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Module 1Professional Identity: Physician, Teacher and Leader

Residents as Teachers & Leaders

Module Created by:

John Culberson, M.D., M.S.

Assistant Professor of Medicine

&

Charlene M. Dewey, M.D., M.Ed., FACP

Associate Professor of Medicine

Web Page and Module Formatting by:

Maria Victoria Tejada-Simon, Ph.D.

Assistant Professor of Molecular Physiology and Biophysics


Welcome

  • Welcome to Module 1: Physician Identity. You should have completed a pretest for this module. Did you complete the “honesty pledge” question?

  • In that pledge you agreed to take the pretest first, then read the module and then take the post-test after reading the module. If you did not complete the pretest, please exit the module now and complete it; then return to the module. Your honesty is appreciated.

Click here if you completed the pretest.

Exit


Welcome

  • Welcome to Module 1: Professional Identity: Physician, Teacher and Leader. As a physician, you will interact with a wide variety of individuals… patients, their family, nurses, medical students, peers and faculty.

  • Your role as a resident physician will be enhanced by adopting appropriate teaching, leadership, and communication principles into your daily routine.


Welcome

  • Module one focuses on professional identity. We estimate about 45-60 minutes to complete this module. Resources for this module can be found on the RATL resources web page.


Introduction

  • What's also important to remember about being a professional is that you are building your reputation and you want always to protect that reputation and avoid any behaviors that will jeopardize your reputation.

  • Developing, maintaining and protecting your reputation will take awareness and prevention on your part. You may also find that sometimes a colleague may need help before he/she jeopardizes their reputation.


Introduction

  • Professionalism is defined in the dictionary as:

    • …the conduct, aims, or qualities that characterize or mark a profession or a professional person.

  • Reflect for a second on those qualities, aims or your conduct up to this point in your training. Are you ready to assume the higher standard of professionalism in medicine?

http://www.merriam-webster.com/dictionary/professionalism


Introduction

  • “Although professionalism has been incorporated into most medical schools across North America, it remains rather difficult to define because it carries many connotations and implied meanings. What is certain, however, is that medicine is a moral endeavor which demands integrity, competence, and high ethical standards among other key attributes.” - University of Ottawa

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html

(With permission)


Introduction

  • “Drs. Richard and Sylvia Cruess of McGill University have become leaders in the field of medical professionalism. They describe the role of the physician as overlapping between that of the healer and that of the professional.

  • Within this model, both positions are necessary to appreciate key attributes of the physician. Although the primary role of the physician is undoubtedly that of the healer, one must simultaneously maintain professionalism in medical practice. The following diagram highlights this crucial balance: “

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html

(with permission)


Introduction

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html

(with permission)


Skip Photostory

Introduction

  • "Develop the frame of mind that whatever you do, you are doing it as a professional and move up to professional standards in it.”

Click on the box to watch the Photostory on professional identity. Click again to stop. (Video is approx 8 minutes.)

http://www.tipsforsuccess.org/professionalism.htm


Goals

  • The goals of this module are:

  • 1. To help you to develop your professional identity as a physician and leader and characterize the relationships that define the physician.

  • 2. To reflect on characteristics of the professional physician and to review the key principles of leadership and effective communication.


Objectives

  • After completing this module, you will be capable of:

    • Identifying four (4) aspects of effective communication.

    • Describing four (4) relationships that define the professional identity of physicians.

    • Demonstrating an appreciation of the physician's role by “being part of the solution, rather than part of the problem” & avoiding the hidden curriculum.

    • Designing an approach to leadership that incorporates Covey’s seven habits.

    • Reflecting on your professional role as physician and leader in medical education.


Agenda

  • Physicians have several roles in health care. In this module we will emphasize the professional and leadership roles of the physician while the teacher role is

  • emphasized in module 2.

  • We will also emphasize effective communication and its role in developing healthy relationships in the medical setting.


Agenda

  • Module 1 will include the following topics:

    • Physician identity & professionalism

    • Relationships in medicine

    • Effective communication

    • Leadership identity

    • Hidden curriculum

    • Summary


Professional Identity

  • Are you a professional? What makes you a professional? How is professionalism defined? What would our great forefathers of medicine say about professionalism?

  • Some greats had much to say about the professional practice of medicine – starting with Hippocrates.


