Fostering a Culture of Accountability and Respect: Resident

advertisement
Fostering a Culture of Accountability and
Respect: Resident Leadership and
Development of a Professionalism
Curriculum
Neha Sachdev, MD
Objectives
Background
II. Why Professionalism?
III. Research Methods
IV. Initial Results]
V. Interventions
VI. Timeline/Next Steps
I.
Background
• Northwestern McGaw Family Medicine Residency
• One of 11 original Teaching Health Center programs
• Partnership with Erie Family Health Center (FQHC), Northwestern
McGaw Medical Center and Norwegian American Hospital
(America’s Essential Hospital)
• Leadership Emphasis
and Culture
Why Study Professionalism?
• ACGME Core Competency / Milestones
• Central to formation of professional identity
• Unprofessional conduct in learners
strongly correlates with future disciplinary actions
• Residents identify importance of professionalism
education in training
• Increasing demands on resident-time
• Required for future leadership
Research Methods
• Outcomes Measures
• Quantitative
• Pre-post-post survey with PMEX
• 24 residents, 6 fellows, 11 faculty members and residency coordinator
• Qualitative
• Small group interviews with R1 and R2 classes
•
Process Measures
• Peer to peer formative feedback sessions
• Longitudinal skill-building sessions
• Longitudinal case-based sessions
PMEX Survey
• Validated tool
• Specific, observable behaviors
• 9 questions in 4 major categories
• Doctor/Patient Skills
• Time Management
• Reflective Skills
• Interpersonal Skills
Assessment- PMEX
Pre Results
Characteristics: 21 Respondents-Faculty & Residents, response rate of 62%
Lowest Professionalism Scores
5
4
3
2
1
Admits
errors/ommissions
Solicit feedback
Accept feedback
Address own gaps in
knowledge and skills
Highest Professionalism Scores
5
4
3
2
1
0
Shows respect for
patients
Maintains appropriate
boundaries
Use health resources
appropriately
Maintain patient
confidentiality
9
Key Findings = Lowest mean
scores in Reflective skills, Highest
mean scores in Doctor-Patient
Relationship skills
Interventions
• Peer to peer feedback sessions on inpatient service
• CCC formalization with resident presence
• Formal feedback trainingSBI method
Timeline
• Winter/Spring 2014
• First Post PMEX Assessment collected
• Small group interviews with PGY1 and PGY2 residents
• 6 professional skill-building sessions held with PGY2/PGY3 residents
• Summer/Fall 2014
• First Post PMEX analysis
• Formal feedback sessions implemented in clinic, MCH service
• 3 ‘On Doctoring’ sessions held with all residents and faculty
• 4 ‘On Doctoring’ sessions held with PGY2/3 residents
• Winter 2015
• Second Post PMEX Assessment collected
• Follow-up small group interviews with PGY2/PGY3 residents
Focus Group Questions
1) We are interested in understanding how residents learn about
professionalism. How would you define professionalism, what do you think it
is?
2) We are interested in understanding your training and educational
experiences in professionalism. Can you describe some of the ways that you
have learned about professionalism? What has been the best educational
experience? Why was this an effective method or approach? Can you
describe some of the least effective ways to learn about professionalism?
What made that educational experience ineffective?
3) What are some of the challenges to teaching professionalism in residency?
What are your suggestions on how to teach professionalism effectively
during residency?
4) Are there any other comments or experiences that you can share that would
help us build an effective professionalism curriculum for residents?
Focus Group Themes Identified
Methods of
Professionalism
teaching/learning
Definitions
(positives and negatives) professionalism
- Reflection
- Respect
- Didactic
- Leadership
- Case-based/situational
- Patient care &
- Role-modeling/mentors
communication
- Code of
- Interprofessional
conduct/standards
relationships
- Evaluations
- Learned vs. innate
(Individualized)
- Self-assessment
- Behavior under stress &
fatigue
Difficulties with
teaching/identifyin
g professionalism
- Skepticism
- Blurring of roles
(peer vs friend
vs colleague)
- Time/scheduling
Timeline/Next Steps
• Winter/Spring 2014
• First Post PMEX Assessment collected
• Small group interviews with PGY1 and PGY2 residents
• 6 professional skill-building sessions held with PGY2/PGY3 residents
• Summer/Fall 2014
• First Post PMEX analysis
• Formal feedback sessions implemented in clinic, MCH service
• 3 ‘On Doctoring’ sessions held with all residents and faculty
• 4 ‘On Doctoring’ sessions held with PGY2/3 residents
• Winter 2015
• Second Post Assessment collected
• Follow-up small group interviews with PGY2/PGY3 residents
“On-Doctoring” Curriculum
• Defining Values
• The Impaired Physician
• Finding Inspiration in Medicine
• Leadership and Communication
• Risk Management and Legal Basics
• Balance and Wellness
• Lapses in Professional Conduct
16
References
• Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system--rationale
•
•
•
•
•
•
•
•
and benefits. N Engl J Med. 2012 Mar 15;366(11):1051-6. doi: 10.1056/NEJMsr1200117.
