leadership & professionalism: practical tools in the workplace for residency training officers
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Leadership & Professionalism: Practical Tools in the Workplace for Residency Training Officers. Erlyn A. Sana, PhD . The resident’s workplace: the ward. The resident’s workplace: the OPD. The Ob-Gyn resident’s workplace. Conference Rooms Library Lecture Halls - PowerPoint PPT PresentationTRANSCRIPT
Leadership & Professionalism: Practical Tools in the Workplace for Residency Training Officers
Erlyn A. Sana, PhD <[email protected]>
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