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A Framework for Professionalism in Surgery: What is Important to Medical Students?

A Framework for Professionalism in Surgery: What is Important to Medical Students?. Disclosures. none. History. 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

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A Framework for Professionalism in Surgery: What is Important to Medical Students?

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  1. A Framework for Professionalism in Surgery: What is Important to Medical Students?

  2. Disclosures • none

  3. History

  4. 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”

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Results – 82% Response Rate

  13. Results – 82% Response Rate

  14. Results - Cont • 53% witnessed unprofessional behavior by faculty

  15. Results - Cont • 64% witnessed unprofessional behavior by residents/fellows

  16. Conclusions • Framework for Professionalism in Surgery has been useful • Clear definition • Foundation for expected behaviors

  17. 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

  18. 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

  19. Thank You

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