created by culberson, dewey, ismail, friedland, tejada-simon & turner. nih funded...

Created by Culberson, Dewey, Ismail, Friedland, Tejada-Simon & Turner. NIH Funded Relationship-Centered Transformation of Curricula, Baylor College of Medicine, 2006.

RATL

Module 1

Professional Identity: Physician, Teacher and Leader

Module 1

Professional Identity: Physician, Teacher and Leader

Module Created by:

John Culberson, M.D., M.S.Assistant Professor of Medicine

&

Charlene M. Dewey, M.D., M.Ed., FACPAssociate Professor of Medicine

Web Page and Module Formatting by:

Maria Victoria Tejada-Simon, Ph.D.Assistant Professor of Molecular Physiology and Biophysics

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Module 12 of 110

Welcome

Welcome to Module 1: Physician Identity. You should have completed a pre-test for this module. Did you complete the “honesty pledge” question?

In that pledge you agreed to take the pre-test first, then read the module and then take the post-test after reading the module. If you did not complete the pre-test, please exit the module now and complete it; then return to the module. Your honesty is appreciated.

Click here if you completed the pretest.Exit


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Module 13 of 110

WelcomeWelcome to Module 1: Professional Identity: Physician, Teacher and Leader. As a physician, you will interact with a wide variety of individuals… patients, their family, nurses, medical students, peers and faculty.

Your role as a resident physician will be enhanced by adopting appropriate teaching, leadership, and communication principles into your daily routine.


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Module 14 of 110

Welcome

Module 1 focuses on professional identity. We estimate about 45-60 minutes to complete this module. Resources for this module can be found on the RATL resources web page.


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Module 15 of 110

Introduction

What's also important to remember about being a professional is that you are building your reputation and you want always to protect that reputation and avoid any behaviors that will jeopardize your reputation.

Developing, maintaining and protecting your reputation will take awareness and prevention on your part. You may also find that sometimes a colleague may need help before he/she jeopardizes their reputation.


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Module 16 of 110

Introduction

Professionalism is defined in the dictionary as:

– …the conduct, aims, or qualities that characterize or mark a profession or a professional person.

Reflect for a second on those qualities, aims or your conduct up to this point in your training. Are you ready to assume the higher standard of professionalism in medicine?

http://www.merriam-webster.com/dictionary/professionalism


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Module 17 of 110

Introduction

“Although professionalism has been incorporated into most medical schools across North America, it remains rather difficult to define because it carries many connotations and implied meanings. What is certain, however, is that medicine is a moral endeavor which demands integrity, competence, and high ethical standards among other key attributes.” - University of Ottawa

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html(With permission)


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Module 18 of 110

Introduction

“Drs. Richard and Sylvia Cruess of McGill University have become leaders in the field of medical professionalism. They describe the role of the physician as overlapping between that of the healer and that of the professional.

Within this model, both positions are necessary to appreciate key attributes of the physician. Although the primary role of the physician is undoubtedly that of the healer, one must simultaneously maintain professionalism in medical practice. The following diagram highlights this crucial balance: “

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html(with permission)


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Module 19 of 110

Introduction

http://intermed.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html(with permission)


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Module 110 of 110

Introduction

"Develop the frame of mind that whatever you do, you are doing it as a professional and move up to professional standards in it.” http://www.tipsforsuccess.org/professionalism.htm

Click on the box to watch the Photo Story on professional identity. Click again to stop.

(Video is approx 8 minutes.)

Skip Photo Story


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Module 111 of 110

GoalsThe goals of this module are:

1. To help you to develop your professional identity as a physician and leader and characterize the relationships that define the physician.

2. To reflect on characteristics of the professional physician and to review the

key principles of leadership and effective communication.


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Module 112 of 110

ObjectivesAfter completing this module, you will be capable of:

1.Identifying four (4) aspects of effective communication.

2.Describing four (4) relationships that define the professional identity of physicians.

3.Demonstrating an appreciation of the physician's role by “being part of the solution, rather than part of the problem” & avoiding the hidden curriculum.

4.Designing an approach to leadership that incorporates Covey’s seven habits.