Physician Identity

  • “The Hippocratic work On the Physician recommends that physicians always be well-kempt, honest, calm, understanding, and serious. The Hippocratic physician paid careful attention to all aspects of his practice: he followed detailed specifications for, "lighting, personnel, instruments, positioning of the patient, and techniques of bandaging and splinting" in the ancient operating room. He even kept his fingernails to a precise length.”

http://en.wikipedia.org/wiki/Hippocrates

Highlights of Hippocratic oath only

More detail on Hippocrates


Physician Identity

  • The original translation of the Hippocratic oath:

    • To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

    • I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

    • To please no one will I prescribe a deadly drug nor give advice which may cause his death.

    • Nor will I give a woman a pessary to procure abortion.

    • But I will preserve the purity of my life and my arts.

    • I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

http://en.wikipedia.org/wiki/Hippocratic_Oath


Physician Identity

  • Continued…

    • In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

    • All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

    • If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

http://en.wikipedia.org/wiki/Hippocratic_Oath


Physician Identity

  • Highlights from that oath include:

    • Valuing in the highest regard those who teach you the art of medicine – teachers, clinicians, patients.

    • Do no harm – according to your ability – being humble and knowing when to ask for help.

    • Preserve the purity of my life and my arts – keeping the profession and your role in it in high esteem.

    • Keeping myself far from all intentional ill-doing and all seduction – understanding boundaries and illegal behaviors.


Physician Identity

  • Highlights continued…

    • I will keep secret and will never reveal – maintaining confidentiality.

    • If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot

  • This last point clearly identifies both the good outcomes of maintaining a professional and ethical practice of medicine and the negative consequences if you don’t.


Physician Identity

  • The Core Values of Professionalism include:  

    • Honesty and Integrity

    • Altruism

    • Respect

    • Responsibility and Accountability

    • Compassion and Empathy

    • Dedication and Self-improvement

http://intermed.med.uottawa.ca/students/md/professionalism/eng/index.html

(with permission)


Physician Identity

  • Reflection time – think about who you are and who you want to be as a physician. Then answer the following questions.

    • List some adjectives that describe who you are as a person.

    • Would others use the same adjectives to describe your interpersonal skills and activities at work?

    • What reputation do you want for yourself?

  • Your identity is your reputation. How you shape that identity and reputation is up to you!


Physician Identity

  • As a physician, you will need to diagnose and treat illness, however, your greatest challenge may lie in developing and maintaining relationships in an environment of time constraints and stress. These relationships will bond you with others in the care of your patients.


Physician Identity

  • Which of the following relationships do you think is the most important to a physician?

    • Doctor-Self

    • Doctor-Colleagues (MD, RN, students)

    • Doctor-Patient

    • Doctor-Community


Physician Identity

  • All relationships require the physician to maintain their physical and emotional health. The Doctor-Self relationship is, in fact, the most important… and most often overlooked!

  • Ensuring time for yourself, friends, and family is a professional obligation and you owe it to yourself!


Doctor-Self

  • Efficiency and the ability to establish professional and personal boundaries are essential skills, however, this may require considerable practice for some.

  • No amount of knowledge and skill can overcome the negative consequences of “physician burnout.” Self-awareness is the primary tool to help identify burnout. But what is burnout?


Doctor-Self

  • Burnout: “Maslach & Leither describe burnout as the index of the dislocation between what people are doing and what they are expected to do.”

  • “Burnout represents a deterioration of values, dignity, spirit, and will. …an ‘erosion of the soul.’ Burnout spreads gradually and continuously over time, sending people into a downward spiral from which it is hard to recover.”

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


Doctor-Self

  • Which of the following are signs of physician burnout?

    • Decreasing efficiency

    • Outbursts of anger

    • Feeling overwhelmed

    • Insomnia

    • All of the above

    • None of the above


Doctor-Self

  • Decreasing efficiency, outbursts of anger,

  • feeling overwhelmed, insomnia, and

  • depression are all signs of physician burnout.

  • This is an unhealthy mental and physical

  • state that adversely effects your training,

  • your relationships, and your ability to provide

  • excellent patient care.


Doctor-Self

  • While everyone feels the effects of stress during their residency training, understanding your own personal stressors and how to avoid them are important.

  • Once one identifies that they are on the road to burnout, seeking help from others is a sign of effective self-monitoring and emotional maturity, not weakness! Burnout can be prevented and treated.


