A Framework for Professionalism
in Surgery: What is Important to
Medical Students?
Maura Sullivan, PhD, Janet Trial, EdD, Craig Baker, MD, Kenji Inaba, MD,
Josette Etcheverry, MSN, Mary Nally FNP, Peter Crookes, MD
www.surgery.usc.edu
Disclosures
• none
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History
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The Problem
• Terms used to explain professionalism
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abstract
Different groups use word differently
Easy to recognize, hard to define
Ways to best teach not well established
Power of the “hidden curriculum”
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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
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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
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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
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Framework for Professionalism
USC Department of Surgery
Clinical Competence
•Technical skill
•Clinical reasoning
•Diagnostic ability
•Inquisitiveness
•Patient-centered care
•Diligence
Altruism
Cultural Competence
•Respect for diversity
•Works across language/cultures
•Understands how culture
affects healthcare
Education
Leadership
•Responsibility to teach (patients,
learners)
Mentoring
Appearance
•Inspires others
•Role modeling
•Understands role on team
Professionalism
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
•Non-judgmental
•Caring
•Civic-minded
•Dedicated
•Compassionate
•Integrity/honesty
•Patient advocate
Accountability
Interpersonal Skills
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
•Effectively communicates
(information gathers, effective
listening, transmits key information,
giving bad news)
•Works well within a team
•Fosters relationship development
•Approachable
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
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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
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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
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Results – 82% Response Rate
Attribute
Most Defined
Most Important
Respect
56%
53%
Altruism
12%
21%
Practice-Based Improvement
9%
3%
Clinical Competence
7%
6%
Interpersonal Skills
6%
8%
Accountability
4%
4%
Ethics/legal
3%
Not mentioned
Education
2%
1%
Appearance
1%
1%
*Leadership
Not mentioned
3%
*Cultural Competence
Not mentioned
Not mentioned
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Results – 82% Response Rate
Attribute
Most Defined
Most Important
Respect
56%
53%
Altruism
12%
21%
Practice-Based Improvement
9%
3%
Clinical Competence
7%
6%
Interpersonal Skills
6%
8%
Accountability
4%
4%
Ethics/legal
3%
Not mentioned
Education
2%
1%
Appearance
1%
1%
*Leadership
Not mentioned
3%
*Cultural Competence
Not mentioned
Not mentioned
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Results - Cont
• 53% witnessed unprofessional behavior by
faculty
Breakdown of Respect Comments
Faculty
Unprofessional Behavior by Faculty
Respect towards Residents
7% 5%
10%
Respect
44%
12%
Practice Improvement
10%
Altruism
Respect towards Patients
25%
Respect towards
Colleagues
16%
Leadership
22%
8%
23%
18%
Education
Respect towards
Nurses/ancillary staff
Respect towards Students
Cultural Competence
Not Specified
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Results - Cont
• 64% witnessed unprofessional behavior by
residents/fellows
Unprofessional Behavior by
Residents/Fellows
5%
5%
4% 4%
Breakdown of Respect Comments
Residents/Fellows
Respect
Practice Improvement
5%
8%
14%
Altruism
51%
8%
18%
Respect towards
Colleagues
2%
Leadership
Ethics/legal
32%
44%
Respect towards Patients
Respect towards
Nurses/ancillary staff
Respect towards Students
Cultural Competence
Education
Not Specified
Accountability
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Conclusions
• Framework for Professionalism in Surgery
has been useful
• Clear definition
• Foundation for expected behaviors
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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
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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
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Thank You
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