Module 1 Professional Identity: Physician, Teacher and Leader

1. 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

2. 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

3. 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.

4. 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.

5. 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.

6. 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

7. 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)

8. 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)

9. Introduction http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html (with permission)

10. 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

11. 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.

12. 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.

13. 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.

14. Agenda • Module 1 will include the following topics: • Physician identity & professionalism • Relationships in medicine • Effective communication • Leadership identity • Hidden curriculum • Summary

15. 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.

16. 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

17. 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

18. 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

19. 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.

20. 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.

21. 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)

22. 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!

23. 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.

24. 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

25. 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!

26. 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?

27. 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

28. 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

29. 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.

30. 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.

31. 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

32. 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

33. 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.

34. 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.

35. 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

36. 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.

37. 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.

38. 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.

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

40. 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.

41. 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.

42. 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

43. 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

44. 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.

45. 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.

46. 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.

47. 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.”

48. 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?

49. 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.

50. 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.