Personal:

Influence happiness through personal values and choices

Spend time with family & friends

Engage in religious or spiritual activity

Maintain self-care (nutrition & exercise)

Adapt a healthy philosophy/outlook

A supportive spouse or partner

Work:

Gain control over environment & workload

Find meaning in work

Set limits and maintain balance

Have a mentor

Obtain adequate administrative support systems

Doctor-Self

Ways to avoid burnout:

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


Doctor-Self

  • If you were to experience signs of “physician

  • burnout”, from whom would you seek help?

    • A medical student

    • An intern

    • A resident

    • A faculty member

    • Aconfidential counseling service


Doctor-Self

  • Often, a peer may seem to be the best option for confiding in and receiving support during burnout, however, specific solutions are usually best provided by individuals who have experience with issues that may arise during training.

  • Chief residents, faculty, and/or counselors are better positioned to objectively identify both problems and solutions. Experienced individuals are more likely to assist with wisdom and confidentiality.


Doctor-Self

  • There are several options for physicians experiencing burnout. Check with your residency office or specific institutional wellness program for assistance.

  • Institutional programs are confidential services and provides counseling and other services free-of-charge to those seeking assistance. They are generally utilized frequently by physicians of all specialties.


Doctor-Self

  • Some resources that can be of assistance include:

  • Vanderbilt’s Center for Professional Health & Faculty & Physician Wellness Program:

  • http://www.mc.vanderbilt.edu/root/vumc.php?site=cph

  • http://www.vanderbilt.edu/HRS/wellness/wlcfpwp.html

  • AAMC Viewpoint: Defusing Physician Burnout

  • http://www.aamc.org/newsroom/reporter/march03/viewpoint.htm

  • Help guide to Workplace burnout

  • http://www.helpguide.org/mental/burnout_signs_symptoms.htm


Doctor-Self

  • Remember, if you are not able to function, you cannot be of assistance to your patients. The Doctor-Self relationship is the most critical relationship you have. Take care of yourself and nourish your inner being in ways that help you feel refreshed and ready to return to work each day.

  • Now lets look at the doctor-colleague relationship. In this section, we will focus on teamwork and communication between colleagues on a healthcare team.


Doctor-Colleague

  • While physicians are conditioned to feel as if self-reliance is a worthy goal to be achieved through rigorous training, excellent medical care requires the coordinated efforts of a team of professionals.

  • Team-building is emphasized in the military, sports, major corporations, and classrooms.

  • Even medical education and healthcare are now recognizing the role and value of effective teamwork in patient care.


Doctor-Colleague

  • Team work is vital in medicine! The welfare of your patients require your best efforts in accurately communicating with members of your immediate team, the extended patient care team and with the patients and their families.


Doctor-Colleague

  • The team that best cares for a patient, is a team that communicates well between its members.


Doctor-Colleague

  • The efficient and effective patient care team includes a large group of individuals including nurses, consultants, social workers, physical therapists, nutritionists, and, of course, the patient and their family.

  • Each of these team members has a relationship with the patient and one another. Good communication between all team members is essential.


Doctor-Colleague

  • As a member of any team, you will have to communicate with other teams. Evidence now supports that the team approach to patient care can improve outcomes and prevent readmissions.

  • Too many physicians try to practice medicine solely in their sub-specialty or department.


Doctor-Colleague

  • Please reflect for a moment. Which of the

  • following are important for ‘Effective

  • Communication’?

    • Good listening

    • Providing concise and specific feedback

    • Providing overview/concepts followed by facts

    • Using appropriate level of language

    • Displayingconfidence


Doctor-Colleague

  • Effective communication is characterized by all of these:

    • Good Listening

    • Communicating on an appropriate level for the learner

    • Providing overviews & general concepts first – then facts

    • Providing appropriate praise

    • Providing specific & concise feedback

    • Summarizing important points


Doctor-Colleague

  • While confidence is important, it is a perception that is supported by effective communication.

  • However, while all aspects are important, “good listening” is the key! It is sometimes difficult for busy, stressed physicians to listen well.


Doctor-Colleague

  • The habits and behaviors you learned early in your training can be difficult to change later… be a “good listener” to each member of “your team” early and build good habits of listening to your patients, colleagues, peers and others.


