by Beth Flippin,
Pharm.D., PGY1-Pharmacy Practice Resident, VA Maryland Health Care System
Professionalism in the health professions has been defined
as “the habitual and judicious use of communication, knowledge, technical
skills, clinical reasoning, emotions, values, and reflection in daily practice
for the benefit of the individual and community being served”.1
Professionalism serves as the basis of a contract between patients and healthcare
providers. Teaching professionalism has become a core concept in health
professional education, both in the didactic and experiential setting. However,
with advances in medical technology and increased
utilization of social media, it can be difficult to ensure that learners are maintaining
expected standards of professionalism.
Common Professional Lapses2
|
· Lack of initiative to assume responsibility / role
· Misrepresentation
or falsification of actions / information
· Failure
to take responsibility for actions
· Abuse
of privileges
· Inadequate
rapport with patients
· Insensitivity
· Disrespectful
language
· Inappropriate
interactions with groups
· Lack
of professional appearance
|
So how should lapses in professionalism be addressed and
corrected? One study published in the Academic Medicine Journal found that the
most effective methods were to address lapses in a timely manner and to provide
constructive feedback rather than punish the learner.3 Several tips
for approaching learners who have a lapse in professionalism have been
published.4
Modeling professional behavior is one of the key remediation
strategies.2 Learners mimic their preceptors, regardless of whether
the behavior is appropriate or not. Modeling involves all aspects of behavior
in the practice setting, from one-on-one interactions with other professionals,
patients, and caregivers; interprofessional team interactions, such as rounds
or peer discussions; maintaining privacy; appropriate documentation, and
adherence to timelines. Everyone must be mindful of the presence of learners in
the experiential learning settings, because learners are observing the actions
and demeanor all practitioners in order to help develop their own professional identity.
Modeling appropriate professional behavior by all members of the interprofessional
team serves as a link between didactic teachings and practical experience.4
The next tip is to acknowledge the hidden curriculum. Instructional regarding professionalism in
preclinical years is sometimes contradicted by unprofessional behaviors
observed in the clinical settings.5 These observations are not just
of the learners’ direct preceptor, but medical attending physicians, residents,
social workers, pharmacists, nurses and any other personnel involved in patient
care. It is important to acknowledge that learner’s may, at times, receive
conflicting messages regarding professionalism from their observations. Having conversations with the learner about
lapses in professionalism committed by more senior practitioners can be a
simple way to address inappropriate professional behavior so that the learner
isn’t left with the impression that such behaviors are acceptable.
It is also important to be familiar with the institution
policies and procedures for addressing lapses in professionalism.4
The institution or department policy should have clear procedures for how
information regarding lapses should be documented, who should receive the information,
and what the potential consequences are. This is beneficial for both the
learner and the preceptor, as the expectations and consequences are clearly
outlined at the beginning of the learning experience.
The next set of tip involves data gathering and fact
checking. It is very important to ensure you have objective evidence to support
the perceived lapses in professionalism.4 Because learners often model their behaviors
based on observations, it is important to gather information from multiple
sources that have had interactions with the learner and can provide first
person testimony, documentation, or evidence of the learner’s behavior. This
can also help to identify potential reasons behind the lapse, as well as ways
to address the lapse in the future.
It’s important to have an experienced educator or mentor
available for advice when needed. This person should have experience with
learners in different types of situations. It’s important to clearly articulate
your questions to your peer, as well as state how the learner expectations
where outlined. The trusted advisor can provide perspective and help develop
the plan for providing feedback to the learner.4
Next the preceptor should be ready to have a conversation
with the learner regarding their professional behaviors. During the encounter,
remember to be a good listener. Learners should have the opportunity to voice
their perceptions of the situation. At times, perceived lapses may be a result
of lack of understanding or misinterpretation of their role. Be sure conduct the conversation in an
environment where the learner feels safe, somewhere private and discrete so
that the learner does not feel that they are being publicly reprimanded. Be care
in your word choices. Use a non-accusatory approach. You don’t want the learner
to feel attacked or become defensive about their actions. The preceptor should
present to the learner the objective evidence gathered, then allow time for the
learner to reflect. The preceptor should provide direct and explicit feedback
to the learner. The learner should leave the encounter with a clear
understanding of why the behavior is considered a lapse and how to improve in the
future.4
Finally, the preceptor should close the loop.4 Preceptors
should help the learner make a behavior change by ensuring the learner develops
his/her decision-making skills. The preceptor can present hypothetical
situations and have the learner voice the steps necessary to make a
decision. This is a helpful way to
develop these problem-solving and ethical reasoning skills. Helping learners to
recognize the impact that their behaviors may have on patient outcomes can also
be motivational.4 Learners should be encouraged to continuously
think about professional values and ways to develop their skills.
Know when to call for back-up. There are always going to be
situations or learners who are difficult or when unexpected issues emerge. It’s
important for the preceptor to know his/her limitations.
Addressing lapses in professional behaviors can daunting. The
right tools can help preceptors feel more confident in addressing these lapses.
Preceptors should have a plan to effectively address professional lapses in a
timely fashion. Professionalism is vital to building a trusting
patient-provider relationship, so it is important that future practitioners are
aware of the importance of professionalism and how lapses can negatively impact
relationships with patients and colleagues.
References:
- Gibbs, T. The changing face of professionalism: Reflections in a cracked mirror. Medical Teacher. 2015; 37:9, 797-798
- Ainsworth, M. Medical Student Professionalism: Are we measuring the right behaviors? A comparison of professional lapses by students and physicians. Academic Medicine. 2006; 81(10); S83-S86
- Ziring, D. How do medical schools identify and remediate professionalism lapses in medical students? A study of U.S. and Canadian medical schools. Academic Medicine. 2015; 90:(7) 914-920
- Rougas. S et. Al. Twelve tips for addressing medical student and resident physician lapses in professionalism. Medical Teacher, 2015; 37:10, 901-907
- Goldstein, E. Professionalism in medical education: an institutional challenge. Academic Medicine, 2006:81(10); 871-876
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