Assessing Professionalism INSET Day 4 th Jan 2018 Daniel Chan, Liz Chan 1
Assessment on Intramural Rotations Students will be assessed in the following categories Professional Activity Practical Skills Clinical Reasoning and application of Knowledge 2
Professional Activity Students should demonstrate behaviour, communication style and personal conduct appropriate to different situations. They should be aware of different situations and client needs that require a change in behaviour or communication style. 3
Professional Activity They should consider the client s needs as a factor in their clinical decision-making, but without pre-judging the client or situation. Students should understand that there is not a single correct way of being, or solution to a clinical or professional problem. They should respect a colleague s right to autonomy in their professional decision making. 4
Professional Activity Students should demonstrate self-awareness: ability to identify their own priorities in professional and clinical decision making based on individual ethical values and beliefs. They should demonstrate self-awareness: identify own lapses in professional behaviour, and the environmental challenges that contribute to these. 5
Professional Activity They should demonstrate empathy (rather than criticism or judgment) with peers and colleagues. They should demonstrate respect and trust not only to staff on the rotation but also to student peers. They should work effectively as part of a team, including supporting other students in the group. They should be able to communicate effectively with peers in difficult conversations. They should also take responsibility for their own learning. 6
Professional Activity Do we actually assess these aims? A student will obtain one of the following grades in each category Pass Fail 7
Professional Activity Cause for Concern If the clinical team have concerns regarding the overall performance of a student, but do not feel these concerns warrant a fail grade in any of the three disciplines, they are at liberty to record a Cause for Concern notification. 8
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How are we preparing future vets to deal with professional issues? 12
The Professional Studies Strand Professionalism and Professional Identity General practice professional identity Ethics Stress, values and self-determination theory The human-animal bond Veterinary business studies Evidence-based veterinary medicine Teamwork Mistakes and errors Communications skills/ professional reasoning 13
The aims of the strand To enable students to make decisions and take appropriate action when faced with complex problem-solving in the veterinary clinic Make a decision that balances the needs of conflicting stakeholders Recognise that not all veterinarians will make the same decision Communicate effectively for shared decisionmaking and implementation of outcome Predict risks and challenges of solution, and plan follow-up accordingly 14
Patient Client Business Clinical Reasoning Human- Animal Bond Professional Reasoning RCVS Self Evidence Public Colleagues 15
Relevant strand theory Theory of effective communication The responsibilities of the veterinary surgeon (RCVS) Heterogeneity in professional identity (self- and conflicting values) Ethical reasoning Determinants of satisfaction (self-determination theory) The influence of context on professional skills and behaviours Evaluation of animal welfare Theories of effective teamwork Evidence-based veterinary decision-making
When faced with a professional scenario: Various stakeholders will be affected There is unlikely a solution that is perfect for all There are usually several possible solutions, which will depend on context, stakeholder needs and personal identity priorities Decision-making includes communications skills, team engagement/ communication, planning for complications A good student: Recognises the needs of all stakeholders, and identifies sources of conflict Negotiates a decision, acknowledging the risks/ challenges Understands the influence of context on skills and behaviours Communicates their decision effectively Recognizes that others may make a different decision, and values this diversity in decision-making 17
How are we preparing future vets to deal with professional issues? And more importantly, how are we assessing professional activity? 18
Assessment Criteria Interactions with clients and colleagues The Student: Demonstrates behaviour, communication style and personal conduct appropriate to different situations Is aware of different situations and client needs that require a change in behaviour or communication style Considers the client s needs as a factor in their clinical decision-making, but without pre-judging the client or situation Teaching & Learning Activities Discussion: Faculty verbalise and explain when they have altered their behaviour, communication and personal conduct in situations experienced by the students Reflection: Analyse own behaviour and communication style in different situations 19
Assessment Criteria Understanding the importance of different professional and personal identities The Student: Understands that there is not a single correct way of being, or solution to a clinical or professional problem Respects a colleague s right to autonomy in their professional decision making Demonstrates self-awareness: ability to identify their own priorities in professional and clinical decision making based on individual ethical values and beliefs Teaching & Learning Activities Discussion: Highlight alternative resolutions in clinical and professional problem-solving, and how these may be influenced by the values and priorities of those involved (client, vet, colleagues, animal welfare) Reflection: Consider the clinical or professional decisions observed, and rationalise these in the context of their own identity ideals, and those of the individuals involved 20
Assessment Criteria Recognizing limitations of professional behaviour The Student: Recognizes that traditional notions of professional behaviour, based on exemplary behaviour at all times, is an aspirational ideal but is challenged by the realities of the clinic Demonstrates self-awareness: identifies own lapses in professional behaviour, and the environmental challenges that contribute to these Demonstrates empathy (rather than criticism or judgment) with peers and colleagues Teaching & Learning Activities Discussion: Examples of faculty members own non-exemplary behaviour are used as a trigger to discuss the challenges of consistent outward expression of inner professional values, and to demonstrate the fallibility of the professional Reflection: Analyse own communication, behaviour and conduct in the clinic, and identify situations where these have been challenged 21
Assessment Criteria Mutual respect and trust The Student: Demonstrates respect and trust not only to staff on the rotation but also to student peers Works effectively as part of a team, including supporting other students in the group Communicates effectively with peers in difficult conversations Teaching & Learning Activities Discussion: Students assess their own teamwork and discuss whether they would work with each other Reflection: Analyse mutual trust and respect within the group 22
