrates humanism and cultural proficiency PROF-4: Maintains emotional, physical, and mental health; and pursues continual personal and professional growth

12. Activity 1 Group 1: - List methods to TEACH professionalism - Annotate methods your program uses - Think about advantages and disadvantages of each method Group 2: - List methods to EVALUATE professionalism - Annotate methods your program uses - Think about advantages and disadvantages of each method 5 min

13. TEACHING PROFESSIONALISM

14. Group 1 Share

15. Teaching Methods Didactics Small group discussion Role Modeling Reflection Simulation Web-based modules Audience response systems Independent learning Mentoring

16. Hidden Curriculum

17. Emotional Intelligence AHME September 2015 Teleconference. Strategies for giving feedback & creating a faculty development program on professionalism by Brian Aboff, MD. Self Awareness Social Awareness Relationship Management Self Management

18. EVALUATING PROFESSIONALISM

19. Group 2 Share

20. Evaluation Methods OSCE Portfolios Reflection Faculty observation Critical incident reports Self assessment 360 evaluation Peer assessment Record review Patient questionnaires Knowledge test

21. The Unprofessional Learner Direct observation and critical incident reports Early lapse identification Determine cause of lapse: –Behavioral/interpersonal –Impairment (medical, psychiatric, substance abuse) –Stress management –Cognitive issue –Family issue Notification Remediation Plan

22. Define and characterize the professional lapse State goals and successful remediation Outline consequences for not completing the plan Articulate requirements for completion of plan

23. Activity 2 Case Vignettes: A. Documentation delinquencies B. Social media presence C. Interprofessional difficulties D. Impaired resident 15 min

24. Professionalism Curriculum Set expectations early & often Provide (consistent) feedback for aberrant behavior & positive behaviors Role modeling Ethics case conferences; resident participation Monitor resident wellness; promote resilience & prevent burnout Points system to identify positive/negative actions

25. Professionalism Disconnect 2 institutions surveyed 375 PGY1 residents. Goal: identify PGY1 perspectives on professionalism issues and their behaviors that may contradict these perceptions Queried 46 behaviors –Professionalism rating (unprofessional, neutral, professional) –Observed or participated in behavior Nagler et al. The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors? BMC Medical Education 2014, 14:60

26. Professionalism Disconnect Behaviors reported having participated in by 10% or greater of respondents

27. Professionalism Disconnect

28. Culture of Professionalism: Faculty Incorporated faculty professionalism as a routine agenda item. Monthly time is allotted at faculty meeting for any concerns to be raised. Quarterly faculty facilitate a case on a “professionalism” topic. Dieter PM, Hudak NM, Robinson PR. Promoting faculty professionalism: a case-based approach. Perspect Med Educ. 2015; 4:188-190

29. Faculty Professionalism Creates atmosphere of expectation of professionalism Keeps professionalism in the forefront; faculty modeling for students Dedicated time prevents neglecting discussions

30. Objectives Define medical professionalism. Critically discuss how to teach and evaluate ACGME Family Medicine Milestones for professionalism. Participate in one method of teaching medical professionalism

31. What Next?

32. Questions?

33. References 1. Smith LG. Medical professionalism and the generation gap. AM J Med. 2005; 118:440 2. ABIM Foundation, ACP-ASIM Foundation, European federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243-6. 3. Guidelines for Professionalism, Licensure, and Personal Conduct The American Board of Family Medicine (ABFM). Version 2015-2. Adopted Effective May 1, 2015. 4. Nagler et al. The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors? BMC Medical Educ. 2014; 14:60. 5. Kanter et al. What does professionalism mean to the physician? Perm J 2013; 17(3): 87-90. 6. AHME September 2015 Teleconference. Strategies for giving feedback & creating a faculty development program on professionalism by Brian Aboff, MD. 7. AHME September 2015 Teleconference. Assessing professionalism in the era of milestones by Dr. Eric Holmboe 8. Birden et al. Teaching professionalism in medical education: a best evidence in medical education (BEME) systematic review. Med Teach. 2013; 35(7) 1252:66. 9. ACGME Outcome Project. Advancing education in medical professionalism. Chicago IL. Accreditation Council for Graduate medical Education; 2004. Available at: http://www.usahealthsystem.com/workfiles/com_docs/gme/2011%20Links/Professionalism%20- %20Faculty%20Dev..pdf. Accessed October 19, 2015. http://www.usahealthsystem.com/workfiles/com_docs/gme/2011%20Links/Professionalism%20- %20Faculty%20Dev..pdf 10. Dieter PM, Hudak NM, Robinson PR. Promoting faculty professionalism: a case-based approach. Perspect Med Educ. 2015; 4:188-190.

34. References, cont. 11. Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ. 2014 Oct;48(10):980-7. 12. Malakoff et al. Accounting for professionalism: an innovative point system to assess resident professionlism. J Community Hosp Intern Med Perspect. 2014 Apr 14;4. 13. Stern D, Papadakis M. The developing physician – becoming a professional. N Engl J Med. 2006;355:1794-9. 14. Stern DT, ed. Measuring Medical Professionalism. New York, NY: Oxford University Press; 2006. 15. ACGME Milestones – Family Medicine. Available at: http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf. Accessed October 20, 2015 http://www.acgme.org/acgmeweb/Portals/0/PDFs/Milestones/FamilyMedicineMilestones.pdf 16. Taylor C, Farver C, Stoller JK. Can emotional intelligence training serve as an alternative approach to teaching professionalim to residents? Acad Med. 2011;86:1551–1554 17. Cruess et al, ed. Teaching Medical Professionalism. New York, NY: Cambridge University Press; 2009. 18. Mueller, PS. Teaching and assessing professionalism in medical learners and practicing physicians. Rambam Maimonides Med J 2015; 6 (2):e0011.

35. Please evaluate this presentation using the conference mobile app! Simply click on the "clipboard" icon on the presentation page.