Skip to main content

Promoting Professionalism

  • Chapter
  • First Online:
Surgeons as Educators

Abstract

Unprofessional behavior can have a wide impact on colleagues and on patient safety. Addressing such behavior includes setting very clear expectations as to what is meant by professional behavior, modeling such behavior, and holding others accountable. All complaints should be taken seriously and fully investigated. It is important to assess an individuals’ insight and ability to take responsibility for personal behavior and also to note system problems that enable unprofessional behavior by providing secondary gain for such activities. Once a problem has been identified, the individual must be provided with a notice of deficiency and an opportunity to improve, with consequences for failing to address the deficiency. In addition to participation in a remedial program, the opportunity for feedback and reflection and post-intervention assessment are necessary to determine the next steps.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. ACGME. ACGME program requirements for graduate medical education in general surgery. 2017. http://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/440_general_surgery_2016.pdf. Accesses 2.23.17.

  2. Lucey CR, Boote R. Working with problem residents: a systematic approach. In: Holmboe ES, Hawkins RE, editors. Practical guide to the evaluation of clinical competence. Philadelphia: Mosby Elsevier; 2008. p. 201–16.

    Google Scholar 

  3. American Medical Association. AMA code of medical ethics: opinion 9.045: physicians with disruptive behavior. 2017. http://journalofethics.ama-assn.org/2016/11/coet1-1611.html. Accessed 2.23.17.

  4. Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. Issue 40, July 9, 2008. https://www.jointcommission.org/assets/1/18/SEA_40.PDF. Accessed 2 .23.17.

  5. Cohen B, et al. Model Medical Staff Code of Conduct. American Medical Association 2009 http://www.ismanet.org/pdf/news/medicalstaffcodeofconduct.pdf. Accessed 2.23.17.

  6. Physicians with disruptive behavior. Report of the Council on Ethical & Judicial Affairs AMA Report. 2000; 2-A-00:2.

    Google Scholar 

  7. Reynolds NT. Disruptive physician behavior: use and misuse of the label. J Med Regul. 2011;98(1):8–19.

    Google Scholar 

  8. Rosenstein AH, O’Daniel M. Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs. 2005;105(1):54–64.

    Article  PubMed  Google Scholar 

  9. Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464–71.

    Article  PubMed  Google Scholar 

  10. Hickson GB, et al. Patient complaints and malpractice risk. JAMA. 2002;287:2951–7.

    Article  PubMed  Google Scholar 

  11. Stelfox HT, Ghandi TK, Orav J, Gustafson ML. The relation of patient satisfaction with complaints against physicians, risk management episodes, and malpractice lawsuits. Am J Med. 2005;118(10):1126–33.

    Article  PubMed  Google Scholar 

  12. Papadakis MA, Hodgson CS, Teherani A, et al. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med. 2004;79:244–9.

    Article  PubMed  Google Scholar 

  13. Hickson GB, Moore IN, Pichert JW, Benegas M. Balancing systems and individual accountability in a safety culture. In: Berman S, editor. From front office to front line: essential issues for health care leaders. 2nd ed. Chicago: Joint Commission Resources International; 2012. p. 1–35.

    Google Scholar 

  14. Moore IN, Pichert JW, Hickson GB, Federspiel CF, Blackford JU. Rethinking peer review: detecting and addressing medical malpractice claims risk. Vanderbilt Law Rev. 2006;59:1175–206.

    Google Scholar 

  15. Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med. 2006;144:107–55.

    Article  PubMed  Google Scholar 

  16. Weber DO. Poll results: doctors’ disruptive behavior disturbs physician leaders. Physician Exec. 2004;30(5):6–14.

    Google Scholar 

  17. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320:745.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Williams RG, Roberts NK, Schwind CJ, Dunnington GL. The nature of general surgery resident performance problems. Surgery. 2009;145(6):651–8.

    Article  PubMed  Google Scholar 

  19. Naylor RA, Reisch JS, Valentine RJ. Factors related to attrition in surgery residency based on application data. Arch Surg. 2008;143(7):647–52.

    Article  PubMed  Google Scholar 

  20. Yeo H, Bucholz E, Ann Sosa J, et al. A national study of attrition in general surgery training: which residents leave and where do they go? Ann Surg. 2010;252(3):529–53.

    PubMed  Google Scholar 

  21. Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005;80(10 Suppl):S84–7.

