Jayne M. Peterson, MD Banner Good Samaritan Medical Center

1. Setting Expectations on Professionalism in Residency:Orientation Workshop on Common Professionalism Issues Jayne M. Peterson, MD Banner Good Samaritan Medical Center

2. Professionalism in Residency • One of 6 Core Competencies required for board certification by the ABIM • Traditionally difficult to define, to “measure” and to teach • “Unwritten rules” only “discovered when you make a mistake” References Medical Professionalism. Chicago: ACGME, 2006 (Accessed Jan. 8, 2007 at http://www.acgme.org/outcome/implement/Profm_resource.pdf) Stern, D, Papadakis, M. The Developing Physician – Becoming a Professional. NEJM 2006;355:1794-9.

3. Setting Expectations in Our Residency • Resident Manual • Orientation for PGY 1 prior to starting residency • Workshop for PGY 2’s prior to moving to supervisory role with follow up workshop in early PGY 3 year • Monthly orientation to each new rotation • Advisor Meetings twice per year

4. Definitions of Professionalism • Prokos = Trust • Respect - for patients & families, peers, other healthcare team members • Appropriate behavior – polite, dedicated, compassionate, hardworking, timely, well groomed, honest, maintain confidentiality

5. Unprofessional Behavior Examples Observed by Attendings • Not taking responsibility for errors, communicating with patient’s family members • Not following “pay back rules”, leaving work undone or not insuring continuity of care during handoffs, not working as a team, falsely calling out “sick” • Discussing patients in a nonprofessional manner in multidisciplinary meetings • Being late for clinical duties without good reason • Poor communication skills in difficult situations • Poor appearance both in dress and attitude/interest • Criticizing other staff & colleagues in public

6. Resident Observed Unprofessional Behavior • Gossiping about other members of healthcare team • Yelling at ancillary staff • Talking about patients in elevator • Residents shirking post call duties to interns, or not assisting in workload • Bad attitudes – “getting hits” or “whining” • Asking for weekdays off so have less patients “schedule squabbling” • Poor “checkouts” & leaving early • “putting down” students & interns • Poor conference attendance • Calling in sick or not showing up for expected duties

7. Why do you think this unprofessional behavior occurred? • Stress/time issues • No consequences • Fatigue/frustration • “People are not secure in who they are” “just their personality” “arrogance” • Clinical duties not well defined/uncomfortable with role in health team

8. Personal Professionalism Plans • Open your envelope from 2007 • Did you do what you said you would do? • Do you have a way to measure your change?

9. Professionalism Quality Improvement Identify Something you want to change: • Plan – What are your opportunities & barriers to change? How will I know that the change was effective? • Do – Try it • Study – Measure the change • Act – See if you can incorporate the change in your life. Start the cycle over again.

10. Summary of PDSA Cycle Act Plan Study Do

11. Example – Jayne Peterson Opportunity: Time Management – I waste too much time looking for things on my desk Plan – Organize my desk & then deal with each item only once – toss it, file it, or complete it. Do – schedule clean up date, get a new on-desk file system Study – In one month – is my desk still clean and can I find what I need? Act – If in one month it is working – I will keep this system and move on to my book shelf.

12. Resident Small Group Discussion • How can we improve professionalism in our residency program? • What do you think should be the consequence of unprofessional behavior? • Does it matter what the behavior is? • Share a personal professional plan for 2008-2009 with your group and how you plan to measure it.