5.Reflecting on your professional role as physician and leader in medical education.


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Module 113 of 110

Agenda

Physicians have several roles in health care. In this module we will emphasize the professional and leadership roles of the physician while the teacher role is

emphasized in Module 2.

We will also emphasize effective communication and its role in developing healthy relationships in the medical setting.


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Module 114 of 110

Agenda

Module 1 will include the following topics:

1. Physician identity & professionalism

2. Relationships in medicine

3. Effective communication

4. Leadership identity

5. Hidden curriculum

6. Summary


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Module 115 of 110

Professional Identity

Are you a professional? What makes you a professional? How is professionalism defined? What would our great forefathers of medicine say about professionalism?

Some greats had much to say about the professional practice of medicine – starting with Hippocrates.


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Module 116 of 110

Physician Identity

“The Hippocratic work On the Physician recommends that physicians always be well-kempt, honest, calm, understanding, and serious. The Hippocratic physician paid careful attention to all aspects of his practice: he followed detailed specifications for, "lighting, personnel, instruments, positioning of the patient, and techniques of bandaging and splinting" in the ancient operating room. He even kept his fingernails to a precise length.” http://en.wikipedia.org/wiki/Hippocrates

More detail on HippocratesHighlights of Hippocratic oath only


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Module 117 of 110

Physician Identity

The original translation of the Hippocratic oath:– To consider dear to me, as my parents, him who taught

me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

– I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

– To please no one will I prescribe a deadly drug nor give advice which may cause his death.

– Nor will I give a woman a pessary to procure abortion.– But I will preserve the purity of my life and my arts.– I will not cut for stone, even for patients in whom the

disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

http://en.wikipedia.org/wiki/Hippocratic_Oath


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Module 118 of 110

Physician Identity

Continued…– In every house where I come I will enter only for the good

of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

– All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

– If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

http://en.wikipedia.org/wiki/Hippocratic_Oath


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Module 119 of 110

Physician Identity

Highlights from that oath include:– Valuing in the highest regard those who teach

you the art of medicine – teachers, clinicians, patients.

– Do no harm – according to your ability – being humble and knowing when to ask for help.

– Preserve the purity of my life and my arts – keeping the profession and your role in it in high esteem.

– Keeping myself far from all intentional ill-doing and all seduction – understanding boundaries and illegal behaviors.


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Module 120 of 110

Physician Identity

Highlights continued…– I will keep secret and will never reveal –

maintaining confidentiality.– If I keep this oath faithfully, may I enjoy my life

and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot

This last point clearly identifies both the good outcomes of maintaining a professional and ethical practice of medicine and the negative consequences if you don’t.


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Module 121 of 110

Physician Identity

The Core Values of Professionalism include:

– Honesty and Integrity – Altruism – Respect – Responsibility and Accountability – Compassion and Empathy – Dedication and Self-improvement

http://intermed.med.uottawa.ca/students/md/professionalism/eng/index.html(with permission)


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Module 122 of 110

Physician Identity

Reflection time – think about who you are and who you want to be as a physician. Then answer the following questions.

– List some adjectives that describe who you are as a person.

– Would others use the same adjectives to describe your interpersonal skills and activities at work?

– What reputation do you want for yourself?

Your identity is your reputation. How you shape that identity and reputation is up to you!


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Module 123 of 110

Physician Identity

As a physician, you will need to diagnose and treat illness, however, your greatest challenge may lie in developing and maintaining relationships in an environment of time constraints and stress. These relationships will bond you with others in the care of your patients.


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Module 124 of 110

Physician Identity

Which of the following relationships do you think is the most important to a physician?

• Doctor-Self• Doctor-Colleagues (MD, RN, students)• Doctor-Patient• Doctor-Community


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Module 125 of 110

Physician Identity

All relationships require the physician to maintain their physical and emotional health. The Doctor-Self relationship is, in fact, the most important… and most often overlooked!

Ensuring time for yourself, friends, and family is a professional obligation and you owe it to yourself!


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Module 126 of 110

Doctor-Self

Efficiency and the ability to establish professional and personal boundaries are essential skills, however, this may require considerable practice for some.

