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. 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