1
|
DiBrito S, Mago J, Reczek A, Suresh D, Kim D, Jacoby L, Shelton W. Medical Student Perspectives on Professionalism in a Third-Year Surgery Clerkship - A Mixed Methods Study. JOURNAL OF SURGICAL EDUCATION 2024; 81:1720-1729. [PMID: 39299055 DOI: 10.1016/j.jsurg.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVE The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors. DESIGN We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods. SETTING Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics. PARTICIPANTS Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys. RESULTS Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001). CONCLUSIONS With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development.
Collapse
Affiliation(s)
- Sandra DiBrito
- Department of Surgery, Albany Medical College, Albany NY
| | - Jacob Mago
- Department of Surgery, Albany Medical College, Albany NY
| | - Annika Reczek
- Department of Surgery, Albany Medical College, Albany NY
| | | | - Daniel Kim
- Department of Surgery, Albany Medical College, Albany NY; Alden March Bioethics Institute, Albany Medical College, Albany NY
| | - Liva Jacoby
- Alden March Bioethics Institute, Albany Medical College, Albany NY
| | - Wayne Shelton
- Department of Surgery, Albany Medical College, Albany NY; Alden March Bioethics Institute, Albany Medical College, Albany NY.
| |
Collapse
|
2
|
Flier LA, Richards JB, Hacker MR, Hovaguimian A, Vanka A, Sullivan A, Royce CS. "Should I Say Something?": A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11359. [PMID: 38089936 PMCID: PMC10713868 DOI: 10.15766/mep_2374-8265.11359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Introduction Medical students may witness lapses in professionalism but lack tools to effectively address such episodes. Current professionalism curricula lack opportunities to practice communication skills in addressing professionalism lapses. Methods We designed a simulation curriculum to introduce professionalism expectations, provide communication tools using elements of the Agency for Healthcare Research and Quality TeamSTEPPS program, and address observed professionalism lapses involving patient safety in hierarchical patient care teams. Students were surveyed on knowledge, skills, and attitude regarding professionalism before, immediately after, and 6 months after participation. Results Of 253 students, 70 (28%) completed baseline and immediate postsurveys, and 39 (15%) completed all surveys. In immediate postsurveys, knowledge of communication tools (82% to 94%, p = .003) and empowerment to address residents (19% to 44%, p = .001) and attendings (15% to 39%, p < .001) increased. At 6 months, 96% of students reported witnessing a professionalism lapse. Discussion The curriculum was successful in reported gains in knowledge of communication tools and empowerment to address professionalism lapses, but few students reported using the techniques to address witnessed lapses in real life.
Collapse
Affiliation(s)
- Lydia A. Flier
- Instructor, Department of Medicine, Mount Auburn Hospital and Harvard Medical School
| | - Jeremy B. Richards
- Assistant Professor of Medicine, Harvard Medical School and Mount Auburn Hospital
| | - Michele R. Hacker
- Associate Professor, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Alexandra Hovaguimian
- Assistant Professor, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Anita Vanka
- Assistant Professor, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Amy Sullivan
- Director of Education Research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Celeste S. Royce
- Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
| |
Collapse
|
3
|
Chrouser KL, Partin MR. Intraoperative Disruptive Behavior: The Medical Student's Perspective. JOURNAL OF SURGICAL EDUCATION 2019; 76:1231-1240. [PMID: 31029574 DOI: 10.1016/j.jsurg.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Intraoperative disruptive behavior can reduce psychological safety and hinder teamwork and communication. Medical students may provide unique insights into how to prevent these adverse impacts. We sought to characterize medical student perspectives on the causes and consequences of intraoperative disruptive behavior and ideal intraoperative working environments. DESIGN In this retrospective qualitative analysis, authors coded de-identified field notes from residency interviews to identify themes and key insights and to explore gender differences in perspectives. SETTING A tertiary academic medical training center in the Midwestern United States. PARTICIPANTS Forty-two medical students applying for urology residency placement. RESULTS Students were 57% male with an average age of 26 years (range 23-34). Most students witnessed intraoperative disruptive behavior (usually by surgeons) such as yelling, throwing instruments, or blaming others. Students described frustration with missing instruments and incompetent assistants as the most common instigators of disruptive behavior. They noted undesirable effects of disruptive behavior, including decreased communication/teamwork, lack of learning, increased technical mistakes, and recalled feeling afraid and stressed by these situations. They described ideal intraoperative working environments as calm, efficient and collaborative environments where questioning and learning is encouraged. CONCLUSIONS Students provide a valuable perspective on the causes and consequences of disruptive behavior during surgery and point to potential pathways to improvement. Their experiences suggest prevention or reduction of surgeon frustration might be a fruitful target for intervention efforts to prevent intraoperative disruption.
