Professionalism

Professionalism

Fiduciary dutyof, relating to, or involving a confidence or trust

(Merriam-Webster)

A contract with society

Law, Medicine, Clergy

Spheres of Professional Responsibility

Medical Professionalism in the New Millennium: A Physicians' Charter1

The Medical Professionalism Project · The 2005 RSNA Professionalism Committee

Commitment to . . .

Professional CompetenceHonesty with Patients

Patients' ConfidentialityMaintaining Appropriate Relationships with Patients

Improving Quality of CareImproving Access to Care

Just Distribution of Finite ResourcesScientific Knowledge

Maintaining Trust by Managing Conflicts of Interest

Professional Responsibilities

Traditional Topics

Conflicts of InterestConfidentiality

ErrorsImpaired Physicians

Incompetent PhysiciansBoundary 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 needsPhysicians 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 MediaDiversity among Patients and WorkplaceNew attitudes toward communication with

patientsNeed for trainee codes of professionalismEvolving Power-Distance

Case 1Social Networking

John Brown, a 2nd 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 2Communicating resultsYou 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?

Case 3Concept 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 4Residents 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 5A 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 6Joe 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 Dreyfus1986

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 abilitiesLearningKnowingUnderstandingComprehensionMastery