THE PROFESSIONALISM CURRICULUM AS A CULTURAL CHANGE AGENT IN SURGICAL RESIDENCY EDUCATION

1. THE PROFESSIONALISM CURRICULUM AS A CULTURAL CHANGE AGENT IN SURGICAL RESIDENCY EDUCATION Mark S. Hochberg, M.D., Adina Kalet, M.D., Sondra Zabar, M.D., Colleen Gillespie, PhD., Russell S. Berman, M.D., H. Leon Pachter, M.D. and the SPICE Study Group Department of Surgery New York University School of Medicine

2. SPICE NATIONAL STUDY GROUPSurgical Professionalism and Interpersonal Communication Education • Albert Einstein • American College of Surgeons • Association of American Medical • Chiba University (Japan) • Cleveland Clinic • Columbia University-College of Physicians and Surgeons • Cornell • Creighton University • Dartmouth Medical School • Drexel Medical • Emory University • Florida International • Florida State University • Georgetown University Medical • Gold Foundation • Harvard/Beth Israel • Harvard/Brigham and • Hofstra University Medical • King Saud University (Riyadh, Saudi Arabia) • Johns Hopkins • Loyola University Medical • LSU Health Center • Macy Foundation • Maine Medical Center • McGill University • Medical College of Georgia • Michigan State University • Mount Sinai Medical Center • National Board of Medical Examiners • Northwestern University School of Medicine • Ottawa Medical Center • Rush University (Chicago) • Southern Illinois University • SUNY/Downstate • Texas Tech Univ. Health Science Center • Tufts Medical School/Baystate • Tulane University • United States University of Health Sciences • University of Arizona • University of British Columbia (Canada) • University of California, Irvine • University of California San Francisco-Fresno • University of Florida School of Medicine • University of Georgia • University of Hawaii   • University of Illinois-Chicago • University of Illinois-Urbana • University of Kansas • University of Minnesota • University of Missouri-Columbia • University of Missouri-Kansas • University of New Mexico • University of North • University of North Dakota • University of Rochester • University of South • University of Southern California • University of Tennessee/Knoxville • University of Texas/San Antonio • University of Utah • University of Washington Medical School • University of Western Ontario (Canada) • Vanderbilt Medical School • Virginia Commonwealth University • Virginia Tech Medical School • Washington University St. Louis • Wayne State University

3. ACGME SIX CORE COMPETENCIES • Patient care • Medical knowledge • Practice based learning and improvement • Interpersonal and communication skills • Professionalism • Systems based practice CHALLENGE FOR SURGEONS: #4 AND #5

4. WHEN WAS THE PROFESSIONALISM COMPETENCY MANDATED BY THE ACGME/RRC? • 1999 • 2002 • 2004 • 2006

5. ER Transfer to Surgery

6. NYU PROFESSIONALISM SEMINAR TOPICS • Advanced Communication Skills for Surgical Practice • Admitting Mistakes - Ethical and Communication Issues • Delivering Bad News – Your Chance to Become a Master Surgeon     • Interdisciplinary Respect  -- Working as a Team   • Working Across Language and Cultures: The Case for Informed Consent      • Medical malpractice and the Surgeon • Stress of Surgical Practice – The Life You Save May Be Your Own

7. OUR TWO QUESTIONS: • Has professionalism education as mandated by the ACGME/RRC in 2002 taken hold? • Is there any evidence that surgical residents’ professionalism skills have improved over time?

8. EVALUATION OF PROFESSIONALISM EDUCATION • STUDY #1 Resident self-assessment of professionalism abilities – annually over four years • STUDY #2 Objective metrics of resident performance during professionalism OSCEs as graded by standardized patients – annually over three years • STUDY #3 SPICE Study Group national survey of 41 departments of surgery

9. STUDY #1 SUBJECTIVE METRICS

10. STUDY # 2 OBJECTIVE METRICS • Studied one cohort of nine surgical residents over a three year period • Each resident completed a six-station OSCE on professionalism each year • The same set of OSCEs are administered as residents entered their PGY1, PGY2 and PGY3 years • Standardized Patients varied over the years – all received similar training; rated each task as “well done”, “partially done” or “not done” by the resident • 54 OSCEs per year; total 162 OSCEs over the three year study period

11. STUDY # 2 OBJECTIVE METRICS

12. STUDY #3 SPICE NATIONAL SURVEY

13. STUDY #3 SPICE NATIONAL SURVEY

14. STUDY #3 SPICE NATIONAL SURVEY

15. Let’s go to the videotape Ending Well

16. ER Transfer to Surgery: Take 2

17. FUNDING SUPPORT • Josiah Macy, Jr. Foundation • Arthur Vining Davis Foundations

18. THANK YOU! • Adina Kalet, MD adina.kalet@nyumc.org • Mark Hochberg, MD mark.hochberg@nyumc.org • Sondra Zabar, MD sondra.zabar@nyumc.org

20. Mostly NOT Significant except Ethics: PGY 2 < 4 N=9 N=8 N=7 N=4