Professionalism in Hand Surgery: Treating the Noncompliant Patient.

Every practicing hand surgeon has had the challenging experience of treating a patient who demonstrates difficulty with, or inability to comply with medical advice. Patient noncompliance can lead to not only poor patient outcomes but also deterioration in the therapeutic relationship, physician burnout, high cost of care, and medical-legal risk. The guiding principles in the ethical practice of medicine render it important to consider noncompliance as a potentially modifiable risk factor, and every attempt should be made to work with these noncompliant patients to achieve the best possible outcomes. Data suggest that noncompliance may be affected by socioeconomic status and race; many of these patients are among the vulnerable. However, in some instances, treatment options may warrant alteration or adjustment to reflect the noncompliance of the patient. Rarely, it may be reasonable for a physician to discharge a patient from care once any urgent problems have been managed. Ethical and responsible management of a noncompliant patient requires a thoughtful and measured approach.

"Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan.

CONTEXT: Malignant fungating wounds (MFWs) occur among 5%-15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. OBJECTIVES: To explore the experiences in caring for patients with MFWs among nurses in Taiwan. METHODS: Qualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. RESULTS: Four themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. CONCLUSION: The findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses' health when caring for this population.

Prediction, prognosis, and professionalism in perioperative medicine.

Guidelines provide a framework to take better care of our patients. They are published by different professional groups and are based on all the research done for us by hardworking colleagues. Compiling a guideline is an enormous amount of work and is generally done with the utmost care. However, recommendations often require a subjective interpretation of published research, where personal and academic interests can influence the outcome. We discuss two recently published guidelines on perioperative cardiovascular assessment that led to different conclusions on some important areas of patient care.

An ophthalmology professionalism survey tool: outcomes from a multi-center study in Central India.

Purpose: To describe a professionalism survey tool and its use to assess knowledge of medical professionalism in ophthalmology training programs in Central India. Settings and Design: Multi-center survey study. Methods: A validated 33-question, scenario-based survey addressing professionalism attributes was administered at five centers in central India. The attributes tested included "personal characteristics," "physician-patient relationships," "workplace practice and relationships," and "socially responsible behaviors." A mean attribute score (%) was calculated and compared to "gold standard" responses by a group of expert senior ophthalmologists (100% agreement for responses). Results: A total of 225 participants completed the survey; 124 residents, 47 fellows, and 54 consultants (98.4% response rate). The total mean attribute score was 80.7 ± 9.1 (min 16.67, max 100). There was variation in the mean attribute score by professionalism attribute (P < 0.001), and a trend toward higher mean attribute scores for consultants compared to trainees across all attribute groups. The scores for "personal characteristics" (93 ± 9.7) and "physician-patient relationship" (82 ± 15.8) were the highest, whereas scores for "socially responsible behaviors" (73.9 ± 18.6) and "workplace practices" were low (72 ± 13). Conclusions: There is a generally high level of professionalism knowledge among ophthalmologists in central India. The results suggest that experience does impact knowledge of professionalism. Potential for improvement in professionalism exists in around "workplace practices", and around "socially responsible behaviors". These findings may serve as a valuable discussion starter and teaching tool to enhance professionalism in ophthalmology training programs.

Research Addressing the Ongoing Changes in the Practice of Family Medicine.

The articles in this issue are divided into 3 categories: 1) increasing our understanding of people's (patients') behaviors; 2) changing how we practice Family Medicine; and 3) rethinking common clinical problems. These categories include multiple topics: nonprescription antibiotic use, recording electronic smoking/vaping, virtual wellness visits, an electronic pharmacist consult service, documenting social determinants of health, medical-legal partnerships, local professionalism, implications of peripheral neuropathy, harm-reduction informed care, decreasing cardiovascular risk, persistent symptoms, and colonoscopy harm.

Percepções de fonoaudiólogos sobre modelo profissional (role model) / Perceptions of speech language pathologists and audiologists on professional model (role model) / Percepciones de los logopedas sobre el modelo profesional (role model)