No amount of knowledge and skill can overcome the negative consequences of “physician burnout.” Self-awareness is the primary tool to help identify burnout. But what is burnout?


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Module 127 of 110

Doctor-Self

Burnout: “Maslach & Leither describe burnout as the index of the dislocation between what people are doing and what they are expected to do.”

“Burnout represents a deterioration of values, dignity, spirit, and will. …an ‘erosion of the soul.’ Burnout spreads gradually and continuously over time, sending people into a downward spiral from which it is hard to recover.”Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


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Module 128 of 110

Doctor-Self

Which of the following are signs of physician burnout?

a) Decreasing efficiency

b) Outbursts of anger

c) Feeling overwhelmed

d) Insomnia

e) All of the above

f) None of the above


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Module 129 of 110

Doctor-Self

Decreasing efficiency, outbursts of anger,

feeling overwhelmed, insomnia, and

depression are all signs of physician burnout.

This is an unhealthy mental and physical

state that adversely effects your training,

your relationships, and your ability to provide

excellent patient care.


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Module 130 of 110

Doctor-Self

While everyone feels the effects of stress during their residency training, understanding your own personal stressors and how to avoid them are important.

Once one identifies that they are on the road to burnout, seeking help from others is a sign of effective self-monitoring and emotional maturity, not weakness! Burnout can be prevented and treated.


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Module 131 of 110

Doctor-Self

Personal:– Influence happiness

through personal values and choices

– Spend time with family & friends

– Engage in religious or spiritual activity

– Maintain self-care (nutrition & exercise)

– Adapt a healthy philosophy/outlook

– A supportive spouse or partner

Work:– Gain control over

environment & workload

– Find meaning in work – Set limits and maintain

balance– Have a mentor– Obtain adequate

administrative support systems

Ways to avoid burnout:

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


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Module 132 of 110

Doctor-Self

If you were to experience signs of “physician

burnout”, from whom would you seek help?

a. A medical student

b. An intern

c. A resident

d. A faculty member

e. A confidential counseling service


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Module 133 of 110

Doctor-Self

Often, a peer may seem to be the best option for confiding in and receiving support during burnout, however, specific solutions are usually best provided by individuals who have experience with issues that may arise during training.

Chief residents, faculty, and/or counselors are better positioned to objectively identify both problems and solutions. Experienced individuals are more likely to assist with wisdom and confidentiality.


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Module 134 of 110

Doctor-Self

There are several options for physicians experiencing burnout. Check with your residency office or specific institutional wellness program for assistance.

Institutional programs are confidential services and provides counseling and other services free-of-charge to those seeking assistance. They are generally utilized frequently by physicians of all specialties.


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Module 135 of 110

Doctor-Self

Some resources that can be of assistance include:

• Vanderbilt’s Center for Professional Health & Faculty & Physician Wellness Program: http://www.mc.vanderbilt.edu/root/vumc.php?site=cphhttp://www.vanderbilt.edu/HRS/wellness/wlcfpwp.html

• Help guide to Workplace burnouthttp://www.helpguide.org/mental/burnout_signs_symptoms.htm


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Module 136 of 110

Doctor-Self

Remember, if you are not able to function, you cannot be of assistance to your patients. The Doctor-Self relationship is the most critical relationship you have. Take care of yourself and nourish your inner being in ways that help you feel refreshed and ready to return to work each day.

Now lets look at the doctor-colleague relationship. In this section, we will focus on teamwork and communication between colleagues on a healthcare team.


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Module 137 of 110

Doctor-Colleague

While physicians are conditioned to feel as if self-reliance is a worthy goal to be achieved through rigorous training, excellent medical care requires the coordinated efforts of a team of professionals.

Team-building is emphasized in the military, sports, major corporations, and classrooms.Even medical education and healthcare are now recognizing the role and value of effective teamwork in patient care.


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Module 138 of 110

Doctor-Colleague

Team work is vital in medicine! The welfare of your patients require your best efforts in accurately communicating with members of your immediate team, the extended patient care team and with the patients and their families.


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Module 139 of 110

Doctor-Colleague

The team that best cares for a patient, is a team that communicates well between its members.


