leadership & professionalism: practical tools in the workplace for residency training officers

Leadership & Professionalism: Practical Tools in the Workplace for Residency Training Officers

Erlyn A. Sana, PhD <erlynsana@yahoo.com.ph>

The resident’s workplace: the ward

The resident’s workplace: the OPD

1. Obstetrics Admission Section (OBAS)

2. Consultation Room3. Labor Room4. Delivery Room5. Operating Room6. Intensive Maternal

Unit

1. Conference Rooms2. Library3. Lecture Halls4. Classrooms with peers

and/or consultants5. Call room

The Ob-Gyn resident’s workplace

The Ob-Gyn resident’s teaching-learning milieu

Resident: learner

Teacher: consultant

PatientSociety

Physical environment TOs

Professional roles & general terminal competencies expected of residents

ClinicianIntegration of Basic, Clinical & Surgical

Knowledge Skills

Educator Facilitating Organizational competence

Researcher Use of evidence for decision making Conduct of research

Manager Organization Management

Social mobilizer Advocacy Networking

Leadership & Professionalism

Professionalism

• Those sets of values that sustain the interest of the patient above one’s own self-interest,

• Entails a wide range of attitudes and behaviours such as altruism, humility, commitment to excellence, duty & commitment to service, honour & respect for others, integrity & compassion, and accountability to patients, colleagues and society

• American Board of Internal Medicine (CPA Bulletin, 2002)

Leadership

• The process through which an individual attempts to intentionally influence another individual or a group in order to accomplish a goal.

• Locus of leadership: a person• Focus of leadership: other individual or groups• Most critical element: influence• Shortell and Kaluzny, 1997

Leadership traits

• Personal: integrity, courage, discipline, loyalty, a sense of justice, sacrifice, honor, unselfishness, tact, decisiveness, reliability, moral character & enthusiasm

• Leadership skills and techniques• Intellectual breadth• Intellectual depth• Resident Leadership Webinar

The trouble with attitudes as learning outcomes:

When we follow codes of conduct or rules of decorum, we are often just play acting, acting appropriately in outer conduct, irrespective of what

is in our hearts.

Sherman, 2005 ; cited inRees, & Knight, Acad Med, 2007

The Affective Domain of Learning (Krathwohl, et al., 1960)

Responding

Valuing

Organization

Characterization

Receiving

Compliance Identification In

ternalization

Consistency

Practical tools to teach leadership & professionalism

Workplace1. Clinical environment(Accreditation Council for Graduate Medical Education, 2004)

Approaches to teach• Clinical (experiential)

teaching-learning – Actual clinical work– Bedside teaching– Rounds– Endorsements– Audits

Teaching : facilitating, explaining, clarifying,

closing consciously by the experiential learning

cycle, inculcating, indoctrination, role

modelling, and values clarification

Practical tools to teach leadership & professionalism

Workplace2. Classrooms and other

related settings (Accreditation Council for Graduate Medical Education, 2004)

Approaches to teach1. Lectures2. Simulations3. Cooperative and team

learning4. Independent study5. Discussions and seminars

Teaching : facilitating, explaining, clarifying,

closing consciously by the experiential learning

cycle, inculcating, indoctrination, role

modelling, and values clarification

The experiential learning cycle (Kolb, 1984)

Concrete Experience(Affective)

Observations &Reflections (Perceptual)

Formation of abstractConcepts & generalizations

(Symbolic)

Testing implications of concepts in new

situations (Behavioral)

The Ob-Gyn resident’s teaching-learning milieu

Resident: learner

Teacher: consultant

PatientSociety

Physical environment

Values clarification (Raths, 1960)

1. Choosing: Asking residents about the choices

they made in given circumstances

2. Prizing : asking residents if they are satisfied

with their choices

3. Acting: asking and observing residents if they

can publicly affirm their choices

Food chain in Ward X (Sana, 2001)(By order of harassment)

Consultant

Fellow

SR Resident

JR Resident

Intern

Nurse

NA

Manong

Bantay

Pasyente

Clerks

Germs

Consultants’ personal attitudes and effects to residents (Morada, 2003)

• Facilitating learningCompetenceApproachabilityRespectabilityConfidenceOrderlinessCaring

• Inhibiting learningTemper/moodInconsistencyDiscouragingIngratitudeAnxietyImpulsiveness

Assessment(Best and Khan, 1989)

• The collection of data, organizing them to measure how the learners have achieved the expected levels of competencies as a result of instruction

The Nature of AssessmentStandard

Collecting relevant dataConstructing tests Making questionnairesDetermining who accomplishes toolsWhen and for how much (content valid)

Applying the Standard

Measurement

Constructs of leadership & professionalism

Valid raters of attitudes (Henerson, et al, 1987)

Raters When appropriateSelf When raters understand the questions

asked; are aware of the information asked; can answer honestly

Others Opposite of aboveRecords When records can be accessed;

complete

Before instruction: Diagnostic

During instruction: formative

After instruction: summative

When to assess

Types of Assessment used for leadership & professionalism (Norcini & Burch, 2007)Bases of

comparisonDiagnostic Formative Summative

Timing Before instruction During After

Frequency Usually once Frequent Once at the end of @ term

Usual instruments

Role playing, oral examination, OSCE

Mini-CEX, DOPS, CbD, MSF

OSCE, DOPS, Mini-CEX, Oral Examination

Purpose for students

To determine readiness

To monitor progress

To determine final grade

Purpose for teachers

To guide teaching To improve teaching

To test effectiveness

Innovations in clinical evaluations (Norcini & Burch, 2007)

Simulated /Controlled

1. Objective Structured Clinical Examination (OSCE)

2. Objective Structured Assessment of Technical Skills (OSATS)

3. OSOE (Oral Examination)4. OSPE (Practical

Examination)

Naturalistic / Work place

1. Case based discussion2. Direct Observation of

Procedural Skills (DOPS) 3. Structured Clinical

Operative Test (SCOT)4. Mini-CEX (

www.hcat.nhs.uk)

Value of feedback The teaching-learning environment

The environment for assessment

The Ob-Gyn resident’s teaching-learning milieu

Resident: learner

Teacher: consultant

PatientSociety

Physical environment