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Professionalism Week 2006. A Case for Education January 27, 2006. Late one afternoon in the teaching hospital. What happened?. Problem List. Late day Multidisciplinary Disorders Demanding client Whiny Attitudes Tension and irritability Blame.

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professionalism week 2006

Professionalism Week 2006

A Case for Education

January 27, 2006

problem list
Problem List
  • Late day
  • Multidisciplinary Disorders
  • Demanding client
  • Whiny Attitudes
  • Tension and irritability
  • Blame
problem 1 late case day differential diagnosis
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
late case day
Late Case/Day
  • Busy day in a busy hospital
  • Sick animals can’t tell time
problem 2 multidisciplinary case
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
multidisciplinary case
Multidisciplinary Case
  • Challenging case that requires teamwork and a “quarterback”
problem 3 demanding client
Problem #3: Demanding Client
  • Just one of those *#&% types
  • Pathologically attached
  • Mentally ill
  • Other bias about individual
  • Entitled high maintenance client
problem 3 demanding client10
Problem #3: Demanding Client
  • Concerned and stressed pet owner
problem 4 whiny attitudes
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
whiny attitudes
Whiny Attitudes
  • Justified to make a point?
  • Emotions and reactions are high
problem 5 blame
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
problem 5 blame14
Problem #5: Blame
  • Everyone is doing the best they can
diagnostic plan
Diagnostic Plan
  • Reflect on problem list and look for common themes
  • Reflect on situation
  • Determine action plan and prognosis
ways of thinking
Ways of Thinking

Wow. That sounds like “cognitive restructuring”!

Dr. Strand

cognitive restructuring
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

solution focused problem solving
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

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

professionals healers
Professionals Healers




Respect for Healing

Respect for Patient








Responsibility to Profession



Responsibility to Society


Steinart et al, McGill University

professionals and educators
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

professionals and educators24
Professionals and Educators
  • Diversity and Tolerance
  • Civility
  • Free Exchange of Ideas
  • Fairness
  • Integrity
  • Intellectual Standards of Excellence
  • Autonomy

AAUP, American Council on Education; 2005

utcvm professional behaviors
UTCVM Professional Behaviors
  • Commitment to EXCELLENCE
  • High MORAL and ETHICAL Standards
  • Act with COMPASSION
  • Treat others with RESPECT
  • Act with HONESTY and INTEGRITY
does professionalism matter
Does professionalism matter?
  • What’s your emotional bank account at the end of the day? Week? Year?
    • Surplus?
    • Deficit?
what s the evidence
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

what s the evidence30
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

what about the rest of us
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

what about the rest of us32
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

what s the evidence33
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

what s the evidence34
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

what s the evidence35
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
educating professionals
Educating Professionals

Remember the Problem List

  • Late day
  • Multidisciplinary Disorders
  • Demanding client
  • Whining
  • Tension and irritability
  • Blame
educating professionals38
Late day

Multidisciplinary Disorders

Demanding client

Stress management Time mgmt Setting limits

Conflict Resolution Teamwork

Communication skills Cultural/diversity training

Educating Professionals
educating professionals39
Whiny Attitudes

Tension and irritability


Self-awareness Professionalism

Stress/coping skills Communication skills Cognitive restructuring

Feedback skills, Conflict resolution

Educating Professionals


Mature Professional



Years of Training

Hilton, Clin Teach, 2004



Mature Professional





Years of Training

Hilton, Clin Teach, 2004



Mature Professional


Positive Experiences




Negative Experiences

Years of Training

Hilton, Clin Teach, 2004

expectations for professionalism week
Expectations for professionalism week
  • Wide participation in dialogue
  • Time for reflection and personalization of professionalism
  • Renewed “vows” toward professionalism
  • New ideas and goals
  • “A professional is one who can do his job well even when he doesn’t feel like it”
  • Veterinary Social Work
  • Educational Enhancement Committee
  • Office of the Dean
  • UT Employee and Organizational Development
  • Instructional Resources
professionalism week
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