Leadership & Professionalism:
Practical Tools in the Workplace
for Residency Training Officers
Erlyn A. Sana, PhD
<erlynsana@yahoo.com.ph>
The resident’s workplace: the ward
The resident’s workplace: the OPD
The Ob-Gyn resident’s workplace
1. Obstetrics Admission
Section (OBAS)
2. Consultation Room
3. Labor Room
4. Delivery Room
5. Operating Room
6. Intensive Maternal
Unit
1.
2.
3.
4.
Conference Rooms
Library
Lecture Halls
Classrooms with peers
and/or consultants
5. Call room
The Ob-Gyn resident’s teachinglearning milieu
Resident:
learner
Physical
environment
Society
Teacher:
TOs
consultant
Patient
Professional roles & general terminal
competencies expected of residents
Clinician
Integration of Basic, Clinical
& Surgical Knowledge
Skills
Educator
Facilitating
Organizational
competence
Researcher
Use of evidence for
decision making
Manager
Organization
Management
Social mobilizer
Advocacy
Networking
Leadership &
Conduct of
research
Professionalism
Professionalism
• Those sets of values that sustain the interest of
the patient above one’s own self-interest,
• Entails a wide range of attitudes and behaviours
such as altruism, humility, commitment to
excellence, duty & commitment to service,
honour & respect for others, integrity &
compassion, and accountability to patients,
colleagues and society
• American Board of Internal Medicine (CPA
Bulletin, 2002)
Leadership
• The process through which an individual
attempts to intentionally influence another
individual or a group in order to accomplish a
goal.
• Locus of leadership: a person
• Focus of leadership: other individual or groups
• Most critical element: influence
• Shortell and Kaluzny, 1997
Leadership traits
• Personal: integrity, courage, discipline, loyalty,
a sense of justice, sacrifice, honor,
unselfishness, tact, decisiveness, reliability,
moral character & enthusiasm
• Leadership skills and techniques
• Intellectual breadth
• Intellectual depth
• Resident Leadership Webinar
The trouble with attitudes
as learning outcomes:
When we follow codes of
conduct or rules of decorum,
we are often just play acting,
acting appropriately in outer
conduct, irrespective of what
is in our hearts.
Sherman, 2005 ; cited in
Rees, & Knight, Acad Med, 2007
The Affective Domain of Learning
(Krathwohl, et al., 1960)
Characterization
Organization
Consistency
Valuing
Responding
Receiving
Practical tools to teach leadership
& professionalism
Workplace
1. Clinical environment
(Accreditation Council for
Graduate Medical Education,
2004)
Approaches to teach
• Clinical (experiential)
teaching-learning
– Teaching
Actual clinical
work
: facilitating,
– Bedside
teaching
explaining,
clarifying,
– closing
Rounds consciously by
experiential learning
–the
Endorsements
cycle, inculcating,
– Audits
indoctrination, role
modelling, and values
clarification
Practical tools to teach leadership
& professionalism
Workplace
2. Classrooms and other
related settings
(Accreditation Council for
Graduate Medical
Education, 2004)
1.
2.
3.
4.
5.
Approaches to teach
Lectures
Simulations
Teaching : facilitating,
Cooperative
and team
explaining, clarifying,
learning
closing consciously by
Independent
study
the experiential
learning
cycle, inculcating,
Discussions
and seminars
indoctrination, role
modelling, and values
clarification
The experiential learning
cycle (Kolb, 1984)
Concrete Experience
(Affective)
Testing implications
of concepts in new
situations (Behavioral)
Observations &
Reflections (Perceptual)
Formation of abstract
Concepts & generalizations
(Symbolic)
The Ob-Gyn resident’s teachinglearning milieu
Resident:
learner
Physical
environment
Society
Teacher:
consultant
Patient
Values clarification
(Raths, 1960)
1.
Choosing: Asking residents about the choices
they made in given circumstances
2.
Prizing : asking residents if they are satisfied
with their choices
3.
Acting: asking and observing residents if they
can publicly affirm their choices
Food chain in Ward X (Sana, 2001)
(By order of harassment)
NA
Consultant
Manong
Fellow
Bantay
SR Resident
Pasyente
JR Resident
Clerks
Intern
Germs
Nurse
Consultants’ personal attitudes and
effects to residents (Morada, 2003)
• Facilitating learning
Competence
Approachability
Respectability
Confidence
Orderliness
Caring
• Inhibiting learning
Temper/mood
Inconsistency
Discouraging
Ingratitude
Anxiety
Impulsiveness
Assessment
(Best and Khan, 1989)
• The collection of data, organizing
them to measure how the learners
have achieved the expected levels of
competencies as a result of
instruction
The Nature of Assessment
Standard
Constructs of
leadership &
professionalism
Applying the
Standard
Measurement
Collecting relevant data
Constructing tests
Making questionnaires
Determining who accomplishes tools
When and for how much (content valid)
Valid raters of attitudes
(Henerson, et al, 1987)
Raters
Self
Others
Records
When appropriate
When raters understand the questions
asked; are aware of the information
asked; can answer honestly
Opposite of above
When records can be accessed;
complete
When to assess
Before instruction: Diagnostic
During instruction: formative
After instruction: summative
Types of Assessment used for leadership
& professionalism (Norcini & Burch, 2007)
Bases of
comparison
Diagnostic
Formative
Summative
Timing
Before instruction
During
After
Frequency
Usually once
Frequent
Once at the end of
@ term
Usual
instruments
Role playing, oral
examination,
OSCE
Mini-CEX,
DOPS, CbD,
MSF
OSCE, DOPS,
Mini-CEX, Oral
Examination
Purpose for
students
To determine
readiness
To monitor
progress
To determine final
grade
Purpose for
teachers
To guide teaching To improve
teaching
To test
effectiveness
Innovations in clinical evaluations
(Norcini & Burch, 2007)
Simulated /Controlled
Naturalistic / Work place
1. Objective Structured
1. Case based discussion
Clinical Examination
2. Direct Observation of
(OSCE)
Procedural Skills (DOPS)
2. Objective Structured
Value of feedback
Assessment of Technical
3. Structured
Clinical
The
teaching-learning
environment
Skills (OSATS)
Operative Test (SCOT)
3. OSOE The
(Oral environment
Examination) for assessment
4. Mini-CEX
4. OSPE (Practical
(www.hcat.nhs.uk)
Examination)
The Ob-Gyn resident’s teachinglearning milieu
Resident:
learner
Physical
environment
Society
Teacher:
consultant
Patient