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ROLE MODELLING: Making the Implicit Explicit

ROLE MODELLING: Making the Implicit Explicit. Caroline Storr, Liliane Asseraf-Pasin, Andrea Moreault. We would like to acknowledge the Faculty Development Office: Dr. Richard Cruess & Dr. Sylvia Cruess. Reflection.

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ROLE MODELLING: Making the Implicit Explicit

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  1. ROLE MODELLING:Making the Implicit Explicit Caroline Storr, Liliane Asseraf-Pasin, Andrea Moreault We would like to acknowledge the Faculty Development Office: Dr. Richard Cruess & Dr. Sylvia Cruess

  2. Reflection • What is the most significant experience you have encountered within your professional training and/or career development?

  3. “Individuals admired for their ways of being and acting as professionals”Côté & Leclère: Academic Medicine, 2000 WHO ARE ROLE MODELS?

  4. Role Modelling is at the heart of character formation Knowledge and skills are essential, but putting them together in a competent and caring response to patients’ needs is learned in personal interaction and Role ModellingKenny, N. Academic Medicine 2003

  5. Role Modelling • “Un modèle de rôle en médecine est un médecin qui, dans le contexte de son exercice professionnel, influence l’apprentissage des externes et des résidents avec qui il est en contact.” (Chamberland & Hivon, 2005) • “The process whereby faculty members exhibit knowledge, attitudes, and skills, demonstrate and articulateexpert thought processes, and manifest positive professional behaviours and characteristics” (After Irby, J Med Ed, 1986)

  6. Pedagogicalmodalities specific to clinical education Clinical Teacher Patient Student Supervision Role modelling Chamberland & Hivon, 2005

  7. “Excellent role models will always inspire, teach by example, and excite admiration and emulation.” PAICE, E. BMJ 2002 • “being a role model is what happens when you are busy doing other things”John Lennon

  8. ACTION!!!

  9. What are some of the differences between a Role Model and a Mentor?

  10. Mentorship differs from role modelling in that the mentor is actively engaged in an explicit two-way relationship with a junior colleague-a relationship that evolves and develops over time and can be terminated by either party • A good mentor is a coach asking questions more often than giving answers • Mentors have an active role in guiding their junior colleaguesPAICE, E. BMJ 2002 MENTORING

  11. WHY DO ROLE MODELS MATTER? Major Influence in the Creation of a Health Professional Part of the formal & informal curriculum (influenced by the hidden curriculum) Can affect career choice Significant influence on peers Negative role modeling is common and can be destructive

  12. WHY DO ROLE MODELS MATTER? RESIDENTS: Less than 50% of teaching physicians are good role models (Wright et al: NEJM, 1998)

  13. Role Models • Are often unaware of what they are demonstrating • Model: A BROAD RANGE OF ATTRIBUTES - expertise/clinical skills - humanism/self awareness, empathy, respect - communication/patient & student - personal qualities/lifestyle - collaborative practice - advocacy

  14. Attributes Competence Commitment Confidentiality Altruism Trustworthy Integrity / Honesty Codes of ethics Morality / Ethical Behavior Responsibility to profession Caring/compassion Insight Openness/ transparency Respect for the healing function Respect patient dignity/autonomy Presence/Accompany Autonomy Self-regulation Associations Institutions Responsibility to society Team work Healer Professional

  15. What Makes a Good Role Model? • Competence • TIME: total hours & % of time spent teaching • Being aware of being a role model • Being explicit about what is being modeled and why • Communicating enthusiasm • (Generalist vs specialist) Wright et al: NEJM,1998 Côté & Leclère: Acad Med, 2000

  16. What Makes a Good Role Model? • Demonstrating sensitivity to student’s needs • Being aware of power difference • Giving feedback • Stressing importance of patient relationship • Stressing psychosocial aspects of medicine • Reflecting and encouraging reflection in students • Institutional support Wright et al: NEJM,1998 Côté & Leclère: Acad Med, 2000

  17. What Makes a Poor Role Model? • Disrespect- patients/students/team members • Insensitivity- patients/students/team members • Professional dissatisfaction • Lack of collegiality • Culture accepting of poor relationships • Lack of institutional support

  18. Time/overwork Impatience Overly opinionated Hostile attitude Lack of enthusiasm Poor interpersonal skills Impersonal approach Too reserved/quiet Barriers to Good Role Modeling

  19. NO ONE IS A GOOD ROLE MODELALL OF THE TIME

  20. HEALTH PROFESSIONALS CAN IMPROVE AS ROLE MODELSBehaviors Can ChangeSkeff: NEJM,1998

  21. CONCEPTUAL MODEL Excellent Clinical Skills High Order Clinical Skills BARRIERS personal Teaching Skills BARRIERS institutional Personal Qualities Reflective Role modeling Threshold Level After Wright et al: CMAJ, 2002

  22. 1. Apprenticeship model • Learning through participation in an environment, where « ways of being » are modeled. • Allows one to observe: • How knowledge and skills are applied to real situations, unique to the profession. • How behaviours and knowledge (as well as the consequences of these) are used in context.

  23. 2. Situated learning • Learning that occurs in the context of practice, including knowledge, skills, and social norms. • Professionals learn from participating in, and gradually being absorbed into, communities of practice. • “Learn to talk from talk” • The process becomes an integral and inseparable aspect of social practice.

  24. 3. Observational Learning(Bandura) • Learning occurs in an environment of constant, dynamic, reciprocal interaction among people, their behaviour and the environment. • Students learn behaviours and ways of being that look successful to them in light of their own goals and experience and the rewards they see present in the environment.

  25. 4. Reflective practice (Schön) • The process of intentionally turning thoughtful practice into a potential learning experience. • Reflection helps the model to make explicit the moral and other judgmental standards by which they guide and judge their behaviour.

  26. 4. Reflective practice(Schön) Reflection and Role Modeling • Reflection IN Action: while performing an act/role, explain what is being done • Reflection ON Action: after Performing the act/role, reflect with the student(s) on the impact of the action on the patient, student, and self • Reflection FOR Action: discuss what has been learned for the future Lachman & Pawlina: Clin Anat, 2006

  27. 5. Ethics Education • The systematic reflection about what we do, believe, and value can contribute powerfully to understanding how we frame and resolve medical ethical dilemmas and how, in reality, professional character is formed.

  28. TAKE HOME MESSAGE • Attention - to the patient - to the student • Retention - use Socratic methods to involve the student and promote retention • Production - getting the student to use knowledge in order to embed it • Motivation - make the event enjoyable (Bandura: 1986)

  29. ALL TEACHERS ARE ALWAYS ROLE MODELS FOR STUDENTS,GOOD, BAD, or INDIFFERENTALTHOUGH WE CAN’T ALWAYS BE “PERFECT”THE GOAL IS TO BE CONSISTENTLY GOOD

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