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Overview of Professional Development in an Era of Interprofessionalism

Overview of Professional Development in an Era of Interprofessionalism. APPIC 2014 Conference. William Robiner, Ph.D., ABPP U NIVERSITY OF M INNESOTA M EDICAL S CHOOL P SYCHOLOGY I NTERNSHIP. Disclosures. I am happy to be here I have no financial relationship to disclose

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Overview of Professional Development in an Era of Interprofessionalism

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  1. Overview of Professional Development in an Era of Interprofessionalism APPIC 2014 Conference William Robiner, Ph.D., ABPP UNIVERSITY OF MINNESOTA MEDICAL SCHOOL PSYCHOLOGY INTERNSHIP

  2. Disclosures • I am happy to be here • I have no financial relationship to disclose • No discussion of off-label use of pharmacological products or devices

  3. Whatis a Professional? Noun • Someone who does a job that requires special training, education, or skill; someone who is a member of a profession • One that is professional; especiallyone that engages in a pursuit or activity professionally • Someone who has a lot of experience or skill in a particular job or activity • Term was first used in 1606

  4. Whatis Professional? Adjective • Of, relating to, or characteristic of a profession • Engaged in one of the learned professions • Law, medicine, or theology... etc. • Characterized by or conforming to the technical or ethical standards of a profession; exhibiting a courteous, conscientious, and generally businesslike manner in the workplace • Having or showing great skill; expert • Engaging in a given activity as a source of livelihood or as a career

  5. What is Professional? • A professional is a member of a profession. • It describes the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform the role of that profession. In addition, most professionals are subject to strict codes of conduct enshrining rigorous ethical and moral obligations. • Professional standards of practice and ethics for a particular field are typically agreed upon and maintained through widely recognized professional associations. • Some definitions of professional are limited to those professions that serve an important aspect of public interest and the general good of society.

  6. Whatis Professional? • …shorthand to describe a particular social stratum of well-educated workers who enjoy considerable work autonomy and who are commonly engaged in creative and intellectually challenging work. • A professional does mainly mental or administrative work, as opposed to engaging in physical work. • The etymology and historical meaning of the term professional seems to indicate an individual whose philosophy and habits have been conditioned by a professor. So, a professional is the follower of a professor.

  7. What is Professionalism?

  8. Definition 1: Professionalism “a calling requiring specialized knowledge and often long and intensive preparation including instruction in skills and methods as well as in the scientific, historical, or scholarly principles underlying such skills and methods, maintaining by force of organization or concerted opinion high standards of achievement and conduct, and committing its members to continued study and to a kind of work which has for its prime purpose the rendering of a public service…”

  9. Being Professional Covered under exemption for Professional Employees under the Fair Labor Standards Act (FLSA), which requires minimum wage and overtime pay. • employees employed as … professional. • employee must be compensated on a salary or fee basis • …primary duty must be the performance of work requiring advanced knowledge, defined as work which is predominantly intellectual in character and …includes work requiring the consistent exercise of discretion and judgment… • The advanced knowledge must be in a field of science or learning; and • The advanced knowledge must be customarily acquired by a prolonged course of specialized intellectual instruction.

  10. Definition 2: Professionalism “…the intrinsic motivation…the way in which a person relies on a personal high standard of competence in providing professional services…a person’s willingness to pursue professional development opportunities that will improve skills within the profession…” (p. 243) VanZandt, C. E. (1990). Professionalism: A matter of personal initiative. Journal of Counseling and Development, 68, 243–245.

  11. Becoming a Professional • Why did you become one? • How did you become one? • Where did you become one? • When did you become one? • Who helped you become one? • What do you need to stay one? • How do we help othersbecome professionals?

  12. My Search for Professional Development

  13. Professional Development • No single definition • No definitions in standard or psychiatric dictionaries • In some disciplines refers to continuing education • In some disciplines refers to in-service training

  14. In the Silo of Psychology What is Professional Development? Skills and knowledge attained for both career advancement and personal development

  15. Definition 1: Professional Development “an ongoing process through which an individual derives a cohesive sense of professional identity by integrating the broad-based knowledge, skills, and attitudes within psychology with one’s values and interests”(p. 89) Ducheny, K. Allezhauser, H. L., Crandell, D., & Schneider, T, R. (1997). Graduate student professional development. Professional Psychology: Research and Practice, 28, 87-91.

  16. Definition 2: Professional Development “the developmental process of acquiring, expanding, refining, and sustaining knowledge, proficiency, skill, and qualifications for competent professional functioning that result in professionalism…” Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional Development: Training for Professionalism as a Foundation for Competent Practice in Psychology. Professional Psychology: Research and Practice, 36, 367-375.

