Professionalism- ACGME’S Perspective- It’s a Competency

Marsha Miller, MA Associate Vice President, Office of Resident Services Professionalism-ACGME’S Perspective-It’s a Competency

Professionalism My encounter with unprofessional behavior—a mother’s story.

Professionalism “Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: • Compassion, integrity, and respect for others; • Responsiveness to patient needs that supersedes self interest;

Professionalism • Respect for patient privacy and autonomy; • Accountability to patients, society and the profession; and • Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.”

Professionalism “Research has shown that medical students often learn the values and ideology of the profession by observing the behavior of those in positions to which they aspire. Through this process of observing, students typically experience pressure to conform to and adopt values and behaviors not espoused by the formal curriculum as normative characteristics of the physician’s role (White, et al., 2009).”

Professionalism Residents underreport duty hours for three reasons: • They want to take care of their patients and not hand them off; • There is an unusual case to observe or didactics scheduled; • There is fear of losing accreditation and having to find another program.

Professionalism “They (program directors) see it (resident survey) as a threat because they may get unfavorable responses (and sometimes they do because residents don’t know how to answer the questions).”

Professionalism • “Duty hours can be complicated. Do we count weekends, backup call? If so, it could look like they are always on call!” • “Program directors know that the results of the survey will be used by the ACGME and their home DIO. We are all nervous about the ACGME and DIO.”

Professionalism • “I don’t tell my residents what to say, but do help them understand the nature of the questions, and like duty hours, help them answer it in a way that is realistic (E. Beresin, MD, personal communication, 2009).”

Professionalism Three stories: • ACGME resident survey • Professional Misconduct • Dismissal

Professionalism What are the objective measures? • Internal Medicine, Pediatrics, OB/GYN, Surgery, and Urology have formed Milestone Groups. • They have convened to define the cognitive and behavioral attributes that are essential.

Professionalism • Transitional Year, Radiology, and Ophthalmology are beginning to form. Each group includes: • representative of the specialty board • review committee member • RRC executive director • ACGME portfolio advisor • one or two residents

Professionalism Eventually the milestones, assessment tools, and common curriculum components will be preloaded into specialty specific versions of the ACGME Learning Portfolio (ALP).

Professionalism • ALP will: • Serve as the required repository for semi-annual documentation. • Aggregate the data and produce local and national reports. • Data collected will support program review by the residency review committees and improvement.

Professionalism • Accreditation review will transform from a process-based system to a system in which programs are periodically evaluated and tracked based on aggregate performance outcomes and compared to national milestones and expectations.

Professionalism • RRCs will build longitudinal profiles of a program’s educational performance, including Professionalism. • This will facilitate continuous monitoring of outcomes, increased accountability to the public, and prompt intercession when difficulties arise.

Professionalism • A natural benefit will be the lengthening of the duration between site visits. • Data will be reviewed annually. • No reason for a site visit if graduates demonstrate proficiency in the competencies, professionalism being but one.

Professionalism How will this system work? • Program Directors will enter the information into ALP at least twice annually. • The RRCs will use the aggregate data for program review and accreditation decisions.

Professionalism What will this accomplish? • Increased communication, consistency, and an outcome-driven approach will enable RRCs to streamline their review of programs, offer timely guidance and assistance, and extend site visits!

Professionalism • DIOS will benefit because they can use the portfolios to assess how well programs are doing within their institutions in preparing competent physicians for practice.

Professionalism In a nutshell— • Residents will have objective path markers. • Program Directors will have measurement tools. • Program Directors will evaluate and measure proficiency in the six competencies.

Professionalism • Program Directors will enter the information into ALP at least twice annually. • The RRCs will use the data for program review and accreditation decisions. • Programs will have extended time between site visits. • Program Directors and DIOs will be happier! And so will we!

Professionalism The good news— • We are making process in defining competence markers and identifying tools to measure Professionalism and the other ACGME competencies. The bad news— • We have only just begun.

Professionalism • To learn more about ALP and the Milestones and Outcomes Projects, please visit the AGME Web site: • http://www.acgme.org/outcome/about/faq.asp • http://www.acgme.org/acWebsite/portfolio/alp_faqs.pdf

Professionalism Last thoughts… Socrates said that an “unexamined life” is not worth living. We need to look inward and to do what is right, not for one’s own benefit, but for the rightness of it.

Professionalism Doctors are very familiar with these concepts because they have taken an oath to place the welfare of the patient above their own because it is the right thing to do. In my opinion—This is Professionalism!

Professionalism

Professionalism- ACGME’S Perspective- It’s a Competency