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Perspectives 2019: Meredith Vanstone


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Addressing and Remediating Professionalism

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Perspectives 2019: Meredith Vanstone

  1. 1. 2019 Perspectives Symposium January 31, 2019 #TSINPerspectives2019
  2. 2. Meredith Vanstone McMaster University Addressing and Remediating Professionalism
  3. 3. ADDRESSING & REMEDIATING PROFESSIONALISM PERSPECTIVES 2019 JANUARY 31, 2019 Meredith Vanstone, PhD Department of Family Medicine McMaster University
  4. 4. OBJECTIVES  Explore the complexity of recognizing, addressing, and responding to professionalism lapses  Consider how the perspective of participants may constrain or enable different responses  Share knowledge about resources and best practices
  5. 5. TABLE ACTIVITY Vignette + Questions to consider Discussion within table groups Prepare to share key insights from your group
  6. 6. FRAMEWORK FOR ADDRESSING & REMEDIATING Recognizing Responding Remediating How do you understand the event? How might others understand it? What are the range of options available to each actor? According to how you understand the issue and potential responses, what element needs to be remediated?
  7. 7. MAKING SENSE OF PROFESSIONALISM LAPSES  Complex, multi-dimensional social construct, evaluation depends on:  Context, geographical location, cultural norms  Standards and social norms of the environment  Values and experiences of observer  Motivations, efforts, intentions of observed (imputed or discussed)
  8. 8. VIGNETTE 1: RECOGNIZING  You are a clinician who works on a surgical ward. One very busy morning, you are attending pre-operative rounds with the clinical team. After leaving the room of one pre-operative patient, the attending physician flips through the patient chart and notices there is no written informed consent form. He asks the medical student clerk to go back and obtain informed consent from the patient, and then file the form in the chart on her way to the operating room. The student asks “I get to scrub in today?” The surgeon responds “As long as we don’t miss the OR time at 9h00 because of a missing informed consent form” as he moves on to the next room.
  9. 9. VIGNETTE 2: RESPONDING Mark Smith is an aspiring physiotherapist who has been admitted to a PT program that will begin in September 2019. Over the summer, he is working as a volunteer in a physiotherapy clinic. He works most closely with Donna Singh, an experienced physiotherapist. One day, a new patient arrives while Ms. Singh is finishing up with her previous patient. She has been double booked and is running behind. Ms. Singh instructs Mark to take the patient into an exam room and start conducting a history and physical exam. She will join them in about 10 minutes. Mark says that he’s not sure he is ready to do this, he has never been instructed on how to conduct a history or physical exam. Ms. Singh replies “Oh, you’ve seen me do it a dozen times by now. Just fill out the information on the charting form. The computer will prompt you for what you need. Tell her you are a physiotherapy student and that I’ll be there to check in with you shortly. You’re just getting me started, you’re not formulating the diagnosis.” [continued on handout]
  10. 10. VIGNETTE 3: REMEDIATION  Your program is conducting a regular in-progress review for all trainees. Jane Lee is brought up for discussion. Her exam scores are excellent. Her clinical evaluations note her competence in clinical skills, but are consistently filled with vague comments about improving communication and interaction with colleagues. There are no specific examples, so you seek out personal experience amongst the committee. Two members contribute that when working with Jane, they have noticed she has an abrupt manner which has offended colleagues and caused interpersonal problems on the unit. Another colleague noted that when listening to her in a family meeting, she discussed the terminal diagnosis in a clinically correct way, but without demonstrating particular empathy or compassion for the emotional reaction of the family. 1. Does Jane require remediation? 2. What additional information do you require to make this decision? 3. As a committee, what professional development program might you suggest? Which parts are mandatory and which parts are optional? 4. How will you evaluate Jane’s progress?
  11. 11. REPORTING AS A COMPASSIONATE EDUCATOR  Is reporting the most likely way to encourage development of professional behaviour?  What are the requirements to report? Where do you exercise professional judgment?
  12. 12. REPORTING PROFESSIONALISM LAPSES  Evaluate action as a professionalism lapse.  Consider reporting:  Who to report to?  Relationship with the person receiving the report  Relationship and responsibilities for person being reported  Likely consequences to person being reported  Potential consequences for team, learners, patients  Social norms and typical responses
  13. 13. UPWARDS AND DOWNWARDS REPORTING Barriers to reporting lapse of a superior  Incident not important enough to report  Didn’t think anything would be done about it  Fear of reprisal  Negative evaluations  Job prospects  Reputation and professional development  Conflicted because can identify many positive traits of teacher outside of this lapse Barriers to reporting lapse of a trainee  Paperwork and “hassle”  Potential for retribution  Worried about impact of reporting on student’s career.  Failing grade means see that student again  Not sure how to address AFMC 2015, AFMC 2016, Mavis et al 2014; Vogel et al 2018; Bell 2019
  14. 14. REMEDIATION What is professionalism? What is a lapse? How should it be addressed? Virtue-based: moral character, moral reasoning Failure to move through moral development Focus on inner habits, development of character, acting in a moral way. Behaviour-based: competence, behaviour, milestones Acts of inappropriate behaviour, lack of skill negotiating conflict-prone situations Enactment of a system to identify lapse, develop a plan, monitor compliance. Teach skills to manage challenging situations. Professional identity formation: evolving and changing identity Failure to progress through identity formation, failure to internalize values of profession Tailored to developmental stage, assist to understand identity and obligations of profession. Irby & Hamstra, 2016