  17. Definition 2: Professional Development “the developmental process of acquiring, expanding, refining, and sustaining knowledge, proficiency, skill, and qualifications for competent professional functioning that result in professionalism. It comprises both (a) the internal tasks of clarifying professional objectives and crystallizing professional identity, increasing self-awareness and confidence; sharpening reasoning, thinking, reflecting and judgment; and (b) the social/contextual dimension of enhancing interpersonal aspects of professional functioning and broadening professional autonomy.” Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional Development: Training for Professionalism as a Foundation for Competent Practice in Psychology. Professional Psychology: Research and Practice, 36, 367-375.

  18. Definition: Professional Competence “The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Competences builds on a foundation of basic clinical skills, scientific knowledge, and moral development.” Epstein, R. M. & Hundert, E. M. (2002). Defining and assessing professional competence. Journal of the American Medical Association, 287, 226 –235.

  19. Developmental Tasks Associated WithProfessional Development • Starting graduate school • Pursuing internship • Completing professional degrees • Pursuing postdoctoral activities • Preparing for licensure • Beginning career • Mid-career years • Nearing retirement

  20. Increasing Skills and Knowledge Are Primary Training and Supervisory Focus • Interview/Assessment • Integration of assessment data • Diagnosis • Knowledge of psychopathology • Psychotherapy/Intervention • Related Knowledge • Psychopharmacology knowledge • Rapport with patients • Maintenance of relationships with colleagues, students • Ability to handle stressful and emotional situations Schippmann, J., Smalley, M. D., Vinchur, A. J. & Prien, E. P. (1988). Using structured multidomain job analysis to develop training and evaluation specifications for clinical psychologists. Professional Psychology: Research and Practice, 19, 141-147.

  21. APA Internship Accreditation Requirements Domain B 4. In achieving its objectives, the program requires that all interns demonstrate an intermediate to advanced level of professional psychological skills, abilities, proficiencies, competencies, and knowledge in the areas of: (a) Theories and methods of assessment and diagnosis and effective intervention (including empirically supported treatments); (b) Theories and/or methods of consultation, evaluation, and supervision; (c) Strategies of scholarly inquiry; and (d) Issues of cultural and individual diversity that are relevant to all of the above.

  22. APA Postdoctoral Accreditation Requirements The program requires that all residents demonstrate an advanced level of professional psychological competencies, skills, abilities, proficiencies, and knowledge in the following content areas: (a) Theories and effective methods of psychological assessment, diagnosis, and interventions; (b) Consultation, program evaluation, supervision, and/or teaching; (c) Strategies of scholarly inquiry; (d) Organization, management, and administration issues pertinent to psychological service delivery and practice, training, and research; (e) Professional conduct, ethics and law, and other standards for providers of psychological services; and (f) Issues of cultural and individual diversity that are relevant to all of the above.

  23. Professional Development: Cognitive Elements • Development of competencies, knowledge, skills and proficiencies • Refinement or specialization • Furthering skill development and attaining or updating of knowledge • Expand competencies and knowledge into expertise in areas beyond formal education and training

  24. Professional Development: Cognitive Elements • Applying knowledge • Problem-solving • Recognizing gaps in knowledge • Self-directed learning • Prevent erosion of competencies as part of “life-long learning”

  25. “Thinking Like a Psychologist” • Logical analysis • Conversant with and utilizing scientific query and professional literature • Conceptualize problems and issues from multiple perspectives (e.g., biological, pharmacological, intrapsychic, familial, organizational/systems, social, cultural) • Understand, integrate and use resources (e.g., empirical evidence, statistical approaches, technology, collegial consultation) Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional Development: Training for Professionalism as a Foundation for Competent Practice in Psychology. Professional Psychology: Research and Practice, 36, 367-375.

  26. ProfessionalDevelopment: PsychologicalElements • Crystallization of professional identity • Securing one’s identity • Looking professional • Acting professional • Internalizing standards of the field (e.g., ethics, standards of practice) • Introjecting of and socialization into the professional role • Sharpening critical thinking • Refining self-reflective skills • Self-care

  27. Professionalism Involves Relationship • Getting engaged • Interacting professionally with patients and others • Teamwork- • Joining the team • “Playing well with others” • Psychologists • Physicians • Other disciplines • Interprofessional activities

  28. Professionalism Involves Communication • Communicating clearly • Verbally • Written • Handling conflict • Communication Skills • Teaching others (patients, students, colleagues)

  29. Personal Qualificationsof Clinical Psychologists • Superior intellectual ability and judgment • Originality, resourcefulness, and versatility • "Fresh and insatiable" curiosity; "self- learner" • Interest in persons as individuals rather than as material for manipulation—a regard for the integrity of other persons • Insight into own personality characteristics; sense of humor • Sensitivity to the complexities of motivation • Tolerance; "unarrogance" • Ability to adopt a "therapeutic" attitude; ability to establish warm and effective relationships with others APA Committee on Training in Clinical Psychology (1947). Recommended graduate training program in clinical psychology. American Psychologist, 2, 539-558.