Doctor-Colleague

  • The dictionary defines communication as a process by which information is exchanged between individuals through a common system of symbols, signs or behaviors.

  • Much important information is conveyed to peers, students, and patients through non-verbal communication.


Doctor-Colleague

  • Imagine a scenario in which a resident and

  • student are seated at a nursing station:

    Student: “This patient has an elevated blood sugar, I think he has diabetes.”

    Resident: (without looking up, and in a condescending voice): “By now, every student should know that most overweight people have diabetes.”


Doctor-Colleague

  • In the picture that you formed in your mind, how do you think the student felt based upon the resident’s communication style?

    • What opinion will the student form about the resident’s communication style?

    • Will this student feel comfortable forming a relationship with this resident?

    • What has the student learned about obese patients? Is there a hidden message?


Doctor-Colleague

  • In the previous scenario, how would you communicate differently in order to help the student to both understand the relationship between diabetes and obesity and observe an excellent physician role model?

  • In general, you want to be a part of the solution, not part of the problem. Avoid perpetuating bad habits. Practice what you might say to this student.


Doctor-Colleague

  • To effectively communicate with this student, first the resident should stop what they are doing and make eye contact. This tells the student they are important. Then, clarify what their question is. This makes sure you are giving the needed information. Then answer the question providing your knowledge and insight into the situation. Then ask them if they understood it or if they have any other questions.


Doctor-Colleague

  • If you do not have time to answer, again, look at the student and say something to affirm their question and give them some guidance on what to do. (E.G: “That’s a good question but we don’t have time to explain it in detail. If you look it up tonight, we can discuss it tomorrow on rounds.”)

  • This helps residents when they are busy and don’t have time to stop. But don’t let this be your only answer to every question!


Doctor-Colleague

  • Also, if you make one of these comments, realize it is good for students to self learn but do make sure to touch upon it during your patient care rounds the next day. If you fail to do so, your students will see you as someone who just blows them off and doesn’t really care enough to follow up. This can backfire if used the wrong way.


Doctor-Colleague

  • Back to teamwork - When the team functions as one, the patient will ultimately benefit, but each member of the team also benefits.

  • Think about this: A patient is admitted to your service with diabetes, uncontrolled hypertension, severe osteomyelitis of the right great toe and distal foot, chest pain and depression. Who are the members of the team that will care for this patient?


The patient

Nurses on the unit

Internal Medicine/Family Medicine

Surgery: vascular and perhaps cardiothoracic

Anesthesia

Psychiatry

Blood technicians

Physical medicine and rehabilitation

Endocrinology

Cardiology

Discharge services

Social worker

Nutrition

Diabetes education

Family members

Doctor-Colleague

At minimum, this patient will require input and care form the following teams :


Doctor-Colleague

  • Thus to care for this patient, many individuals from various teams will need to communicate and work together efficiently.

  • Your role as the resident, intern or student is to be a part of the service team and the whole patient care team. Lets look at an example of a team effort.


Doctor-Colleague

  • Below is a link to an example of teamwork with effective communication between several members of a team. Click on the link below to watch the 4-minute video and reflect on the following questions:

    • Who are the team members?

    • How are they communicating with each other?

    • How is it their product turned out so great?

    • Can you see the similarities in medicine?

Click on the link: http://www.youtube.com/watch?v=VCIyzNISw1Q


Doctor-Colleague

  • This team had a specific purpose…to make beautiful music together.

  • There are probably a hundred members on this team and they are all different but several are similar in their function: the lead singers, the back-up singers, the violinists, the cellists, the lighting team, sound team, etc. are all smaller teams that work well together as a whole in order to produce this beautiful concert.


Doctor-Colleague

  • This is no different in medicine where small teams work together as a whole to heal patients. They all used their skills to create the final product that is a masterpiece!

  • Not any one individual could have created that masterpiece by themselves. This is an example of how a team effort can create a great outcome.


Doctor-Colleague

  • The Institute of Medicine 2004:

  • “It is therefore crucial that physicians know how to work effectively in the context of integrated teams. They must understand their roles as part of the team and why it is important to foster positive relationships with other team members.”

  • (Pg 73)


Doctor-Colleague

  • Each of us can help improve communication across departments if we are willing to try. Thus, we can each be a part of the solution instead of being part of the problem. Therefore, your role as an effective communicator and team player is key!