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Module 140 of 110

Doctor-Colleague

The efficient and effective patient care team includes a large group of individuals including nurses, consultants, social workers, physical therapists, nutritionists, and, of course, the patient and their family.

Each of these team members has a relationship with the patient and one another. Good communication between all team members is essential.


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Module 141 of 110

Doctor-Colleague

As a member of any team, you will have to communicate with other teams. Evidence now supports that the team approach to patient care can improve outcomes and prevent readmissions.

Too many physicians try to practice medicine solely in their sub-specialty or department.


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Please reflect for a moment. Which of thefollowing are important for ‘EffectiveCommunication’?

a) Good listeningb) Providing concise and specific

feedbackc) Providing overview/concepts followed

by factsd) Using appropriate level of languagee) Displaying confidence

Doctor-Colleague


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Effective communication is characterized by all of these:

Good Listening Communicating on an appropriate level for

the learner Providing overviews & general concepts

first – then facts Providing appropriate praise Providing specific & concise feedback Summarizing important points

Doctor-Colleague


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Module 144 of 110

While confidence is important, it is a perception that is supported by effective communication.

However, while all aspects are important, “good listening” is the key! It is sometimes difficult for busy, stressed physicians to listen well.

Doctor-Colleague


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Module 145 of 110

The habits and behaviors you learned early in your training can be difficult to change later… be a “good listener” to each member of “your team” early and build good habits of listening to your patients, colleagues, peers and others.

Doctor-Colleague


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Module 146 of 110

The dictionary defines communication as a process by which information is exchanged between individuals through a common system of symbols, signs or behaviors.

Much important information is conveyed to peers, students, and patients through non-verbal communication.

Doctor-Colleague


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Module 147 of 110

Doctor-Colleague

Imagine a scenario in which a resident andstudent are seated at a nursing station:

Student: “This patient has an elevated blood sugar, I think he has diabetes.”

Resident: (without looking up, and in a condescending voice): “By now, every student should know that most overweight people have diabetes.”


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Module 148 of 110

Doctor-Colleague

In the picture that you formed in your mind, how do you think the student felt based upon the resident’s communication style?

– What opinion will the student form about the resident’s communication style?

– Will this student feel comfortable forming a relationship with this resident?

– What has the student learned about obese patients? Is there a hidden message?


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Module 149 of 110

Doctor-Colleague

In the previous scenario, how would you communicate differently in order to help the student to both understand the relationship between diabetes and obesity and observe an excellent physician role model?

In general, you want to be a part of the solution, not part of the problem. Avoid perpetuating bad habits. Practice what you might say to this student.


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Module 150 of 110

Doctor-Colleague

To effectively communicate with this student, first the resident should stop what they are doing and make eye contact. This tells the student they are important. Then, clarify what their question is. This makes sure you are giving the needed information. Then answer the question providing your knowledge and insight into the situation. Then ask them if they understood it or if they have any other questions.


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Module 151 of 110

Doctor-Colleague

If you do not have time to answer, again, look at the student and say something to affirm their question and give them some guidance on what to do. (E.G: “That’s a good question but we don’t have time to explain it in detail. If you look it up tonight, we can discuss it tomorrow on rounds.”)

This helps residents when they are busy and don’t have time to stop. But don’t let this be your only answer to every question!


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Module 152 of 110

Doctor-Colleague

Also, if you make one of these comments, realize it is good for students to self learn but do make sure to touch upon it during your patient care rounds the next day. If you fail to do so, your students will see you as someone who just blows them off and doesn’t really care enough to follow up. This can backfire if used the wrong way.


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Module 153 of 110

Doctor-Colleague

Back to teamwork - When the team functions as one, the patient will ultimately benefit, but each member of the team also benefits.

Think about this: A patient is admitted to your service with diabetes, uncontrolled hypertension, severe osteomyelitis of the right great toe and distal foot, chest pain and depression. Who are the members of the team that will care for this patient?


