Physician professional behaviour affects outcomes: A framework for teaching professionalism during anesthesia residency

Abstract

Purpose In this review, we examine the association between physician professional behaviour and indicators measuring patient outcomes and satisfaction with care as well the potential for complaints, discipline, and litigation against physicians. We also review issues related to the structured teaching of professionalism to anesthesia residents, including resident evaluation. Source A search of the OVID Medline and PubMed databases was carried out using keywords relevant to the topics under consideration. Program directors of Canadian anesthesiology training programs were also surveyed to assess the current state of professionalism training and evaluation in their programs. Principal findings Unprofessional behaviour is frequently manifested in practice by medical students, residents, and physicians, and it is associated with personality characteristics that are evident early in training. There is a correlation between unprofessional physician behaviours and patient dissatisfaction, complaints, and lawsuits as well as adverse outcomes of care. Physician health and workplace relationships are negatively impacted by such behaviours. Canadian program directors recognize the need to approach the teaching of professionalism in an organized fashion during physician training. Conclusions A framework is provided for defining behavioural expectations, and mechanisms are offered for teaching and evaluating behaviours and responding to individuals with behaviours that persistently breach defined expectations. There is a need to define explicitly not only the expectations for behaviour but also the processes by which the behaviours will be assessed and documented. In addition, emphasis is placed on the nature, order, and magnitude of the responses to behaviours that do not meet expectations.

“GIOSAT”: a tool to assess CanMEDS competencies during simulated crises

“…Our finding of poor reliability and construct validity of some of the intrinsic competencies not included in the NTSs discourse is in keeping with the literature on professionalism which is not often taught formally (i.e., part of the hidden curriculum) and is difficult to assess. 41,42 Our study has a number of limitations. The data are based on a re-analysis of scenarios not designed to identify certain competencies, such as Professional, Health Advocate, and Scholar.…”

Impact of a Video-Based Interactive Workshop on Unprofessional Behaviors Among Internal Medicine Residents

“…Challenges to developing curricula have included finding effective formats, identifying specific behaviors, and measuring meaningful outcomes. [7][8][9][10][11][12][13][14][15] In earlier work, [16][17][18][19] we identified unprofessional behaviors based on surveys of students, postgraduate year 1 (PGY-1) residents, and hospitalists. We found significant rates of participation in certain unprofessional behaviors by PGY-1 internal medicine residents, and that these behaviors worsened over the course of PGY-1.…”

Review article: Closing the research gap at the interface of learning and clinical practice

“…With further analysis, articles were selected wherein interventions relevant to one or more of the three themes were studied, resulting in a final selection of 56 citations Twenty-one studies analyzed transitions in, during, and after residency education; 19 studies addressed the educational effects of duty hour limits, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 16 articles presented research on use of the competencies in teaching and assessing anesthesiology residents. [19][20][21][22][23][24][25][26][27][52][53][54][55][56][57][58] For the theme ''duty hours and the acquisition of competence'', the only articles included were those that assessed the effect of duty hour limits on measures of physician competence and those that studied changes in patient care experience in anesthesiology that could be attributed to the reduction in resident hours.…”

“…While the focus of much of the work in anesthesiology is still on medical knowledge and technical skills, [19][20][21][22][23][24][25] it is promising that the focus of recent research has been to improve adherence to care guidelines, 52 to validate and demonstrate the utility of the CanMEDS framework, 53 to contextualize professionalism, systems-based practice, and other non-technical skills for anesthesiologists, [54][55][56][57] and to put forward a model that will enable anesthesiology residents to integrate the competencies and the aims of the Institute of Medicine for the health care system. 58 The focus is on approaches to teach and assess the non-technical competencies, including the development of validated tools.…”

“…101 There are recent examples that show the value of the competencies in anesthesiology. [53][54][55][56][57][58] Future research could build on this beginning to develop and validate explicit ''milestones'' of expected learning achievements modelled on the competencies or the CanMEDS roles. Such an effort has the potential to offer enhanced models for teaching and assessment that could bridge the three themes discussed in this article, lead to clearer aims for educational progress across the continuum, enhance the assessment of clinical competence under restricted hours while ensuring its acquisition, and allow society and the profession to articulate expectations for the capabilities and skills of physicians in practice.…”