Assessment Criteria Taking responsibility for learning and management of self The Student: Takes responsibility for their own learning Offers assistance in different situations Engages with all environments in the clinic Teaching & Learning Activities Discussion: Student-led discussion of experiences in the clinic and what was learned from them Reflection: Analyse own learning opportunities and the outcomes achieved during a rotation 23
How are we doing in recording our assesment? Review of all comments by assessors on Gradebook for 2016/17 Rotation Year Scanned for any Cause for Concern or Fail in any category Highlighted Professional Activity related comments 24
Generally poor participation though demonstrated more enthusiasm in smaller group sessions. However the apparent disinterest warrants a cause for concern. Hard to assess knowledge as a result of participation but experience in previous rotations has given a basic level of knowledge. 25
Following discussion with my colleagues we feel it is only fair to the rest of the rotation and year to record a cause for concern. Failure to attend an afternoon seminar due to not making adequate arrangements to attend. There was no attempt to communicate with the staff which would allowed us to understand your reasons more sympathetically. 26
The way you communicated in this rotation has sometimes limited your demonstration of clinical reasoning and even professional attitude. The reasons involved in your poor communication skills are for you to reflect on and understand how you can work on it, to allow you to progress with your learning and professional development. 27
XXX is very stressed! He needs to be calm and relax. I told him that we will not let him make any mistakes. He is very stressed and on Tuesday last week would not take any case in the afternoon (because he had portosystemic shunt case during the day which stressed him). He complained of having chest pains. He says that he cannot multitask and cannot follow the induction procedure step by step 28
He also cannot follow what he has to do when moving his patients,. He struggles with completing his anaesthesia records. When asked questions he says he cannot multitask. It is difficult to judge his knowledge. At the moment we do not feel he is 'safe' and he will need to show his practical skills. I have also asked him to take on simple cases so that there is very little to stress him. 29
Overall the level of initiative, engagement with and co-responsibility for cases and procedures was below that expected at this stage of training. Ways of sharing observations and thoughts to demonstrate engagement and increase involvement more generally were discussed 30
As discussed face-to-face during the week, there was concern over your behaviour, communication style and conduct not always being appropriate to the situation, and its disruptive potential at times. This was less noticeable pronounced towards the end of the week. 31
It is apparent that you took advice the following day after your first shift and have improved professionally, and for that reason you have passed the rotation, though it is significant enough to merit a cause for concern. To send a client home and discussing plans to the client without speaking to any vet, is worrisome and baffling and could have had serious consequences. 32
It seems there were a few other instances where it might have benefits to think a little more about what you were doing, e.g. walking a dog with a suspected myelopathy. That being said you have showed improvement and demonstrated good practical skills and knowledge for this stage in your career. You worked well with the team and were helpful throughout, thank you. Please remember if you are unsure about what is expected of you then please communicate this with a member of the team that you are working with. Please think a little more about your decisions. Good luck with the rest of your rotations 33
During the course of the two rotation we have had concerns relating to your professional skills. In particular in relation to taking responsibility for your cases and pro-activity in terms of ensuring that you are aware of what is happening and when. We would encourage you to ensure that in future rotations you are more engaged with your patients and trying to take on the role of 'being the vet'. 34
As discussed in person, we would recommend you to make further pro-active steps to becoming an independently thinking vet who is on top of her cases and less of a student who just follows the cases in a passive way or needs to be told what is going on with your own cases. Such proactive attitude will benefit you on all rotations and make you more comfortable once qualified. Thanks for your hard work. 35
As discussed in your feedback session, we are concerned with your professionalism and knowledge at this stage. We feel you have not taken advantage of your cases and applied yourself to show that you can professionally handle a case and be safe when administering drugs 36
Examples were when you were repeatedly arriving late in the morning, not leaving you enough time to do SOAPs and physical exams on your patients, not recording data on the kennel sheet from your physical and forgetting to take temperatures in the morning... 37
You also seemed to be unsure about dosages for sedation and would have overdosed a dog had it not been picked up by one of the nurses. Your knowledge at this stage is also quite patchy and you seemed to not have made an effort to read up on some of the cases that you knew you were taking on the night before.we are failing you therefore for knowledge and professionalism and would like you to focus on getting engaged in the rotation next time, apply yourself and make every effort to take advantage of your cases, showing responsibility in every aspect of patient care and problem solving, including writing letters on CRIS for other professionals or owners. 38
However, we did have to give you a CFC in the area of professionalism, due to repeated instances of you not following hospital standards regarding the below the elbows policy: on multiple occasions you were instructed by residents, faculty and the nursing team to remove rings and watches and your fleece, and this continued to be an ongoing issue throughout the rotation despite receiving this feedback. We take these hospital standards very seriously as we work with many immunocompromised patients and patients with serious infections at the QMH, so we must do our due diligence to maximize the patients' safety at all times. 39
Cause for concern in first week due to instances of unprofessional communication with nurses and clinicians. Specific examples discussed at the end of week one. Emphasised importance of professionalism as a grading criteria. Some improvement in communication with nurses and clinicians in second week but still responds poorly on occasion to direct questioning or a request to help with something 40
Poor response to feedback, very distressed: explained that cultural differences, personal pressure, anxiety, depression and medication she takes all contribute to behaviour changes. I acknowledged this explanation and suggested getting support from specialists within college. 41
Future of Assessment In light of what we would like to achieve in terms of nurturing future vets, should we adapt the way we assess professional activity? 42