Collapse
Affiliation(s)
- Kristin L Chrouser
- Department of Urology, University of Minnesota and University of Michigan, Minneapolis VA Health Care Center, Minneapolis, Minnesota.
| | - Melissa R Partin
- Department of Medicine, University of Minnesota, VA Center for Chronic Disease and Outcomes Research (CCDOR), Minneapolis, Minnesota.
| |
Collapse
|
4
|
Stites SD, Clapp J, Gallagher S, Fiester A. Moving beyond the theoretical: Medical students' desire for practical, role-specific ethics training. AJOB Empir Bioeth 2018; 9:154-163. [PMID: 29727598 DOI: 10.1080/23294515.2018.1472149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this, most U.S. medical schools include ethics curricula in their undergraduate programs. However, the contents of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain. METHODS This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus-group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences. RESULTS While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education. CONCLUSION We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension about acting on ethical concerns.
Collapse
Affiliation(s)
- Shana D Stites
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Justin Clapp
- b Department of Anesthesiology and Critical Care , University of Pennsylvania
| | - Stefanie Gallagher
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| | - Autumn Fiester
- a Department of Medical Ethics and Health Policy , University of Pennsylvania
| |
Collapse
|
5
|
Earnest MA, Williams J, Aagaard EM. Toward an Optimal Pedagogy for Teamwork. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1378-1381. [PMID: 28379932 DOI: 10.1097/acm.0000000000001670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Teamwork and collaboration are increasingly listed as core competencies for undergraduate health professions education. Despite the clear mandate for teamwork training, the optimal method for providing that training is much less certain. In this Perspective, the authors propose a three-level classification of pedagogical approaches to teamwork training based on the presence of two key learning factors: interdependent work and explicit training in teamwork. In this classification framework, level 1-minimal team learning-is where learners work in small groups but neither of the key learning factors is present. Level 2-implicit team learning-engages learners in interdependent learning activities but does not include an explicit focus on teamwork. Level 3-explicit team learning-creates environments where teams work interdependently toward common goals and are given explicit instruction and practice in teamwork. The authors provide examples that demonstrate each level. They then propose that the third level of team learning, explicit team learning, represents a best practice approach in teaching teamwork, highlighting their experience with an explicit team learning course at the University of Colorado Anschutz Medical Campus. Finally, they discuss several challenges to implementing explicit team-learning-based curricula: the lack of a common teamwork model on which to anchor such a curriculum; the question of whether the knowledge, skills, and attitudes acquired during training would be transferable to the authentic clinical environment; and effectively evaluating the impact of explicit team learning.
Collapse
Affiliation(s)
- Mark A Earnest
- M.A. Earnest is professor of medicine and division head, General Internal Medicine Division, University of Colorado School of Medicine, Denver, Colorado. J. Williams is assistant professor of pediatrics and training director of child psychology, University of Colorado School of Medicine, Denver, Colorado. E.M. Aagaard is professor of medicine and associate dean for educational strategy, University of Colorado School of Medicine, Denver, Colorado
| | | | | |
Collapse
|
6
|
Hanson ER, Finley EP, Petershack JA. What Do Pediatric Residents Gain From an Experience in Juvenile Justice? A Qualitative Analysis of Community-Based Learning. Acad Pediatr 2017; 17:296-302. [PMID: 27988206 DOI: 10.1016/j.acap.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Training in advocacy and community pediatrics often involves the use of community site visits. However, data on the specific knowledge, skills, and attitudes gained from these experiences are limited. In this study we used qualitative analysis of written narratives to explore the response of residents to a juvenile justice experience. METHODS Pediatric residents participated in a week-long experience in the juvenile probation department and completed a written narrative. Narratives were analyzed using grounded theory to explore the effects of this experience on residents' views of youth in the juvenile justice system. RESULTS Analysis of 29 narratives revealed 13 themes relating to 5 core concepts: social determinants of behavior, role of professionals and institutions, achieving future potential, resolving discrepancies, and distancing. A conceptual model was developed to explore the interactions of these concepts in the resident view of youth in the juvenile justice system. Of the themes only 3 (23%) were related to content explicitly covered in the assigned reading materials. CONCLUSIONS Several important concepts emerged as elements of this experience, many of which were not covered in the explicit curriculum. Variability in attitudinal response to the experience raised important questions about the influence of the ideological framework of the learner and the hidden curriculum on the learning that occurs in community settings. We propose a theoretical model that delineates the factors that influence learning in community settings to guide educators in planning these types of experiences.