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Module 154 of 110

Doctor-Colleague

– The patient– Nurses on the unit– Internal Medicine/Family

Medicine– Surgery: vascular and

perhaps cardiothoracic– Anesthesia– Psychiatry– Blood technicians

– Physical Medicine and Rehabilitation

– Endocrinology – Cardiology– Discharge services– Social worker– Nutrition– Diabetes education– Family members

At minimum, this patient will require input and care form the following teams :


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Module 155 of 110

Doctor-Colleague

Thus to care for this patient, many individuals from various teams will need to communicate and work together efficiently.

Your role as the resident, intern or student is to be a part of the service team and the whole patient care team. Lets look at an example of a team effort.


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Module 156 of 110

Doctor-Colleague

Below is a link to an example of teamwork with effective communication between several members of a team. Click on the link below to watch at least 3m of the 5-minute video and reflect on the following questions:

– Who are the team members? – How are they communicating with each other?– How is it their product turned out so great?– Can you see the similarities in medicine?

Click on the link: http://www.youtube.com/watch?v=IliwQImJrYE


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Module 157 of 110

Doctor-Colleague

This team had a specific purpose…to make beautiful music together.

There are probably a hundred members on this team and they are all different but several are similar in their function: the lead players, the back-up cello players, the violinists, the drummer, the lighting team, sound team, etc. are all smaller teams that work well together as a whole in order to produce this beautiful concert.


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Module 158 of 110

Doctor-Colleague

This is no different in medicine where small teams work together as a whole to heal patients. They all used their skills to create the final product that is a masterpiece!

Not any one individual could have created that masterpiece by themselves. This is an example of how a team effort can create a great outcome.


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Module 159 of 110

Doctor-Colleague

The Institute of Medicine 2004:

“It is therefore crucial that physicians know how to work effectively in the context of

integrated teams. They must understand their roles as part

of the team and why it is important to foster positive

relationships with other team members.”

(Pg 73)


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Module 160 of 110

Doctor-Colleague

Each of us can help improve communication across departments if we are willing to try. Thus, we can each be a part of the solution instead of being part of the problem. Therefore, your role as an effective communicator and team player is key!

Now let’s look at the Doctor–Patient relationship. This relationship also needs good listening and communication skills.


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Module 161 of 110

Doctor-Patient

The doctor-patient relationship may produce particularly challenging communication issues. Language, ethnicity, culture, and other issues will play a role in the doctor-patient relationship.

Unfortunately, it is not uncommon for physicians to exhibit poor listening skills and use vocabulary that is not understood by the patient.


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Module 162 of 110

Doctor-Patient

Patients often drop hints rather than communicate concretely about problems or concerns. This requires physicians to have astute listening skills while they calibrate their vocabulary to a level of the learner (the patient). You will also need to watch the patient closely for their use of non-verbal communication and frequently ask if they understand or test their understanding.

This skill does not come naturally but can be developed with practice.


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Module 163 of 110

Doctor-Patient

Developing good communication between the doctor and patient is important. Effective communication is an excellent opportunity to demonstrate trust, compassion, empathy and appreciation to your patients.

Doctor Says… Patient hears…

Fibroids of the uterus Fire balls of my ucerus

Cirrhosis of the liver Sir roaches of the liver

Spinal meningitis Smiling mighty Jesus

These are real examples I have heard over time!


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Module 164 of 110

Doctor-Patient

Identify yourself as a leader and role model for patients, their families, students, peers, and other members of the medical care team by looking at the patient, being attentive while they are speaking and demonstrating your empathy.

Training institutions often teach students to ask open-ended questions and listen to their patient’s stories as part of their history. This is the foundation of patient-centered care.


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Module 165 of 110

Doctor-Patient

However, a lack of time often causes us to force patients into simple yes or no questions, leaving no time for patients to tell their stories. This makes us more doctor-centered.

Effective communication requires both parties to explicitly define their own unique views of illness and align them toward a common therapeutic goal.


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Module 166 of 110

Doctor-Patient

This may seem more time consuming but studies have demonstrated that patients will only talk for about 3 minutes to tell their story when asked using an open-ended question.

You can be more directive with other parts of the history later. Allowing the patient to tell their story is a key issue for building relationships with them.


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Module 167 of 110

Doctor-Patient

Patients feel valued and heard when doctors spend the time to listen to them.

