Teaching Professionalism to Medical Residents WB06

Transcription

1 Teaching Professionalism to Medical Residents WB06 SGIM 28 th Annual Meeting New Orleans, Louisiana May 5, 2005 Gwen Z. Beck, M.D. Lauris Kaldjian, M.D.

2 Teaching Professionalism to Medical Residents M. Gwen Z. Beck M.D. Lauris Kaldjian M.D. May 5, 2005 I. Defining Professionalism A. Project Professionalism ABIM 1. B. ABIM Medical Professionalism in the new millenium: A physician charter. Ann Internal Med 2002; C. Blank, L., Medical Professionalism in the new millennium; A physician charter 15 months later. Ann Internal Medicine 2003; 138; II. Teaching methods for professionalism A. Model Curriculum Project on Bioethics and Humanism American Society for Bioethics and Humanities response to the ACGME competency on professionalism B. ACGME Advancing Education in Medical Professionalism Educational resources to aid teaching and assessing professionalism C. Use of film to promote self reflection 1. ABIM Foundation The Choice is Yours. The film uses interviews with patients and physicians and examples of reflective practice. The film and users guide is available from ABIM Foundation D. Klein, E., et al, Teaching Professionalism to Residents. Academic Medicine 2003; 78: Description of a curriculum for professionalism for a pediatric resident retreat. E. Wear, D., The House of God: Another Look. Academic Medicine 2002; 77: Description of use of a popular literary text to promote critical reflection on self and profession. F. Kuczewski, M., Fostering Professionalism: The Loyola Model. Cambridge Quarterly of Healthcare Ethics, 2003; 12: G. Branch, W., Feedback and Reflection: Teaching Methods for Clinical Settings. Academic Medicine 2002; 77: H. Siegler, M., Training Doctors for Professionalism: Lessons Learned from Teaching Clinical Medical Ethics. Mount Sinai Journal of Medicine, 2002; 69: III. Evaluating Professionalism A. ACGME Toolbox of Assessment Methods Version 1.0; Description of assessment methods that can be used for residents including the following: Degee evaluation instrument 4. Checklist evaluation of live or recorded performance 5. Global rating of live or recorded performance 6. Objective Structured Clinical Examination (OSCE) 7. Chart Stimulated Recall Oral Examination (CSR) 8. Patient surveys 9. Portfolios 10. Standardized Patients

3 B. ACGME Competencies: Suggested Best Methods for Evaluation Table summarizing the best assessment tools from the ACGME toolbox for evaluating residents in each competency. C. ACGME Outcomes project; Professionalism: Assessment Approaches A table of professional assessment approaches with files available as PDF. D. ACGME Advancing Education in Medical Professionalism ABIM Scale to measure professional attitudes and behaviors in medical education. Pages in PDF. 3. Musick 360 degree Assessment. Pages in PDF. E. Portfolio for Internal Medicine Residency Programs Includes resident evaluation forms for all competencies F. Project Professionalism ABIM Strategies for Evaluating Professionalism a. Rely on multiple observations by multiple evaluators b. Use peer evaluation and Professional Associate Ratings (PARS) form to assess components of professionalism c. Develop self assessment questionnaire regarding components of professionalism for residents and faculty d. Develop a critical events file and/or feedback cards for trainees to document both positive and constructive comments e. Expand performance evaluation forms to include formal evaluation of professionalism f. Include professionalism items into in service exams IV. General Information on Competencies A. Portfolio for Internal Medicine Residency Programs 1. B. Advancing Education in Medical Professionalism; An educational resource from ACGME outcomes project 1. V. Additional Links to Useful Websites A. Gold Foundation Humanism in Medicine 1. B. ABIM Foundation 1. C. ACP Center for Ethics and Professionalism 1. D. AMA s Ethics Standards Group Ethics resource center with STEP Strategies for Teaching and Evaluating Professionalism E. AAMC Flag in the wind report on education on professionalism in medicine 1. F. NBME Embedding Professionalism in Medical Education: Assessment as a tool for Implementation 2002

4 1. G. NBME Behaviors of Professionalism 1. VI. University of Iowa approach to Professionalism Curriculum Teaching Method Evaluation Method Challenges to professionalism Interactions with pharmaceutical industry Medical errors Understanding limits of abilities Communication; Sharing bad news End-of-life discussions Small group discussion Teachable moments Role modeling Simulated patients Self-reflection See also ACGME Advancing Education in Medical Professionalism Preceptor summative evaluation Direct observation Feedback with Mini CEX 360 Evaluation Standardized patients See also ACGME Toolbox of Assessment Methods

5 Seminar on Professionalism Ambulatory Block Curriculum Department of Internal Medicine Drs. Beck and Kaldjian Objectives Characterize the professional attributes of respected peers. Identify challenges to professionalism in clinical training and practice. Consider ways to respond to specific professional challenges. I. Hand out 4 questionnaires (sequentially, one after the other) 1. What are the most important challenges to your professionalism as a physician in training? 2. What do you think are the most important values or characteristics of professionalism for a resident? 3. List 3 of the residents in your training program who show the highest levels of professionalism. After each one, please list 3 of their most important professional qualities. 4. Program and Personal Assessment II minute break (collate and organize questionnaire response) III. Feedback/discussion of questionnaires #2 and #3 (and perhaps #4) IV. Feedback/discussion of challenges to professionalism (questionnaire #1) Clinical Contexts to be covered (if possible): Interactions with pharmaceutical representatives Responding to and disclosing medical errors Handling limits to clinical ability Code status discussions Attitudes toward less desirable patients Accepting additional work (eg, patients added to clinic schedule) Handling the pressures of productivity (RVU expectations in clinic) Handling the pressures to reduce length of stay (rapidity of care on the wards) Patient advocacy (tension between patient care and management of resources) Challenges posed by the 80 hour work week

6 1. What are the most important challenges to your professionalism as a physician in training?

7 2. What do you think are the most important values or characteristics of professionalism for a resident?

8 List 3 of the residents in your training program who show the highest levels of professionalism. After each one, please list 3 of their most important professional qualities. Name of resident: List three of their most important professional qualities: Name of resident: List three of their most important professional qualities: Name of resident: List three of their most important professional qualities:

9 4. Program and Personal Assessment Strongly Agree Agree Neutral Disagree Strongly Disagree I am satisfied with my own level of professionalism. My residency program provides a training environment in which professionalism is valued. My residency program provides a training environment in which professionalism is practiced. Some degree of personal self-sacrifice is part of professionalism. Professionalism requires that I am willing, at times, to let the needs of my patients interfere with my personal schedule outside the hospital. Overall, the 80 hour work week requirement has increased my level of professionalism.

10 Seminar on Professionalism Ambulatory Block Curriculum Evaluation Form Department of Internal Medicine Drs. Beck and Kaldjian I. Please rate the following aspects of the seminar. The seminar helped me recognize characteristics of professionalism. The seminar helped me identify challenges to professionalism. The facilitators made me feel free to express what I really thought. I felt comfortable saying what I really felt in front of my peers. The content of the seminar dealt with professionalism problems that were real to me. Strongly Agree Agree Neutral Disagree Strongly Disagree II. Areas for improvement III. Strengths