  • Now let’s look at the Doctor–Patient relationship. This relationship also needs good listening and communication skills.


Doctor-Patient

  • The doctor-patient relationship may produce particularly challenging communication issues. Language, ethnicity, culture, and other issues will play a role in the doctor-patient relationship.

  • Unfortunately, it is not uncommon for physicians to exhibit poor listening skills and use vocabulary that is not understood by the patient.


Doctor-Patient

  • Patients often drop hints rather than communicate concretely about problems or concerns. This requires physicians to have astute listening skills while they calibrate their vocabulary to a level of the learner (the patient). You will also need to watch the patient closely for their use of non-verbal communication and frequently ask if they understand or test their understanding.

  • This skill does not come naturally but can be developed with practice.


Doctor-Patient

  • Developing good communication between the doctor and patient is important. Effective communication is an excellent opportunity to demonstrate trust, compassion, empathy and appreciation to your patients.

These are real examples I have hear over time!


Doctor-Patient

  • Identify yourself as a leader and role model for patients, their families, students, peers, and other members of the medical care team by looking at the patient, being attentive while they are speaking and demonstrating your empathy.

  • Training institutions often teach students to ask open-ended questions and listen to their patient’s stories as part of their history. This is the foundation of patient-centered care.


Doctor-Patient

  • However, a lack of time often causes us to force patients into simple yes or no questions, leaving no time for patients to tell their stories. This makes us more doctor-centered.

  • Effective communication requires both parties to explicitly define their own unique views of illness and align them toward a common therapeutic goal.


Doctor-Patient

  • This may seem more time consuming but studies have demonstrated that patients will only talk for about 3 minutes to tell their story when asked using an open-ended question.

  • You can be more directive with other parts of the history later. Allowing the patient to tell their story is a key issue for building relationships with them.


Doctor-Patient

  • Patients feel valued and heard when doctors spend the time to listen to them.

  • Will you stop to listen to your patients or will you rush through while working on other tasks?


Doctor-Patient

  • What percentage of your medical school

  • clinical experience was consistent with a

  • patient-centered model?

    • Less than 25%

    • 26-50%

    • 51-75%

    • Greater than 75%


Doctor-Patient

  • The Institute of Medicine 2004

  • “Medical students who learn how to elicit information needed to understand biological, personal, and social factors in the onset and maintenance of illness will diagnose and treat their future patients more effectively.” (Pg 75)

  • This quote speaks for itself! Now let’s look at Doctor-Community relationships where we will emphasize professionalism & leadership skills.


Doctor-Community

  • The physician also has a professional obligation to the community they serve. An obligation to represent themselves in a professional manner, to identify diseases that affect their communities and to preserve our vital resources in our health care system.

  • A professional always strives to improve themselves and acts in a manner supportive of the greater good.


Physician Identity

  • List the four (4) relationships in medicine.

Click here for the answer


Physician Identity

  • Doctor-Self

  • Doctor-Colleagues (MD, RN, students)

  • Doctor-Patient

  • Doctor-Community


Leadership Identity

  • Physicians are recognized as the leaders of large interdisciplinary teams of healthcare providers. Leadership skills are emphasized in corporate America, however, are often overlooked in the medical education process.

  • Even as an intern, you may find yourself in the unfamiliar territory of leadership. It is a myth that great leaders are born… like teaching skills, leadership skills can both be learned and perfected.


Leadership Identity

  • Stephen Covey has written “The Seven Habits of Highly Effective People.” These habits are divided into “Private Victories” and “Public Victories.”

  • Covey defines a habit as the intersection of knowledge, skill, and desire. He describes a pathway to develop the security to adapt to change and to take advantage of the opportunities that change creates.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • The Seven Habits:

    • Be proactive

    • Begin with the end in mind

    • Put first things first

    • Think win-win

    • Seek first to understand, then be understood

    • Synergize

    • Sharpenthe saw

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • In his book, Covey provides a plan to use the “Seven Habits” as a step-by-step pathway for living with fairness, integrity, and honesty, the security to adapt to change, and the security to take advantage of the opportunities that change creates.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • The Seven Habits are divided into private & public victories:

    • “Private Victories” involve self-mastery and move the individual from dependence toward independence, and

    • “Public Victories” involve teamwork, cooperation, and communication and bring about an interdependent outlook.