  30. Personal Qualificationsof Clinical Psychologists • Industrious; methodical work habits; ability to tolerate pressure • Acceptance of responsibility • Tact and cooperativeness • Integrity, self-control, and stability • Discriminating sense of ethical values • Breadth of cultural background—"educated man” (or woman) • Deep interest in psychology, especially in its clinical aspects APA Committee on Training in Clinical Psychology (1947). Recommended graduate training program in clinical psychology. American Psychologist, 2, 539-558.

  31. For ≈ 70 years we’ve known “The list is formidable but in the present state of our knowledge, represents the kind of selection goals towards which we must work. Characteristics of this type seem a necessary foundation for work in a field which requires so much in the way of maturity, sensitivity, and knowledge.” APA Committee on Training in Clinical Psychology (1947). Recommended graduate training program in clinical psychology. American Psychologist, 2, 539-558.

  32. Indicators of Professional Development • Grades/Supervision evaluations • Licensure/Passing EPPP • Board certification • Activities in professional/scientific organizations • Grants • Career advancement • Supervisory • Administrative/managerial • Academic promotion • Awards

  33. Basic Aspects of Professionalism • Character • Attitude • Excellence • Competence • Conduct

  34. Character • Integrity • Honesty • Truthfulness/Forthrightness • Trustworthiness • Responsible • Diligence • Doing what is right • Professional image • Advocates for patients • Promotes justice

  35. Attitude • Service mentality • Seeking Responsibility • Determination • Persistence • Team player • Critical curiosity • Technical Skill • Surpassing minimum standards/goals

  36. Pursuing Excellence • Continualimprovement(CQI, TQM, QAI, 6 Sigma) • Being attentive • Generating questions • Information management • Applying knowledge to real-world situations • Respect for patients • Following instructions

  37. Competence • Expertise • Performance • Personal effectiveness • Communication • Stewardship of resources • Managing uncertainty

  38. Conduct • Professional • Dependable/Responsible • Maturity • Respect • Manners • Confidentiality • Timely/punctual • Classy

  39. Broader Aspects of Professionalism • Do no harm • Have concern for and work to benefit the welfare of others • Act with integrity • Place the rights and dignity of others in highest regard • Promote justice • Adhere to the best standards of knowledge and practice (e.g., evidence based) • Use data before opinion • Put respect before bias • Place compassion before convenience

  40. Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and Practice, 36, 367-375.

  41. Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and Practice, 36, 367-375.

  42. Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and Practice, 36, 367-375.

  43. Elman, N. S., Illfelder-Kaye, J. & Robiner, W. N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and Practice, 36, 367-375.

  44. Crossing the Quality Chasm: A New Health System for the 21st Century “…a revamped system…centered on the needs, preferences, and values of patients…encourages teamwork among health care workers…makes much greater use of information technology” Institute of Medicine, Committee on the Quality of Health Care in America (2001).

  45. It Is Time To Blast Out of Our Psychology Silo

  46. Into the Era of Interprofessional Professionalism From Uniprofessional Care/Ed to Interprofessional Care/IPE T E A M S O L O Ψ Ψ

  47. Triple Aim and Interprofessional Care “The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes.” Brandt, B., Lutfiyya, M. N., King, J. A., & Chioreso, C. (2014). A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. Journal of Interprofessional Care, early online 1-7. doi: 10.3109/13561820.2014.906391

  48. Triple Aim • Quality • Safe • Effective • Outcomes • Satisfaction • Patient • Provider • Cost • Total • Per capita • Utilization “The Triple Aim (Berwick et al., 2008) has become a galvanizing force drawing attention to a generalized approach needed to fix the US healthcare system by simultaneously improving patient experiences of care (including quality and satisfaction), improving the health of populations and reducing the per capita cost of healthcare.” Berwick, D.M., Nolan, T.W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27, 759–769. Brandt, B., Lutfiyya, M. N., King, J. A., & Chioreso, C. (2014). A scoping review of interprofessional collaborative practice and education using the lens of the Triple Aim. Journal of Interprofessional Care, early online 1-7. doi: 10.3109/13561820.2014.906391

  49. Definitions Interprofessional Collaboration (IPC) • Collaborative practice occurs when professionals from different disciplines “work together with patients, families and communities to deliver the highest quality of care” (WHO, 2010) • An interpersonal process of communication and decision making that enables the separate and shared knowledge and skills of health care providers to synergistically influence the patient care provided (Way et al., 2000) Way, D. O., Busing, N., & Jones., L. (May 18, 2000). Implementation strategies: Collaboration in primary care-family doctors and nurse practitioners delivering shared care, The Ontario College of Family Physicians, 3. World Health Organization, Health Professions networks Nursing & Midwifery Human Resources for Health, 2010. Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: Word Health Organization.

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