Collapse
Affiliation(s)
- Elizabeth R Hanson
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Erin P Finley
- Departments of Medicine and Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas; South Texas Veterans Health Care System, San Antonio, Texas
| | - Jean A Petershack
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| |
Collapse
|
7
|
Taylor CL, Grey NJA. Professional behaviours demonstrated by undergraduate dental students using an incident reporting system. Br Dent J 2017; 218:591-6. [PMID: 25998353 DOI: 10.1038/sj.bdj.2015.386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Abstract
Critical incident reporting is widely used across healthcare and other sectors for reporting adverse events or behaviours. More recently it has been used in medical education as a means of assessing student professionalism. The aims of this study were to determine the usage of critical incident forms when reporting behaviours related to professionalism demonstrated by undergraduate dental students, and the types of behaviours exhibited. Three types of form could be awarded for highly professional (green), minor unprofessional (yellow) and serious unprofessional (red) behaviours. All forms completed over a two-year period were analysed recording the year of student, type of card and demographic of the member of staff reporting the incident. All text relating to the nature of the incident was entered into a qualitative data analysis software package and analysed thematically. In total, 583 cards were awarded, 55% green, 34% yellow and 11% red. Seventy-four percent of cards were awarded in a clinical environment, with administrative staff using them the most (29%). The overwhelming professional behaviours demonstrated related to altruism. The most common unprofessional behaviours related to a lack of conscientiousness, although a greater range of common unprofessional behaviours were reported. In conclusion, critical incidents forms were widely used for reporting both professional and unprofessional behaviours particularly in clinical environments by a range of staff. Such forms may be a valuable addition to the professionalism assessment portfolio, capturing behaviours not previously reported using traditional methods.
Collapse
Affiliation(s)
- C L Taylor
- Clinical Lecturer/Hon StR in Restorative Dentistry, Oxford Road, Manchester, M19 1PL
| | - N J A Grey
- University of Manchester Dental School, JR Moore Building, University of Manchester, Oxford Road, Manchester, M19 1PL
| |
Collapse
|
8
|
Tucker CR, Choby BA, Moore A, Parker RS, Zambetti BR, Naids S, Scott J, Loome J, Gaffney S. Speaking up: using OSTEs to understand how medical students address professionalism lapses. MEDICAL EDUCATION ONLINE 2016; 21:32610. [PMID: 27814779 PMCID: PMC5097152 DOI: 10.3402/meo.v21.32610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/31/2016] [Accepted: 09/26/2016] [Indexed: 05/27/2023]
Abstract
BACKGROUND Objective-structured teaching encounters (OSTEs) are used across many disciplines to assess teaching ability. The OSTE detailed in this paper assesses 191 fourth-year medical students' (M4) ability to identify and address lapses in professionalism based on Association of American Medical Colleges' professionalism competencies. The research questions addressed are How frequently do M4s address professionalism lapses observed during an OSTE? What factors influence whether M4s provide feedback when they observe professionalism lapses in an OSTE? METHODS Standardized patients (SPs) and standardized learners (SLs) were recruited and trained to participate in a standardized encounter with specific cognitive, social, and behavioral errors, including professionalism lapses. M4s viewed this encounter and then offered feedback to the SL, while remotely observed by faculty. Post-encounter, the SL and faculty completed identical checklists to assess both teaching readiness and ability to address professionalism concerns. RESULTS An analysis of frequencies showed that six of the Association of American Medical Colleges' nine professional competencies were addressed in the checklist and/or discussed in the focus group. Analysis of transcribed debriefing sessions confirmed that M4s did not consistently address professionalism lapses by their peers. CONCLUSIONS In focus groups, M4s indicated that, while they noticed professionalism issues, they were uncomfortable discussing them with the SLs. Findings of the current study suggest how medical educators might support learners' ability to address lapses in professionalism as well as topics for future research.
