How best to respond where doctors in training face problems with professionalism
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- Philomena Hart
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1 How best to respond where doctors in training face problems with professionalism Professor Richard Hays Dr Roger Worthington YSM, April
2 Richard B Hays, PhD MD Former dean, Faculty of Health Sciences and Medicine, Bond University, Australia; Professor of Medical Education, University of Tasmania Roger P Worthington, PhD MA Assistant (Adjunct) Professor of Medicine, Yale University; Consultant advisor, Workforce Intelligence and Planning, Ministry of Health, New Zealand 2
3 Outline Ø Following this introduction, we ll split into groups to discuss cases Ø You may have some cases of your own Ø However, we ve brought some along for you to consider Ø We ll reconvene as a single group after 40 mins for plenary discussion to identify take-home messages and learning outcomes 3
4 Our work to date Ø We have been collaborating on professionalism and behavioural issues for some years, running workshops and giving talks Ø Last week we ran a workshop in Ottawa Ø Last year we published a book with our findings, including case studies from the USA, UK, Australia and New Zealand Ø Contributing authors were senior medical educators, including two faculty from YSM, a Yale student, and a past chair of GMC (UK) Education 4
5 Our take on terminology Professionalism: a concept that applies to a category of persons, their attributes and behaviors, in (and possibly out of) the workplace Unprofessionalism: behaviors that do not conform to normative standards set by an independently regulated profession, such as medicine 5
6 Behaviors Ø Professionalism acquires meaning through application; it is more than an abstract concept Individual health professionals behave in certain ways; as persons they display a range of different attributes But it is institutions that have to respond to the consequences of harmful, inappropriate behaviors 6
7 Types of problem behaviors Unprofessional conduct comprises lapses in judgment covering a spectrum of behaviors a) A single isolated but serious incident of poor behavior, possibly involving the police b) Impaired judgment that impacts directly on clinical performance, putting patients at risk c) Consistent low level noise with repeated incidences, such as late attendance, poor team-working, or dishonesty NB These categories are not mutually exclusive 7
8 Consequences Ø In serious cases, files have to be shared with relevant authorities, and the outcome can be career-ending Ø At intermediate levels, where professional misconduct is established through internal disciplinary hearings, the result could be sanctions, a period of suspension and/or required additional training / supervision Ø Remediation is the primary goal, balancing public interest against justice for the individuals concerned 8
9 Information Ø Information is rarely complete; panels may have to act quickly (to protect others) and make decisions based on limited information Ø In our experience, cases are rarely open and shut 9
10 Special factors to consider 1. To what extent do local legal frameworks affect outcomes? 2. To what extent do local cultural expectations exert an influence? 3. Is there a unique element to your case that you would like to share with others? 10
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