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Professionalism Week 2006

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  1. Professionalism Week 2006 A Case for Education January 27, 2006

  2. Late one afternoon in the teaching hospital...

  3. What happened?

  4. Problem List • Late day • Multidisciplinary Disorders • Demanding client • Whiny Attitudes • Tension and irritability • Blame

  5. Problem #1: Late Case/Day“Differential diagnosis” • Client got here late • Referring vet waited too long • The emergency service is slow • Medicine is always in rounds • Got stuck in “bottlenecks” • Hospital inefficiencies

  6. Late Case/Day • Busy day in a busy hospital • Sick animals can’t tell time

  7. Problem #2: Multidisciplinary Case • Let me know when you have a diagnosis • Let me know if it needs to go to surgery • Not my table syndrome • They always go to medicine

  8. Multidisciplinary Case • Challenging case that requires teamwork and a “quarterback”

  9. Problem #3: Demanding Client • Just one of those *#&% types • Pathologically attached • Mentally ill • Other bias about individual • Entitled high maintenance client

  10. Problem #3: Demanding Client • Concerned and stressed pet owner

  11. Problem #4: Whiny Attitudes • One of those days • Research grant/paper/presentation due • Problems at home? • She’s always like that • It’s those darn whiny students these days

  12. Whiny Attitudes • Justified to make a point? • Emotions and reactions are high

  13. Problem #5: Blame • It must be someone’s fault.. • “They never” syndrome • It’s harmless ribbing, get used to it • The RDVM should have known better

  14. Problem #5: Blame • Everyone is doing the best they can

  15. Diagnostic Plan • Reflect on problem list and look for common themes • Reflect on situation • Determine action plan and prognosis

  16. Ways of Thinking Wow. That sounds like “cognitive restructuring”! Dr. Strand

  17. Cognitive Restructuring • Three Rational Questions • Is my thinking based on fact? • Does my thinking help me achieve my goals? • Does my thinking help me feel the way I want to feel? Pucci, 1999

  18. Solution-Focused Problem Solving • Identify a time in the recent past when this was not a problem? • What was happening that worked well? • What would we see if we were watching things go well on videotape? Kim-berg, 2002

  19. So what does this have to do with professionalism?

  20. Professionalism • From “profess”: to make a vow, admission, claim, allegiance • “The conduct, aims or qualities that mark a profession or professional person”

  21. Professionalism • A vocation or occupation requiring long period of intense study • Performing specialized work for pay • “the following of a profession for gain or livelihood” Is it just a job?

  22. Professionals Healers Caring/Compassion Insight Openness Respect for Healing Respect for Patient Presence Competence Commitment Confidentiality Altruism Integrity Ethics Responsibility to Profession Autonomy Self-Regulation Responsibility to Society Teamwork Steinart et al, McGill University

  23. Professionals and Educators • Recognize special responsibility • Encourage free spirit of learning • Foster honest academic conduct • Demonstrate respect for students • Recognize obligations in community of scholars • Serve as responsible member of academic institution • Maintain rights/obligations as citizen of larger community American Association of University Professors, 1966/1987

  24. Professionals and Educators • Diversity and Tolerance • Civility • Free Exchange of Ideas • Fairness • Integrity • Intellectual Standards of Excellence • Autonomy AAUP, American Council on Education; 2005

  25. UTCVM Professional Behaviors • Commitment to EXCELLENCE • High MORAL and ETHICAL Standards • Act with COMPASSION • PRIDE, DIGNITY, ALTRUISM • Treat others with RESPECT • Act with HONESTY and INTEGRITY • Be TRUSTWORTHY and PREPARED • Exhibit COLLEGIALITY • Act with CONFIDENTIALITY

  26. Does it matter?

  27. Does it matter?

  28. Does professionalism matter? • What’s your emotional bank account at the end of the day? Week? Year? • Surplus? • Deficit?

  29. What’s the Evidence? • Student behavior predictive of future disciplinary actions for physicians • Particularly with 3 domains • Poor responsibility/reliability • Lack of self-improvement/adaptability • Poor initiative/motivation Academic Medicine, 2004 New England Journal of Medicine, 2005

  30. What’s the Evidence? • Compared 5 yrs of student report data with physician citations in state • Most were breaches of integrity/ professionalism (75% of students, 79% of physician citations) • Failure to meet requirements, attendance • Abuses of privilege • Substance abuse • 16% for arrogance, abusive behavior, poor group interaction Ainsworth et al, AAMC, 2005

  31. What about the rest of us? • Students observed and reported Operating Room behaviors • Residents and anesthesiologists • good > bad • Attendings and surgeons • bad > good Curry, et al, AAMC, 2005

  32. What about the rest of us? • Most “bad” interactions in communication and respect • More “bad” interactions with colleagues, co-workers than students or patients Curry, et al, AAMC, 2005

  33. What’s the Evidence? • N= 281 veterinary students and 142 recent grads • Students who felt comfortable discussing emotional veterinary issues with their professors also felt more confident and competent discussing and handling these issues with their clients Tinga et al, 2001. JAVMA

  34. What’s the Evidence? • Malpractice • Virtually all malpractice claims are associated with breakdown in communication within the veterinary team and between the team and the client. Newman, Esq., 2004, NAVC Proceedings; Richardson, F. 2005

  35. What’s the Evidence? • Malpractice • Once a medical mistake has been made these are the most common complaints against veterinarians: • Delay in informing the client • Attempts to understate the problem • Treatments to fix the problem without the client’s approval or knowledge • Altered records

  36. Can Professionalism be Taught?

  37. Educating Professionals Remember the Problem List • Late day • Multidisciplinary Disorders • Demanding client • Whining • Tension and irritability • Blame

  38. Late day Multidisciplinary Disorders Demanding client Stress management Time mgmt Setting limits Conflict Resolution Teamwork Communication skills Cultural/diversity training Educating Professionals

  39. Whiny Attitudes Tension and irritability Blame Self-awareness Professionalism Stress/coping skills Communication skills Cognitive restructuring Feedback skills, Conflict resolution Educating Professionals

  40. Student Mature Professional Naivete Idealism Years of Training Hilton, Clin Teach, 2004

  41. Student Mature Professional Naivete Wisdom Idealism Cynicism Years of Training Hilton, Clin Teach, 2004

  42. Student Mature Professional Naivete Positive Experiences Wisdom Idealism Cynicism Negative Experiences Years of Training Hilton, Clin Teach, 2004

  43. Expectations for professionalism week • Wide participation in dialogue • Time for reflection and personalization of professionalism • Renewed “vows” toward professionalism • New ideas and goals

  44. Another day in the veterinary teaching hospital…

  45. What happened this time?

  46. Professionalism • “A professional is one who can do his job well even when he doesn’t feel like it”

  47. Acknowledgments • Veterinary Social Work • Educational Enhancement Committee • Office of the Dean • UT Employee and Organizational Development • Instructional Resources

  48. Professionalism Week • Departmental and Unit Workshops • Wednesday February 1, 8 – 10 am • Building Trust within an Organization • Dr. Linda Francisco • Thursday, February 2, 3 pm • Followed by reception/social hour