Epub 2012 Feb 22.
ACGME Program Requirements for Graduate Medical Education in Family Medicine.
ACGME, September 29, 2013.
http://www.acgme.org/acgmeweb/tabid/132/ProgramandInstitutionalAccreditation/MedicalSp
ecialties/FamilyMedicine.aspx, Accessed on February 2, 2014.
Baldwin DC Jr, Daugherty SR, Rowley BD. Unethical and unprofessional conduct observed
by residents during their first year of training. Acad Med. 1998 Nov;73(11):1195-200.
Bahaziq W, Crosby E. Can J Anaesth. 2011 Nov;58(11):1039-50. doi: 10.1007/s12630-0119579-2. Epub 2011 Aug 25. Review.
Barry D, Cyran E, Anderson RJ. Common issues in medical professionalism: room to grow.
Am J Med. 2000 Feb;108(2):136-42.
Gillespie C, Paik S, Ark T, Zabar S, Kalet A. J Grad Med Educ. 2009 Dec;1(2):208-15. doi:
10.4300/JGME-D-09-00018.1.
Humphrey HJ, Smith K, Reddy S, Scott D, Madara JL, Arora VM. Promoting an environment
of professionalism: the University of Chicago "Roadmap". Acad Med. 2007 Nov;82(11):1098107. Erratum in: Acad Med. 2008 Nov;83(11):1048.
Cruess RL, Cruess SR. Teaching professionalism: general principles. Med Teach. 2006
May;28(3):205-8.
Taylor C, Farver C, Stoller JK. Acad Med. 2011 Dec;86(12):1551-4. doi:
10.1097/ACM.0b013e318235aa76. Review.
References
• Gaiser RR. Anesth Analg. 2009 Mar;108(3):948-54. doi: 10.1213/ane.0b013e3181935ac1.
•
•
•
•
•
•
•
Review.
Meade LB, Borden SH, McArdle P, Rosenblum MJ, Picchioni MS, Hinchey KT. From theory
to actual practice: creation and application of milestones in an internal medicine residency
program, 2004-2010. Med Teach. 2012;34(9):717-23. doi: 10.3109/0142159X.2012.689441.
Epub 2012 May 30.
Lee AG, Beaver HA, Boldt HC, Olson R, Oetting TA, Abramoff M, Carter K. Teaching and
assessing professionalism in ophthalmology residency training programs. Surv Ophthalmol.
2007 May-Jun;52(3):300-14. Review.
Swing SR. Assessing the ACGME general competencies: general considerations and
assessment methods. Acad Emerg Med. 2002 Nov;9(11):1278-88.
Regis T, Steiner MJ, Ford CA, Byerley JS. Professionalism expectations seen through the
eyes of resident physicians and patient families. Pediatrics. 2011 Feb;127(2):317-24. doi:
10.1542/peds.2010-2472. Epub 2011 Jan 17.
Roberts LW, Warner TD, Hammond KA, Geppert CM, Heinrich T. Becoming a good doctor:
perceived need for ethics training focused on practical and professional development topics.
Acad Psychiatry. 2005 Jul-Aug;29(3):301-9.
17. Ratanawongsa N, Bolen S, Howell E, Kern D, Sisson S, Larriviere D. Residents’
Perceptions of Professionalism in Training and Practice: Barriers, Promoters, and Duty Hour
Requirements. J Gen Intern Med. 2006; 21:758–763.
18. Cruess R, McIlroy JH, Cruess S, Ginsburg S, Steinert Y. The Professionalism MiniEvaluation Exercise: A Preliminary Investigation.Acad Med. 2006 Oct; 81 (10): S74-S78.
Download