Giving Feedback on Professionalism with RESPECT Julie Crosson

Giving Feedback on Professionalism with RESPECT Julie Crosson, MD Henri Lee, MD Robert Lowe, MD Craig Noronha, MD February 7, 2011

Resident and Faculty survey on Communication Skills and Professionalism 2008 3 Main points for today 1. Residents found role modeling the most effective teaching method 2. Residents wanted more feedback 3. Many attendings cited the need for faculty development in communication skills and professionalism.

Goals 1. Put giving feedback on professionalism more prominently on clinician-educators radar 2. Provide them with a tool to do it

Objectives by the end of the workshop participants will: • Engage in reflection on their own successes/challenges in giving feedback on professionalism • learn a tool to use in giving feedback on professionalism based on the RESPECT model • have an opportunity to practice using the tool in a scenario most attendings would find challenging.

Unprofessional Behavior • Treatment of patients – Derogatory comments – Jokes • Treatment of colleagues • Substandard medical care – “Cutting corners” – “Discharge fever”

Do we teach this well? • Burack and Irby 1999 – 4 medical teams at an AMC – Observations and interviews over 2 weeks – Review of a vignette • Unprofessional behaviors – Cutting corners – Referring to patients derogatively – Outright rudeness

Attending response • Most common response = NOTHING • Responses – Nonverbal • Often unnoticed – Humor • Was taken to be agreement by learner – Appealing to self-interest of learner • “Others might think this is unprofessional” – Medicalization • “Being nice improves compliance”

Why no response? • • • Reluctance to criticize based on limited data Sympathy for the stress of residency The folly of youth Feedback is hard to give People cannot be changed Don’t want to poison the work atmosphere

Opportunities • Role-modeling works – People change – We need to model “explicitly” • • More direct observation of trainees Faculty development programs Discussing professionalism as a topic openly Treating our learners with respect

Reflection Exercise Reflect on experiences you have with positive or negative professionalism cases - Why was this instance memorable? - What was feeback given? - What went well? What challenge did you overcome? What helped you get there?

Why we actually DO want to give feedback on professionalism • if we don’t say anything residents think the attending is in agreement (Burak/Irby article) • people who have professionalism issues in training- go on to have them in their career and are more frequently sued (Papadakis, NEJM) • to avoid “how did this person get to be a senior resident!” and improve our program • opportunity to point out blind spots, people might not realize how they come across • to reinforce we want to see- positive feedback on exemplary behavior

The RESPECT MODEL Skills set for giving feedback • • R E S P E C T espect xplanatory model ocial context ower mpathy oncerns rust/ T herapeutic alliance “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson , Sandra Gordon, Sheila Chapman, Peter Gonzalez, Eric Hardt, Thea James, Michele David, JGIM 2010 25(supply 2): 146 -54.

RESPECT • Self awareness: Be aware of our own hot buttons • Model the parallel process: Treat the resident the way we want them to treat the patient “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Explanatory Model • “What do you think is behind the patient’s reaction/behavior? ” • “What do you think is behind your own reaction/behavior? ” “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Social Context • Parallel process: respectful curiosity. • Think about generalizations/stereotypes/ assumptions that are occurring. • How do the values on which we are raised influence our clinical behavior? “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Power • Non-verbals • Ask their sense of power differential. • Explicitly identify the role modeling – asking their point of view – listening without interrupting “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Empathy • “You seemed really frustrated…” • “What comes up for you in this scenario from your personal experience? ” “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Concerns and Fears • “What are you worried about? ” • “What is the patient worried about? ” “How can you know? ” “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Trust/Therapeutic Alliance • Discuss the feedback • “What learning points would you like to work on? • “Let’s talk about any ways that I could help you. ” “Treating and Precepting with RESPECT: A Relational Model Addressing Race, Ethnicity, and Culture in Medical Training” C Mostow, J Crosson et al. JGIM 2010 25(supply 2): 146 -54.

Skills Practice • Participants play preceptor and resident role ( 15 min. ) • Identify which aspect of the RESPECT model you will utilize • Workshop leaders- join you as coach and to voice 3 rd party concerns as needed • Small group debrief after 15 minutes

Preparation for role play Reflection for Resident • What are your motivations/ barriers? • Which aspects of RESPECT are you least in touch with? Why? Reflection for the Preceptor • What challenges you most in giving feedback? • What will you do to help resident be open to “hear” • What skills of RESPECT will you use?

Big Group debrief What worked? What are your still struggling with?

Take Home Points • Feedback on professionalism is not happening (Burack/Irby article) • Ways to make feedback easier – Set it up as an expectation – Give feedback on positive examples of professionalism (we don’t do it enough!) – Use tools available to keep their ears open

Closing and Evaluations We are craving some feedback!