1. Accountability and Transparency: Re-focusing on Professionalism
Raj Woolever, MD
Program Director
Deborah Taylor, PhD
Associate Program Director
Central Maine Medical Center
Family Medicine Residency

2. Objectives Define components of professionalism
Discuss the concepts of accountability and transparency and consider of the current state of accountability and transparency at your home FM department/residency
Develop strategies and tools that may improve accountability and transparency and result in more effective teaching and evaluation of professionalism

3. ACGME/AOA Competencies
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Practice Based Learning and Improvement
System Based Practice
Osteopathic Principles and Practice

4. ACGME/AOA Competencies
Medical Knowledge
Patient Care
Interpersonal and Communication Skills
Practice Based Learning and Improvement
System Based Practice
Osteopathic Principles and Practice
Professionalism

5. Professionalism
How would you define professionalism?

6. Professionalism OR Do you just know it when you see it?
How would you define professionalism? OR
Do you just know it when you see it?

7. Professionalism Self-Assessment
Arnold, LE, Thompson, GS, Quaintance, J; University of Missouri-Kansas City School of Medicine.

8. Professionalism Components:
Respectful of patients, families, colleagues, teachers and co-workers
Compassionate
Honest
Recognizes and accepts responsibility for errors
Considers the needs of others

9. Professionalism Attributes:
Subordinate own interests to those of others
Adhere to high ethical and moral standards
Respond to societal needs
Evince core humanistic values
Exercise accountability for themselves and colleagues
Demonstrate a continuing commitment to excellence
Reflect upon their actions and decisions
Swick, HM; “Toward a Normative Definition of Medical Professionalism”; Academic Medicine, No. 75, 2000.

10. Professionalism What it is NOT: Dishonesty
Arrogance and disrespectfulness
Prejudice
Abrasive interactions
Lack of accountability
Fiscal irresponsibility
Lack of commitment to self-learning
Lack of due diligence
Personal excesses
Sexual misconduct
Duff, P; “Teaching and Assessing Professionalism in Medicine”; Obstetrics and Gynecology, Vol. 104, No. 6, December 2004.

11. Professionalism Competency or personal traits?
Strikes a little “close to the heart”

12. Professionalism Competency or personal traits?
Strikes a little “close to the heart”
How do you TEACH professionalism?

13. Professionalism Distinct curriculum Part of Practice Management
Part of Orientation
Role playing/case scenarios
Professionalism Mini-Evaluation Exercise (P-MEX)
Other activities?

14. “… medical training is also a process of moral enculturation, and that in transmitting normative rules regarding behaviors and emotions to its trainees, the medical learning environment functions as a moral community…”
Chuang, A, Nuthalapaty, F, Casey, P; To the point: reviews in medical education-taking control of the hidden curriculum; Am J of ObGyn 2010; Oct: 316.e1-316.e6.

15. 3 common medical student criticisms of physicians:
do not care enough about their patients
do not know enough to practice the best medicine
do not do enough to maintain the public’s trust
Chuang, A, Nuthalapaty, F, Casey, P; To the point: reviews in medical education-taking control of the hidden curriculum; Am J of ObGyn 2010; Oct: 316.e1-316.e6.

16. Professionalism The Business of Medicine
Business values:
Profit
Competition
Responsible to stockholders
Services driven by the market
Standards set by external forces
Consumerism
Short-term goals
Giving society what it thinks it wants
Professional values:
Service
Advocacy
Responsible to those served
Services driven by a body of knowledge
Standards set and maintained internally
Humanism
Long-term goals
Meeting society’s needs
Swick, HM; “Toward a Normative Definition of Medical Professionalism”; Academic Medicine, No. 75, 2000.

17. Professionalism Duty Hour Requirements
“Professionalism in the Era of Duty Hours: Time for a Shift Change?”
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

18. Professionalism Duty Hour Requirements
Nostalgic professionalism
Needs of patient and/or profession before self
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

19. Professionalism Duty Hour Requirements
Nostalgic professionalism
May be in conflict with duty hour requirements
May result in “breaking the rules” and/or “lying” about hours
Senior residents more likely to violate than interns
24/7 electronic access
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

20. Professionalism Duty Hour Requirements
Nostalgic professionalism
vs.
New
professionalism
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

21. Professionalism Duty Hour Requirements
Nostalgic professionalism
vs.
New
professionalism
Recognize limits
Emphasize physician health and alertness
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

22. Professionalism Duty Hour Requirements
Nostalgic professionalism
vs.
New
professionalism
Look to other industries for models
Aviation
Nursing
Law enforcement
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty
Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.

23. Professionalism How do you TEACH professionalism? Much more about:
“Walking the talk”
Modeling appropriate behavior
“In word and deed…”

24. Accountability and Transparency
What is the level of accountability in your organization?
Are assigned tasks followed-up on?
Do projects get completed?
Are deadlines met?

25. Accountability and Transparency
What is the level of accountability in your organization?
Are assigned tasks followed-up on?
Do projects get completed?
Are deadlines met?
What are the consequences when the above doesn’t happen?

26. Accountability and Transparency
What is the level of transparency in your organization?
Are decisions made in isolation?
Is information/data guarded?
Is there a mechanism for open communication?

27. Accountability and Transparency the Central Maine way…
Start with your faculty group
Do what you say you are going to do

28. Accountability and Transparency the Central Maine way…
Start with your faculty group
Do what you say you are going to do consistently

29. Accountability and Transparency the Central Maine way…
Start with your faculty group
Do what you say you are going to do consistently
Task lists
Action items
Tell residents what to expect and who to expect it from

30. Accountability and Transparency the Central Maine way…
Determine your key metrics (may be surrogate markers):
Medical record completion
Duty hour reporting
Punctuality/attendance
Quality measures
Make results visible

31. Accountability and Transparency the Central Maine way…
Shared information:
Star chart(s)
Outpatient records
“Same-day” evals
Point system
Duty hours
Dashboards
Quality metrics

32. Accountability and Transparency the Central Maine way…
Monthly “Professionalism Report” of metrics
Professionalism Award at graduation to all those above assigned thresholds

33. Professionalism Honesty/integrity Altruism/advocacy Accountability
Life-long Learning
Self Efficacy

34. Thanks for participating
Questions/Comments?
Thanks for participating

35. References
Arnold, LE, Thompson, GS, Quaintance, J; University of Missouri-Kansas City School of Medicine.
Arora, VM, Farnan, JM, Humphrey, HJ; “Professionalism in the Era of Duty Hours: Time for a Shift Change?”; JAMA, Vol 308, No 21, December 5, 2012.
“Assessment of Professional Behaviors: A Multi-Competency, Multi-Source Feedback Program” at Accessed 9/7/12.
Chuang, A, Nuthalapaty, F, Casey, P; “To the Point: Reviews in Medical Education-Taking Control of the Hidden Curriculum”; Am J of ObGyn, October 2010.
Duff, P; “Teaching and Assessing Professionalism in Medicine”; Obstetrics and Gynecology, Vol. 104, No. 6, December 2004.
Swick, HM; “Toward a Normative Definition of Medical Professionalism”; Academic Medicine, No. 75, 2000.
ten Cate, O, Scheele, F; “Competency-Based Postgraduate Training: Can We Bridge the Gap Between Theory and Clinical Practice?”; Academic Medicine, Vol 82, No 6, June 2007.
Winter, RO, Birnberg, B; “Teaching Professionalism Artfully”; Family Medicine, Vol 38, No 3, March 2006.