Collapse
Affiliation(s)
- Constance R Tucker
- Faculty Development, McGlothlin Medical Education Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA;
| | - Beth A Choby
- Department of Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew Moore
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert Scott Parker
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benjamin R Zambetti
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah Naids
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jillian Scott
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer Loome
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sierra Gaffney
- Graduate Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
9
|
Carney PA, Palmer RT, Fuqua Miller M, Thayer EK, Estroff SE, Litzelman DK, Biagioli FE, Teal CR, Lambros A, Hatt WJ, Satterfield JM. Tools to Assess Behavioral and Social Science Competencies in Medical Education: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:730-42. [PMID: 26796091 PMCID: PMC4846480 DOI: 10.1097/acm.0000000000001090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. METHOD The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. RESULTS Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. CONCLUSIONS These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development.
Collapse
Affiliation(s)
- Patricia A Carney
- P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. R.T. Palmer is assistant professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. M.F. Miller is senior research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. E.K. Thayer is research assistant, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. S.E. Estroff is professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. D.K. Litzelman is D. Craig Brater Professor of Medicine and senior director for research in health professions education and practice, Indiana University School of Medicine, Indianapolis, Indiana. F.E. Biagioli is professor of family medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. C.R. Teal is assistant professor, Department of Medicine, and director, Educational Evaluation and Research, Office of Undergraduate Medical Education, Baylor College of Medicine, Houston, Texas. A. Lambros is active emeritus associate professor, Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina. W.J. Hatt is programmer analyst, Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon. J.M. Satterfield is professor of clinical medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Rougas S, Gentilesco B, Green E, Flores L. Twelve tips for addressing medical student and resident physician lapses in professionalism. MEDICAL TEACHER 2015; 37:901-907. [PMID: 25665630 DOI: 10.3109/0142159x.2014.1001730] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Medical educators have gained significant ground in the practical and scholarly approach to professionalism. When a lapse occurs, thoughtful remediation to address the underlying issue can have a positive impact on medical students and resident physicians, while failure to address lapses, or to do so ineffectively, can have long-term consequences for learners and potentially patients. Despite these high stakes, educators are often hesitant to address lapses in professionalism, possibly due to a lack of time and familiarity with the process. Attention must be paid to generalizable, hands-on recommendations for daily use so that clinicians and administrators feel well equipped to tackle this often difficult yet valuable task. This article reviews the literature related to addressing unprofessional behavior among trainees in medicine and connects it to the shared experience of medical educators at one institution. The framework presented aims to provide practical guidance and empowerment for educators responsible for addressing medical student and resident physician lapses in professionalism.
Collapse
Affiliation(s)
- Steven Rougas
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Bethany Gentilesco
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Emily Green
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Libertad Flores
- a The Warren Alpert Medical School of Brown University , Providence , RI , USA
| |
Collapse
|
11
|
Moon MR, Hughes MT, Chen JY, Khaira K, Lipsett P, Carrese JA. Ethics skills laboratory experience for surgery interns. JOURNAL OF SURGICAL EDUCATION 2014; 71:829-38. [PMID: 25012607 DOI: 10.1016/j.jsurg.2014.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 05/17/2023]
Abstract
INTRODUCTION AND PURPOSE Ethics curricula are nearly universal in residency training programs, but the content and delivery methods are not well described, and there is still a relative paucity of literature evaluating the effect of ethics curricula. Several commentators have called for more ethics curriculum development at the postgraduate level, and specifically in surgery training. We detail our development and implementation of a clinical ethics curriculum for surgery interns. METHODS We developed curricula and simulated patient cases for 2 core clinical ethics skills--breaking bad news and obtaining informed consent. Educational sessions for each topic included (1) framework development (discussion of interns' current experience, development of a consensus framework for ethical practice, and comparison with established frameworks) and (2) practice with simulated patient followed by peer and faculty feedback. At the beginning and end of each session, we administered a test of confidence and knowledge about the topics to assess the effect of the sessions. RESULTS A total of 98 surgical interns participated in the ethics skills laboratory from Spring 2008 to Spring 2011. We identified significant improvement in confidence regarding the appropriate content of informed consent (<0.001) and capacity to break bad news (<0.001). We also identified significant improvement in overall knowledge regarding informed consent (<0.01), capacity assessment (<0.05), and breaking bad news (0.001). Regarding specific components of informed consent, capacity assessment, and breaking bad news, significant improvement was shown in some areas, while we failed to improve knowledge in others. CONCLUSIONS Through faculty-facilitated small group discussion, surgery interns were able to develop frameworks for ethical practice that paralleled established frameworks. Skills-based training in clinical ethics resulted in an increase in knowledge scores and self-reported confidence. Evaluation of 4 annual cohorts of surgery interns demonstrates significant successes and some areas for improvement in this educational intervention.