Will you stop to listen to your patients or will you rush through while working on other tasks?


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Module 168 of 110

Doctor-Patient

What percentage of your medical school

clinical experience was consistent with a

patient-centered model?

• Less than 25%• 26-50%• 51-75%• Greater than 75%


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Module 169 of 110

Doctor-Patient

The Institute of Medicine 2004“Medical students who learn how to elicit information needed to understand biological, personal, and social factors in the onset and maintenance of illness will diagnose and treat their future patients more effectively.” (Pg 75)

This quote speaks for itself! Now let’s look at Doctor-Community relationships where we will emphasize professionalism & leadership skills.


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Module 170 of 110

Doctor-Community

The physician also has a professional obligation to the community they serve. An obligation to represent themselves in a professional manner, to identify diseases that affect their communities and to preserve our vital resources in our health care system.

A professional always strives to improve themselves and acts in a manner supportive of the greater good.


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Module 171 of 110

Physician Identity

List the four (4) relationships in medicine.

Click here for the answer


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Module 172 of 110

Physician Identity

1. Doctor-Self

2. Doctor-Colleagues (MD, RN, students)

3. Doctor-Patient

4. Doctor-Community


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Module 173 of 110

Leadership Identity

Physicians are recognized as the leaders of large interdisciplinary teams of healthcare providers. Leadership skills are emphasized in corporate America, however, are often overlooked in the medical education process.

Even as an intern, you may find yourself in the unfamiliar territory of leadership. It is a myth that great leaders are born… like teaching skills, leadership skills can both be learned and perfected.


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Module 174 of 110

Leadership Identity

Stephen Covey has written “The Seven Habits of Highly Effective People.”

Covey defines a habit as the intersection of knowledge, skill, and desire. He describes a pathway to develop the security to adapt to change and to take advantage of the opportunities that change creates.

(Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


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Module 175 of 110

Leadership Identity

The Seven Habits:

1. Be proactive2. Begin with the end in mind3. Put first things first4. Think win-win5. Seek first to understand, then be

understood6. Synergize7. Sharpen the saw



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Module 176 of 110

Leadership Identity

In his book, Covey provides a plan to use the “Seven Habits” as a step-by-step pathway for living with fairness, integrity, and honesty, the security to adapt to change, and the security to take advantage of the opportunities that change creates.



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Module 177 of 110

Leadership Identity

The Seven Habits are divided into private & public victories:

1. “Private Victories” involve self-mastery and move the individual from dependence toward independence, and

2. “Public Victories” involve teamwork, cooperation, and communication and bring about an interdependent outlook.

Covey emphasizes that private victories always proceed public victories.



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Module 178 of 110

Leadership Identity

Private victories:

1. Be Proactive: Take action! Leaders lead, don’t wait for someone else to do it.

2. Begin with the End in Mind: Organize your actions based upon the desired end-point.

3. Put First Things First: Prioritize based on the “big-picture.”



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Module 179 of 110

Leadership Identity

Let’s use a very common scenario for the hospital setting. Having a patient-family conference about prognosis and therapy for your patient’s new diagnosis. The patient went to radiology at 1:00 and the conference is scheduled for 3:00. The nurse gives you a message that a key family member was unaware of the meeting. You also need to get to the bank before it closes.

The next few slides list Covey’s habits and what you might do for each to be a more effective leader.


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Module 180 of 110

Leadership Identity

1. Be Proactive: Your patient is waiting in the radiology waiting area after their x-ray. Go get them or arrange for their return.

2. Begin with the End in Mind: The goal is to have a patient-family conference. Make sure everyone is aware of the purpose and importance ahead of time.

3. Put First Things First: Organize your day so you and team members are able to get to the patient-family meeting on time – go to the bank before or after the conference-remember your balance is important too!



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Module 181 of 110

Leadership Identity

You have just handled this situation in a positive way; thus making you a highly functional team member – and personally victorious.