  • Covey emphasizes that private victories always proceed public victories.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Private victories:

    • Be Proactive: Take action! Leaders lead, don’t wait for someone else to do it.

    • Begin with the End in Mind: Organize your actions based upon the desired end-point.

    • Put First Things First: Prioritize based on the “big-picture.”

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Let’s use a very common scenario for the hospital setting. Having a patient-family conference about prognosis and therapy for your patient’s new diagnosis. The patient went to radiology at 1:00 and the conference is scheduled for 3:00. The nurse gives you a message that a key family member was unaware of the meeting. You also need to get to the bank before it closes.

  • The next few slides list Covey’s habits and what you might do for each to be a more effective leader.


Leadership Identity

  • Be Proactive: Your patient is waiting in the radiology waiting area after their x-ray. Go get them or arrange for their return.

  • Begin with the End in Mind: The goal is to have a patient-family conference. Make sure everyone is aware of the purpose and importance ahead of time.

  • Put First Things First: Organize your day so you and team members are able to get to the patient-family meeting on time – go to the bank before or after the conference-remember your balance is important too!

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • You have just handled this situation in a positive way; thus making you a highly functional team member – and personally victorious.

  • Once you have achieved the personal habits of a leader, these habits must be combined with the habits of successful leadership in relationships with others. This task requires excellent communication skills.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Think Win-Win: Negotiate so that the circumstances are improved for both parties – the patient and family should certainly “win” – but that win may mean you need to educate them so they better understand what the best “win” is.

  • Seek First to Understand: Listen and empathize with the families point-of-view and understand your own passion or drive toward one side or the other. Then help them understand your position.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Synergize: Create new alternatives together that both parties are happy with. Decide what are the most important pieces to continue working on. Assure the patient and family you will work to obtain the goals of everyone - create new alternatives if needed.

  • Demonstration:What does this leader need to learn about leadership and communication? How did others react based on his actions?http://www.youtube.com/watch?v=oQBNMT9318A (If needed, click to start or select USS Montana)

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Keep in mind patients and most family members do not have significant understanding of medical terminology, our ways of doing things, treatments, options for treatment or withholding treatment. It is your job to help them understand – this is also providing informed consent.


Leadership Identity

  • Public victories are instrumental in providing

  • team-based medical care. How might you apply Covey’s habits as the leader of a medical care team for these situations?

    • The patient is refusing a diagnostic test.

    • The nurse is overwhelmed and has not given the patient’s antibiotics yet.

    • The psychiatry resident must cover several hospitals when on call and your patient is not in their room.


Leadership Identity

  • In each circumstance, the interests of both the health care providers and patient are best served through the demonstration of excellent professional and leadership skills.

  • Your identity as a physician and colleague is

  • based upon the consistent use of simple principles outlined by Covey.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Covey emphasizes, above all else, that taking care of personal needs is an important habit of effective leaders. He refers to his seventh habit as “Sharpening the Saw.”

  • Covey states that to function optimally, one must learn to renew four dimensions of their nature.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


Leadership Identity

  • Habit #7. Balanced Self-Renewal

    • Physical

    • Mental

    • Social/Emotional

    • Spiritual

  • This habit emphasizes the concept of personal leadership and was covered previously in our discussion of the Doctor-Self relationship.


Leadership Identity

  • “To begin with the end in mind means to start with a clear understanding of your destination. It means to know where you’re going so that you better understand where you are now so that the steps you take are always in the right direction.”~ pg 98.

Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989


Leadership Identity

  • What is Covey’s 7th habit that pertains to the individual?

Click here for the answer


Leadership identity

  • Sharpen the saw! Balanced Self-Renewal

    • Physical

    • Mental

    • Social/Emotional

    • Spiritual


Hidden Curriculum

  • Now let’s look at how you affect learners when you don’t even realize you’re doing it.

  • It’s called the “hidden curriculum” of medicine because its that part of medicine that students learn without being taught. It is a dark side of medical education that can be undone with effort on your part.


Hidden Curriculum

  • Each interaction in the medical environment is observed by someone: students, nurses, technicians, colleagues, etc.

  • As the observer, students especially, will learn the culture of their environment. They are learning how to act and what is/is not acceptable in their medical school, clinic, inpatient team or hospital.