Collapse
Affiliation(s)
- Margaret R Moon
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Mark T Hughes
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jiin-Yu Chen
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Kiran Khaira
- National College of Natural Medicine, Portland, Oregon
| | - Pamela Lipsett
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph A Carrese
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
12
|
Spampinato CM, Wittich CM, Beckman TJ, Cha SS, Pawlina W. "Safe Harbor": evaluation of a professionalism case discussion intervention for the gross anatomy course. ANATOMICAL SCIENCES EDUCATION 2014; 7:191-198. [PMID: 24039220 DOI: 10.1002/ase.1395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/10/2013] [Accepted: 07/09/2013] [Indexed: 05/28/2023]
Abstract
Medical professionalism is a multifaceted paradigm and is an essential component of medical education. Gross anatomy is a laboratory to teach professionalism, and promoting critical reflection in medical students is a prerequisite to furthering professionalism. The aim of this study was to determine if professionalism case discussions during a Gross Anatomy course improve students' reflections using a validated reflection instrument (12 items; five-point Likert scale where 1 = Disagree, 2 = Disagree with reservation, 3 = Neutral, 4 = Agree with reservation, 5 = Agree). Four facilitated reflection sessions were aimed at fostering reflective capacity through reflection on elements of professionalism. Results did not show a significant change between pre-and postintervention reflection scores (3.45 ± 0.61 vs. 3.48 ± 0.51; P = 0.82). Historical control students were found to have significantly higher reflection scores when compared with postintervention students (3.91 ± 0.53 vs. 3.48 ± 0.51; P < 0.001). However, the historical control students were found to have significantly higher professionalism scores (P = 0.001) as compared with the intervention students. Student satisfaction was high, with 25 of 28 (89.2%) students reporting that the sessions should be included as a component of future anatomy courses. While reflection scores were not significantly increased as a result of the intervention, students expressed appreciation for the opportunity to discuss professionalism issues related to the dissection of cadavers. Additionally, the intervention students had both lower professionalism scores and lower reflection scores, which supports the idea that highly professional students are more capable of reflecting on professionalism. Future studies should determine whether this case discussion intervention improves objective measures of professionalism.
Collapse
|
13
|
Fayez R, Nawwab A, Al-Jahdali H, Baharoon S, Binsalih S, Al Sayyari A. Negative ethical behaviors in Saudi hospitals: How prevalent are they perceived to be? - Statement agreement study. Avicenna J Med 2013; 3:57-62. [PMID: 24251232 PMCID: PMC3818780 DOI: 10.4103/2231-0770.118458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: There is limited information about the prevalence of unethical behavior and how is perceived among health care providers. The aim of this study is to assess such behavior and how is perceived. MATERIALS AND METHODS: This is a cross-sectional study among three groups of professionals. Total participants were 370 and included medical staff, medical residents, and nurses in five medical specialties in four tertiary hospitals in Saudi Arabia (two Ministry of Health Hospitals and two military Hospitals). Participants were asked to rate their agreement with occurrence of 15 “negative” unethical behavior scenarios in their workplace. The scenarios covered areas of “respect for persons”, “interprofessional relationships”, and “empathy with patients”. RESULTS: Majority of respondents agreed that “unethical” behavior occurred in their workplace, including confidentiality being compromised (36.3%), informed consent not taken properly (60.2%), and bad news not well-delivered (62.2%). Other significant area agreement included doctors lacking empathy (47.8%), patient autonomy not fully respected (42.5%), discrimination (41.2%), and being pressurized to write inaccurate reports (31.2%). Respondents in medicine had the lowest rate of agreement and those in psychiatry had the highest (mean of 49.8% and 82.3%, respectively). Respondents with length of employment of less than 6 years had significantly higher agreement that unethical behavior occurs compared to those with length of employment of more than 6 years. Males were more likely than females to agree that unethical behavior occurs. The biggest difference was seen in the behavior of “informed consent not properly taken” with a gender margin of 18.7% (P = 0.001). CONCLUSION: There is high prevalence of behavior that is considered unethical as perceived by various health care workers at Saudi hospitals.
Collapse
Affiliation(s)
- R Fayez
- Department of Psychiatry, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | | |
Collapse
|