Once you have achieved the personal habits of a leader, these habits must be combined with the habits of successful leadership in relationships with others. This task requires excellent communication skills. (Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989)


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Module 182 of 110

Leadership Identity

1. Think Win-Win: Negotiate so that the circumstances are improved for both parties – the patient and family should certainly “win” – but that win may mean you need to educate them so they better understand what the best “win” is.

2. Seek First to Understand: Listen and empathize with the families point-of-view and understand your own passion or drive toward one side or the other. Then help them understand your position.



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Module 183 of 110

Leadership Identity

3.Synergize: Create new alternatives together that both parties are happy with. Decide what are the most important pieces to continue working on. Assure the patient and family you will work to obtain the goals of everyone - create new alternatives if needed.

Example Demonstration: What does this leader need to learn about leadership and communication? How did others react based on his actions? http://www.youtube.com/watch?v=oQBNMT9318A (If needed, click to start or select USS Montana)



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Module 184 of 110

Leadership Identity

Keep in mind patients and most family members do not have significant understanding of medical terminology, our ways of doing things, treatments, options for treatment or withholding treatment. It is your job to help them understand – this is also providing informed consent.


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Module 185 of 110

Leadership Identity

Public victories are instrumental in providing

team-based medical care. How might you apply Covey’s habits as the leader of a medical care team for these situations?

– The patient is refusing a diagnostic test.– The nurse is overwhelmed and has not given

the patient’s antibiotics yet.– The psychiatry resident must cover several

hospitals when on call and your patient is not in their room.


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Module 186 of 110

Leadership Identity

In each circumstance, the interests of both the health care providers and patient are best served through the demonstration of excellent professional and leadership skills.

Your identity as a physician and colleague isbased upon the consistent use of simple principles outlined by Covey.



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Module 187 of 110

Leadership Identity

Covey emphasizes, above all else, that taking care of personal needs is an important habit of effective leaders. He refers to his seventh habit as “Sharpening the Saw.”

Covey states that to function optimally, one must learn to renew four dimensions of their nature.



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Leadership Identity

Habit #7. Balanced Self-Renewal

1. Physical2. Mental 3. Social/Emotional 4. Spiritual

This habit emphasizes the concept of personal leadership and was covered previously in our discussion of the Doctor-Self relationship.


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Leadership Identity

“To begin with the end in mind means to start with a clear understanding of your destination. It means to know

where you’re going so that you better understand where you are now so that the steps you take are always in the

right direction.” ~ pg 98.

Covey SR, The Seven Habits of Highly Successful People, Fireside, 1989


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Leadership Identity

What is Covey’s 7th habit that pertains to the individual?

Click here for the answer


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Leadership identity

Sharpen the saw! Balanced Self-Renewal

1. Physical

2. Mental

3. Social/Emotional

4. Spiritual


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Hidden Curriculum

Now let’s look at how you affect learners when you don’t even realize you’re doing it.

It’s called the “hidden curriculum” of medicine because its that part of medicine that students learn without being taught. It is a dark side of medical education that can be undone with effort on your part.


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Hidden Curriculum

Each interaction in the medical environment is observed by someone: students, nurses, technicians, colleagues, etc.

As the observer, students especially, will learn the culture of their environment. They are learning how to act and what is/is not acceptable in their medical school, clinic, inpatient team or hospital.


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Hidden Curriculum

“The authors propose that the chief barrier to medical professionalism education is unprofessional conduct by medical educators, which is protected by an established hierarchy of academic authority. Students feel no such protection, and the current structure of professionalism education and evaluation does more to harm students' virtue, confidence, and ethics than is generally acknowledged.”….

Brainbard AH, Brislen HC. “Learning Professionalism: A View from the Trenches.” Acad Med 2007;82(11)1010-14.


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Hidden Curriculum

“The authors maintain that deficiencies in the learning environment, combined with the subjective nature of professionalism evaluation, can leave students feeling persecuted, unfairly judged, and genuinely and tragically confused. They recommend that administrators, medical educators, residents, and students alike must show a personal commitment to the explicit professionalism curriculum and address the hidden curriculum openly and proactively.”

Brainbard AH, Brislen HC. “Learning Professionalism: A View from the Trenches.” Acad Med 2007;82(11)1010-14.