Hidden Curriculum

  • “The authors propose that the chief barrier to medical professionalism education is unprofessional conduct by medical educators, which is protected by an established hierarchy of academic authority. Students feel no such protection, and the current structure of professionalism education and evaluation does more to harm students' virtue, confidence, and ethics than is generally acknowledged.”….

Brainbard AH, Brislen HC. “Learning Professionalism: A View from the Trenches.” Acad Med 2007;82(11)1010-14.


Hidden Curriculum

  • “The authors maintain that deficiencies in the learning environment, combined with the subjective nature of professionalism evaluation, can leave students feeling persecuted, unfairly judged, and genuinely and tragically confused. They recommend that administrators, medical educators, residents, and students alike must show a personal commitment to the explicit professionalism curriculum and address the hidden curriculum openly and proactively.”

Brainbard AH, Brislen HC. “Learning Professionalism: A View from the Trenches.” Acad Med 2007;82(11)1010-14.


Hidden Curriculum

  • Your verbal and non-verbal behavior becomes part of your teaching identity. Students witness your behaviors and can incorporate them into their view of patients, doctors, hospitals, and medical schools.

  • The authors of the article clearly encourage and emphasize everyone taking a role to undo this darker side of medicine.


Hidden Curriculum

  • The Hidden Curriculum is often observed in the clinical arena. Picture in your mind some actual behaviors sometimes observed by students in the clinical setting:

    • Pimping students to the point of embarrassment.

    • Frequently interrupting patients.

    • Using “social stigmas” in your conversation.

    • Yelling at learners about their incompetence in front of others.


Hidden Curriculum

  • This is in contrast to the concepts of patient-

  • centered medical care and professional

  • behavior that students are taught as

  • paramount to the Doctor-Patient and Doctor-

  • Colleague relationships.

  • These contradictions create inner conflict in

  • students, diminish the credibility of medical

  • teachers, undermine ethics, and create cynicism as highlighted by the authors.


Hidden Curriculum

  • Remember, the Hidden Curriculum is

  • conveyed through both verbal, non-verbal, and para-verbal behaviors. That means you can say something, do something or emphasize something the wrong way and you just contributed to the hidden curriculum.

  • Let’s look at some examples so you can stay clear of them in the future.


Hidden Curriculum

Here are examples of behaviors that teach a negative lesson through the hidden curriculum.


Hidden Curriculum


Hidden Curriculum

  • These are all examples of the hidden curriculum and avoiding them can be challenging, but is not impossible. It starts with being aware of the problem and choosing to be different.

  • Thus, you want to be part of the solution, not part of the problem. Through practice and self-identifying you will be able to prevent or change such behaviors, and in doing so, will be achieving both private/public victories while reducing the effects of the hidden curriculum!


Hidden Curriculum

  • “If a teacher have any opinion which he wishes to conceal, his pupils will become as fully indoctrinated into that as into any which he publishes.”

  • - Ralph Waldo Emerson

  • Clearly this takes understanding of the issues and attempts to prevent the problems in the future. What will you chose?


Summary

  • Physicians learn much of their professional identity as physicians, teachers and leaders by interacting with others in the clinical environment. As a student or resident you will have the opportunity to contribute significantly to the learning environment of your team.


Summary

  • Students, patients, peers, and other members of the interdisciplinary team will benefit from your understanding of your professional role and the value of effective communication, relationships in medicine, leadership skills and how to avoid being part of the negative effects of the hidden curriculum.


Take Home Points

  • There are four types of relationships in medicine; Doctor-Self is the most important!

  • Communication is your most powerful tool to build relationships, teach learners and lead effectively.

  • Leadership is not just a higher rank, but it is the effort to serve, understand and advance the team as a whole.

  • Where possible, don’t be part of the problem, be part of the solution-avoid contributing to the hidden curriculum!


Conclusion

  • It is our hope that each of you will respect each other’s chosen profession and that with practice and mutual respect you will join together to serve your patients and become the next generation of physician leaders.

  • We hope this module helped you identify yourself as physician and leader. Module 2 will focus on your identity as a teacher and introductory teaching skills.


Closing Instructions

  • You have now successfully completed

  • Module 1: Professional identity. Please take the post-test for this module immediately upon completion.

  • The evaluation form and other learning materials for module 1 can be found on the main RATL web page. Thank you for participating!!!!!


PDF References

  • See RATL web page for pdf references.


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