Addressing and Remediating Professionalism

1. 2019 Perspectives Symposium
January 31, 2019
#TSINPerspectives2019

2. Meredith Vanstone
McMaster University
Addressing and Remediating
Professionalism

3. ADDRESSING & REMEDIATING PROFESSIONALISM
PERSPECTIVES 2019
JANUARY 31, 2019
Meredith Vanstone, PhD
Department of Family Medicine
McMaster University
Meredith.Vanstone@mcmaster.ca

4. OBJECTIVES
 Explore the complexity of recognizing, addressing, and
responding to professionalism lapses
 Consider how the perspective of participants may
constrain or enable different responses
 Share knowledge about resources and best practices

5. TABLE ACTIVITY
Vignette + Questions to consider
Discussion within table groups
Prepare to share key insights from your group

6. FRAMEWORK FOR ADDRESSING & REMEDIATING
Recognizing
Responding
Remediating
How do you understand the
event? How might others
understand it?
What are the range of
options available to each
actor?
According to how you
understand the issue and
potential responses, what
element needs to be
remediated?

7. MAKING SENSE OF PROFESSIONALISM LAPSES
 Complex, multi-dimensional social construct, evaluation
depends on:
 Context, geographical location, cultural norms
 Standards and social norms of the environment
 Values and experiences of observer
 Motivations, efforts, intentions of observed (imputed or
discussed)

8. VIGNETTE 1: RECOGNIZING
 You are a clinician who works on a surgical ward. One very busy morning, you
are attending pre-operative rounds with the clinical team. After leaving the
room of one pre-operative patient, the attending physician flips through the
patient chart and notices there is no written informed consent form. He asks
the medical student clerk to go back and obtain informed consent from the
patient, and then file the form in the chart on her way to the operating room.
The student asks “I get to scrub in today?” The surgeon responds “As long as
we don’t miss the OR time at 9h00 because of a missing informed consent
form” as he moves on to the next room.

9. VIGNETTE 2: RESPONDING
Mark Smith is an aspiring physiotherapist who has been admitted to a PT program that
will begin in September 2019. Over the summer, he is working as a volunteer in a
physiotherapy clinic. He works most closely with Donna Singh, an experienced
physiotherapist. One day, a new patient arrives while Ms. Singh is finishing up with her
previous patient. She has been double booked and is running behind. Ms. Singh instructs
Mark to take the patient into an exam room and start conducting a history and physical
exam. She will join them in about 10 minutes. Mark says that he’s not sure he is ready to
do this, he has never been instructed on how to conduct a history or physical exam. Ms.
Singh replies
“Oh, you’ve seen me do it a dozen times by now. Just fill out the information on the
charting form. The computer will prompt you for what you need. Tell her you are a
physiotherapy student and that I’ll be there to check in with you shortly. You’re just
getting me started, you’re not formulating the diagnosis.”
[continued on handout]

10. VIGNETTE 3: REMEDIATION
 Your program is conducting a regular in-progress review for all trainees. Jane Lee is brought up for
discussion. Her exam scores are excellent. Her clinical evaluations note her competence in clinical skills,
but are consistently filled with vague comments about improving communication and interaction with
colleagues. There are no specific examples, so you seek out personal experience amongst the
committee. Two members contribute that when working with Jane, they have noticed she has an abrupt
manner which has offended colleagues and caused interpersonal problems on the unit. Another
colleague noted that when listening to her in a family meeting, she discussed the terminal diagnosis in
a clinically correct way, but without demonstrating particular empathy or compassion for the emotional
reaction of the family.
1. Does Jane require remediation?
2. What additional information do you require to make this decision?
3. As a committee, what professional development program might you suggest? Which parts are
mandatory and which parts are optional?
4. How will you evaluate Jane’s progress?

11. REPORTING AS A COMPASSIONATE EDUCATOR
 Is reporting the most likely way to encourage
development of professional behaviour?
 What are the requirements to report? Where do you
exercise professional judgment?

12. REPORTING PROFESSIONALISM LAPSES
 Evaluate action as a professionalism lapse.
 Consider reporting:
 Who to report to?
 Relationship with the person receiving the report
 Relationship and responsibilities for person being reported
 Likely consequences to person being reported
 Potential consequences for team, learners, patients
 Social norms and typical responses

13. UPWARDS AND DOWNWARDS REPORTING
Barriers to reporting lapse of a superior
 Incident not important enough to report
 Didn’t think anything would be done about it
 Fear of reprisal
 Negative evaluations
 Job prospects
 Reputation and professional development
 Conflicted because can identify many positive
traits of teacher outside of this lapse
Barriers to reporting lapse of a trainee
 Paperwork and “hassle”
 Potential for retribution
 Worried about impact of reporting on student’s
career.
 Failing grade means see that student again
 Not sure how to address
AFMC 2015, AFMC 2016, Mavis et al 2014; Vogel et al 2018; Bell
2019

14. REMEDIATION
What is professionalism? What is a lapse? How should it be addressed?
Virtue-based: moral character, moral
reasoning
Failure to move through moral
development
Focus on inner habits, development of
character, acting in a moral way.
Behaviour-based: competence, behaviour,
milestones
Acts of inappropriate behaviour, lack of skill
negotiating conflict-prone situations
Enactment of a system to identify lapse,
develop a plan, monitor compliance. Teach
skills to manage challenging situations.
Professional identity formation: evolving
and changing identity
Failure to progress through identity
formation, failure to internalize values of
profession
Tailored to developmental stage, assist to
understand identity and obligations of
profession.
Irby & Hamstra, 2016