Fostering a Culture of Accountability and Respect: Resident

Report
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
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