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This study explores professionalism in surgery, defining attributes valued by students, faculty, and residents. The framework aims to establish a culture of professionalism and improve behaviors in the surgical field.
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A Framework for Professionalism in Surgery: What is Important to Medical Students?
Disclosures • none
The Problem • Terms used to explain professionalism abstract • Different groups use word differently • Easy to recognize, hard to define • Ways to best teach not well established • Power of the “hidden curriculum”
Our Goals • Develop an institutional culture of professionalism • Establish expectations regarding professional behavior • Explicitly define professionalism • Attributes and principles must be clearly defined and understood
Purpose • Develop a comprehensive definition (framework) of professionalism in surgery • Determine which attributes are most valued by medical students • Determine which attributes are most demonstrated by faculty and residents
Methods • Framework for Professionalism in Surgery • Phase 1 • Core group of educational leaders • Brainstorming sessions • Review of literature and resources • List of all attributes • Phase 2 • Attributes grouped into similar concepts • Served as foundation for attribute categories • Final categories decided upon by expert consensus
Framework for Professionalism USC Department of Surgery • Clinical Competence • Technical skill • Clinical reasoning • Diagnostic ability • Inquisitiveness • Patient-centered care • Diligence • Cultural Competence • Respect for diversity • Works across language/cultures • Understands how culture affects healthcare • Altruism • Non-judgmental • Caring • Civic-minded • Dedicated • Compassionate • Integrity/honesty • Patient advocate • Education • Responsibility to teach (patients, learners) • Mentoring • Leadership • Inspires others • Role modeling • Understands role on team Professionalism Appearance Accountability • Ethics/Legal • Maintains appropriate relationships (industry, patients, peers, subordinates) • Manages conflicts of interest • Practices beneficence • Full disclosure • Reports mistakes • Follows institutional guidelines • Research ethics • Just distribution of resources • Interpersonal Skills • Effectively communicates (information gathers, effective listening, transmits key information, giving bad news) • Works well within a team • Fosters relationship development • Approachable Practice Improvement Self-awareness Self-reflection Recognizes limits manages emotions Admits mistakes Response to criticism Aware of biases Motivation to improve Commitment to LLL • Respect • Interdisciplinary • Patient autonomy • Patient confidentiality • Allied health • Colleagues
Methods- cont • All Year III students (N=168) • Structured focus group • Define professionalism • List most important attributes • Describe any witnessed unprofessional behavior • Written questionnaire • Recorded and transcribed verbatim
Coding • Coded by two independent raters • Assigned an attribute category • Iterative process of discussion, refinement of coding schema and consensus • Achieved inter-rater agreement of 99% • Comments assigned up to three attribute categories
Coding Example • Belittling those below you on the hierarchical chain • Respect and leadership • Making negative comments about a very sick ICU patient • Altruism and Respect
Results - Cont • 53% witnessed unprofessional behavior by faculty
Results - Cont • 64% witnessed unprofessional behavior by residents/fellows
Conclusions • Framework for Professionalism in Surgery has been useful • Clear definition • Foundation for expected behaviors
Conclusions - Cont • Respect most important attribute • Most violated • Rude or argumentive behavior • Interlay between emotionally charged behavior and cognitive skills • Rudeness may impair thinking skills and/or cause distraction • Able to target faculty development program
Future Studies • Further explore the impact of rude behavior on performance • Study of human behavior in high risk environments • Safety studies in other disciplines • Few in medicine