    Article  PubMed  Google Scholar 

  22. Hauer KE, Ciccone A, Henzel TR, et al. Remediation of the deficiencies of physicians across the continuum from medical school to practice: a thematic review of the literature. Acad Med. 2009;84(12):1822–32.

    Article  PubMed  Google Scholar 

  23. Torbeck L, Canal DF. Remediation practices for surgery residents. Am J Surg. 2009;197(3):397–402.

    Article  PubMed  Google Scholar 

  24. Sanfey H, DaRosa D, Hickson G, et al. Pursuing professional accountability: an evidence based approach to addressing residents with behavior problems. Arch Surg. 2012;147(7):642–7.

    Article  PubMed  Google Scholar 

  25. Stoll M. In the best medical schools. New York: Princeton Review Publishing; 1999.

    Google Scholar 

  26. Yao DC, Wright SM. National survey of internal medicine residency program directors regarding problem residents. JAMA. 2000;284(9):1099–104.

    Article  CAS  PubMed  Google Scholar 

  27. Hickson GB, Pichert JW, Webb LE, Gabbe SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82(11):1040–8.

    Article  PubMed  Google Scholar 

  28. Reason JT. Managing the risks of organizational accidents. Aldershot: Ashgate Publishing; 1997.

    Google Scholar 

  29. Dyrbye LN, Harper W, Moutier C, et al. A multi-institutional study exploring the impact of positive mental health on medical students professionalism in an era of high burnout. Acad Med. 2012;87(8):1024–31.

    Article  PubMed  Google Scholar 

  30. Americans With Disabilities Act. Updated March 25, 2009. https://www.ada.gov/pubs/ada.htm. Accessed 2.23.17.

  31. Kennedy TJ, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(10 suppl):S89–92.

    Article  PubMed  Google Scholar 

  32. Dweck CS. Mindset: the new psychology of success. New York: Random House; 2006.

    Google Scholar 

  33. Roberts N, Williams R. The hidden costs of failing to fail residents. J Grad Med Educ. 2011;3(2):127–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. McMurray JE, Schwartz MD, Genero NP, et al. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–8.

    Article  CAS  PubMed  Google Scholar 

  35. Daugherty SR, Baldwin DC Jr, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA. 1998;279(15):1194–9.

    Article  CAS  PubMed  Google Scholar 

  36. Elnicki M, Linger B, Asch E, et al. Patterns of medical student abuse during the internal medicine clerkship: perspective of student at 11 medical schools. Acad Med. 1999;74(10 Suppl):S99–101.

    Article  CAS  PubMed  Google Scholar 

  37. Eckenfels EJ, Daugherty SR, Baldwin DC, et al. A sociocultural framework for explaining perceptions of mistreatment and abuse in the professional socialization of future physicians. Ann Behav Sci Med Educ. 1997;4:11–8.

    Google Scholar 

  38. Krizek TJ. Ethics and philosophy lecture: surgery… is it an impairing profession? J Am Coll Surg. 2002;194(3):352–66.

    Article  PubMed  Google Scholar 

  39. Williams BW, Williams MV. The disruptive physician: a conceptual organization. J Med Licens Discip. 2008;94(3):12–20.

    Google Scholar 

  40. Williams BW. The prevalence and special educational requirements of dyscompetent physicians. J Contin Educ Health Prof. 2006;26(3):173–91.

    Article  PubMed  Google Scholar 

  41. Board of Curators of the University of Michigan v Horowitz, 435 US 78, 98 S Ct 948; 1978.

    Google Scholar 

  42. Schwind CJ, Williams RG, Boehler ML, Dunnington GL. Do individual attendings’ post-rotation performance ratings detect residents’ clinical performance deficiencies? Acad Med. 2004;79(5):453–7.

    Article  PubMed  Google Scholar 

  43. Williams RG, Schwind CJ, Dunnington GL, Fortune J, Rogers D, Boehler M. The effects of group dynamics on resident progress committee deliberations. Teach Learn Med. 2005;17(2):96–100.

    Article  PubMed  Google Scholar 

  44. Wu JS, Siewert B, Boiselle PM. Resident evaluation and remediation: a comprehensive approach. J Grad Med Educ. 2010;2(2):242–5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hilary Sanfey MB, BCh, MHPE, FACS .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sanfey, H. (2018). Promoting Professionalism. In: Köhler, T., Schwartz, B. (eds) Surgeons as Educators . Springer, Cham. https://doi.org/10.1007/978-3-319-64728-9_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64728-9_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64727-2

  • Online ISBN: 978-3-319-64728-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics