Chapter Authors: Michael A. Barone, MD, and Joseph Gilhooly, MD The specific objectives for this chapter are to: The following components from the American Board of Internal Medicine Foundation Physician Charter2 relate to professionalism in patient care:
Behavioral StatementsThe dimensions of professionalism related to patient care that are listed above provide general goals. In discussions with trainees, it may be helpful to identify specific behaviors or practices that exemplify professionalism in this domain and other behaviors or practices that would represent lapses of professionalism.
Examples of Exemplary Professional Conduct
Examples of Lapses in Professional Conduct
Teaching ProfessionalismLearning Objectives for Trainees
Reflective Exercises These reflective exercises can be used for individual reflection on professionalism issues or can be modified and discussed as part of a larger group meeting.
Note: Considering the different competencies and milestones for professionalism, discuss the vignettes from the point of view of different training levels across the continuum (students, junior resident, senior resident, attending physician). What would be the expected behaviors of different levels of professional in these vignettes? Chapter 2 Vignettes — Professionalism in Patient CareThe vignettes that follow were developed for use in a small group setting to help stimulate discussions about issues regarding professionalism. Medical educators are encouraged to expand upon these to reflect local issues and experiences. Vignette 1 — TrustworthinessYou are on rounds with your attending and one of the medical students is presenting. The student has been working very hard and doing a good job. The attending asks the student about the results of a laboratory test that the student was supposed to have checked. You know that the student did not yet have an opportunity to get the test results, but the student responds by saying that the test was normal. Points to consider during discussion:
Vignette 2 — Tardy ParentA trainee in clinic is informed by a nurse that a family has arrived an hour late for their appointment. The trainee is refusing to see the two children because her schedule is already backed up, and this mother is frequently late for appointments. The mother is upset that she is being turned away because her children’s immunizations are already delayed. Points to consider during discussion:
Vignette 3 — Error DisclosureA 6-month-old prematurely born infant you cared for in the NICU returns from surgery to the PICU. You learn that during surgery the endotracheal tube had been in the right main stem bronchus for several hours. You are no longer directly responsible for the infant, but the father continues to talk to you about his infant’s progress. The next three weeks are stormy. The infant contracts RSV, improves, and then dies suddenly. The autopsy is unrevealing. The father asks you if anything went wrong. Points to consider during discussion:
Vignette 4 — Elevator ChatsYou are on your hospital’s elevator and you overhear another physician discussing the behavior of a parent of one of her patients. Points to consider during discussion:
Vignette 5 — Work/life IntegrationAs a trainee, you care for a 15-year-old boy with a malignancy. You develop a close relationship with him during your residency. Later in your training, he is terminal, and he has begun to talk openly with you about dying. You have assured him that you will be there as a support for him whenever needed. He is admitted to the hospital conscious but close to death, and he asks one of the other residents to call you at home and ask you to come in. You are not on call, and you are on your way out the door to your 3-year-old daughter’s dance recital. Points to consider during discussion:
Vignette 6 — Firing a PatientA trainee asks that one of his continuity families be reassigned to another physician. He explains that he just does not see eye-to-eye with the mother, who he believes does not follow his advice. He is frustrated with her and prefers that someone else take care of her child. Points to consider during discussion:
Vignette 7 — Too Much or Too Little Information?You are a trainee participating in continuity clinic in a community pediatrician’s office. The pediatrician prescribes levetiracetam for migraine headaches to one of the patients, but he does not sufficiently review the risks and benefits related to hypersensitivity reactions. You ask, “Shouldn’t you mention the need to stop the medication if the patient gets a rash.” The pediatrician replies, “If I did that, they would never take the medication.” Points to consider during discussion:
Assessment ToolsAn assessment of professional behavior is an essential aspect of the pediatric milestones. However, many other tools are also well-suited for assessing professionalism in patient care. This includes direct observation assessments of the trainees’ behavior with actual or simulated patients. Among the most widely used tools are the Mini-CEX, the Professional Mini-Evaluation Exercise (P-MEX), and the Standardized Direct Observation Assessment Tool. The available tools vary widely in their being subject to validity measures. This is well-covered in a systematic review.11 Multisource evaluation tools, which receive input from all members of the health care team along with patients and their families, are also useful. Ad hoc evaluations are an effective method to document and assess critical incidents both for positive behaviors and when there are opportunities for improvement. When assessing something as complex as professional behavior, it is important to remember that no one instrument can capture all dimensions. Furthermore, accurate assessment of professionalism requires a longitudinal perspective. While there are certainly unprofessional behaviors that require immediate attention and possibly action, it would not be appropriate to base a trainee’s entire professional assessment on one single event. References
Go to next chapter >> What is meant by professionalism in health care?Professionalism provides the cornerstone for safe, effective and ethical health care practice. It prioritises the welfare and well being of the patient/client at its centre, in line with public expectations, ensuring it remains central in all clinical decisions and actions.
What is the best definition of professionalism?“The skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well” Merrium-Webster, n.d. “'Professionalism' is commonly understood as an individual's adherence to a set of standards, code of conduct or collection of qualities that characterize accepted practice within a ...
Which best defines professionalism quizlet?Professionalism is the assimilation of nursing skills and knowledge integrated with dignity and respect for all human beings. It incorporates the assumptions and values of the profession while maintaining accountability and self-awareness.
What is healthcare professionalism quizlet?standards of conduct and moral judgement.
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