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Hidden Curriculum

Your verbal and non-verbal behavior becomes part of your teaching identity. Students witness your behaviors and can incorporate them into their view of patients, doctors, hospitals, and medical schools.

The authors of the article clearly encourage and emphasize everyone taking a role to undo this darker side of medicine.


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Hidden Curriculum

The Hidden Curriculum is often observed in the clinical arena. Picture in your mind some actual behaviors sometimes observed by students in the clinical setting:

– Pimping students to the point of embarrassment.

– Frequently interrupting patients.– Using “social stigmas” in your conversation.– Yelling at learners about their incompetence in

front of others.


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Hidden Curriculum

This is in contrast to the concepts of patient-centered medical care and professionalbehavior that students are taught asparamount to the Doctor-Patient and Doctor-Colleague relationships.

These contradictions create inner conflict instudents, diminish the credibility of medicalteachers, undermine ethics, and create cynicism as highlighted by the authors.


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Hidden Curriculum

Remember, the Hidden Curriculum is

conveyed through both verbal, non-verbal, and para-verbal behaviors. That means you can say something, do something or emphasize something the wrong way and you just contributed to the hidden curriculum.

Let’s look at some examples so you can stay clear of them in the future.


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Hidden Curriculum

Here are examples of behaviors that teach a negative lesson through the hidden curriculum.

Action Lesson LearnedConsistently arriving five minutes late to a team meeting.

It’s ok to be disrespectful to colleagues and students aren’t worth your time.

Throwing a clamp back onto the tray and yelling at the nurse, “That’s not what I asked for.”

Yelling is ok; treating subordinates rudely is acceptable when they make mistakes – even if honest ones


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Hidden CurriculumAction Lesson learnedStating, “If you didn’t have so many kids, you could take better care of your patients.”

Family life should be sacrificed if you want to be a great physician.

Informing the student that surgery residents are notorious for not answering pages.

Bashing colleagues and maintaining stereotypes is ok regardless of what that surgeon was doing at the time.

Telling a story about how you had a sexual relationship with a nurse colleague.

There are no sexual boundaries in medicine. Have sex with anyone you want, after all you are a doctor.


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Hidden Curriculum

These are all examples of the hidden curriculum and avoiding them can be challenging, but is not impossible. It starts with being aware of the problem and choosing to be different.

Thus, you want to be part of the solution, not part of the problem. Through practice and self-identifying you will be able to prevent or change such behaviors, and in doing so, will be achieving both private/public victories while reducing the effects of the hidden curriculum!


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Hidden Curriculum

“If a teacher have[sic] any opinion which he wishes to conceal, his pupils will become as fully indoctrinated into that as into any which he publishes.”

- Ralph Waldo Emerson

Clearly this takes understanding of the issues and attempts to prevent the problems in the future. What will you chose?


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Summary

Physicians learn much of their professional identity as physicians, teachers and leaders by interacting with others in the clinical environment. As a student or resident you will have the opportunity to contribute significantly to the learning environment of your team.


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Summary

Students, patients, peers, and other members of the interdisciplinary team will benefit from your understanding of your professional role and the value of effective communication, relationships in medicine, leadership skills and how to avoid being part of the negative effects of the hidden curriculum.


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Take Home Points

1. There are four types of relationships in medicine; Doctor-Self is the most important!

2. Communication is your most powerful tool to build relationships, teach learners and lead effectively.

3. Leadership is not just a higher rank, but it is the effort to serve, understand and advance the team as a whole.

4. Where possible, don’t be part of the problem, be part of the solution-avoid contributing to the hidden curriculum!


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Conclusion

It is our hope that each of you will respect each other’s chosen profession and that with practice and mutual respect you will join together to serve your patients and become the next generation of physician leaders.

We hope this module helped you identify yourself as physician and leader. Module 2 will focus on your identity as a teacher and introductory teaching skills.


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Closing Instructions

You have now successfully completed

Module 1: Professional identity. Please take the post-test for this module immediately upon completion.

The evaluation form and other learning materials for module 1 can be found on the main RATL page in Moodle. Thank you for participating!!!!!


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PDF References

See RATL web page for pdf references.


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