Objetivo: Identificar a percepção de egressos de um curso de Fonoaudiologia sobre modelos profissionais (role model) importantes durante a prática profissionalizante na graduação. Método:Estudo transversal aprovado pelo Comitê de Ética e Pesquisa (parecer nº 4.188.795). Foram incluídos como voluntários 106 egressos de Fonoaudiologia de uma instituição pública do interior do estado de São Paulo que receberam um instrumento (Google Forms) composto por afirmativas relacionadas ao modelo profissional em escala de resposta psicométrica do tipo Likert (1-5). Os dados foram tabulados e analisados por estatística não paramétrica. Resultados: Os participantes identificaram docentes e preceptores como sendo os seus principais modelos profissionais. Os atributos referentes às habilidades clínicas obtiveram um maior grau de importância, enquanto as habilidades de pesquisa foram consideradas menos representativas de um modelo profissional. Conclusão: Os atributos relacionados a um bom modelo profissional encontrados neste estudo poderão contribuir no desenvolvimento profissional dos docentes e preceptores e na formação de um ambiente de aprendizagem favorável ao aluno. (AU)

Purpose: To identify the perception of graduates of a Speech, Language and Hearing Sciences course at a public university about important professional models (role models) during their professional practice in undergraduate courses. Methods: A questionnaire with a Likert scale (1-5) was completed by 106 graduates and analyzed quantitatively. Results: Participants identified professors and preceptors as their main professional models. Attributes referring to clinical skills had a higher degree of importance, while research skills were considered less representative of a professional model. Conclusion: The attributes related to a good professional model found in this study may contribute to the professional development of teachers and preceptors and to the formation of a favorable learning environment for the student. (AU)

Objetivo: Identificar la percepción de los egresados de un curso de logopedia sobre modelos profesionales importantes (role model) durante la práctica profesional en la graduación. Método:Estudio transversal aprobado por el Comité de Ética e Investigación (Dictamen nº 4.188.795). Los voluntarios incluyeron 106 graduados de Logopedia de una institución pública del interior del estado de São Paulo que recibieron un instrumento (Google Forms) compuesto por declaraciones relacionadas con el modelo profesional en una escala de respuesta psicométrica del tipo Likert (1-5) . Los datos fueron tabulados y analizados utilizando estadísticas no paramétricas. Resultados: Los participantes identificaron a los profesores y preceptores como sus principales referentes profesionales. Los atributos referidos a habilidades clínicas obtuvieron un mayor grado de importancia, mientras que las habilidades investigativas se consideraron menos representativas de un modelo profesional. Conclusión: Los atributos relacionados con un buen modelo profesional encontrados en este estudio pueden contribuir para el desarrollo profesional de profesores y preceptores y para la creación de un ambiente de aprendizaje favorable para el estudiante. (AU)

Perception of professionalism in clinical practice among clinical year radiography students in a tertiary institution in Ghana.

INTRODUCTION: Professionalism describes the positive attitudes, conduct, aims, values, skills, and behaviours that characterize a profession or a group of professionals. The steady professional growth of radiographers, which begins during undergraduate training, continues to be significantly influenced by education. As professional traits are ingrained in radiography students through official clinical instruction and observations, research on professionalism is necessary to monitor the perception of the subject matter. However, no study on Ghanaian radiography students on professionalism has been conducted. The goal of this study was to determine how clinical radiography students at a higher education facility in Ghana viewed the professionalism of radiography practice. METHODS: Sixty-four consenting Level 300 (3rd year) and Level 400 (4th year) students in the University of Ghana School of Biomedical and Allied Health Sciences' BSc Diagnostic Radiography and BSc Therapy programmes completed the Pennsylvania State College of Medicine Professionalism Questionnaire (PSCOM-PQ) which was used to determine the impacts and challenges to professionalism. Version 23.0 of the Statistical Package for Social Science program (SPSS 23.0) was used to analyze the collected data. RESULTS: A good sense of professionalism in clinical practice was held by the majority of clinical radiography students. More than 56% of them observed professional practice among the majority of radiographers, contrary to 40.6% of them who witnessed it among only a few radiographers. The students observed both positive and negative effects on the professionalism of radiography practice. As a result, 77.9% of the students said that it was difficult to exhibit professionalism in radiography during their clinical training. CONCLUSION: The students agreed that professionalism impacted positively and negatively on radiography practice, and consequently identified to need to address the mitigating challenges to improve the level of professionalism. By this, most of the clinical year students had a better understanding of perceptions of the professionalism of radiography practice. IMPLICATION FOR PRACTICE: According to the study's findings, clinical students' radiography practice is affected either positively or negatively by their conceptions of professionalism and their adherence to them during the entire training period.

Shifting the narrative and practice of assessing professionalism in dietetics education: An Australasian qualitative study.

AIM: We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? METHOD: We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace-based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team-based, framework analysis. RESULTS: Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. CONCLUSIONS: These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student-centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation.

Evaluation of Self-Reported professionalism lapses among dental undergraduate students: A cross-sectional study from a Malaysian dental faculty.

INTRODUCTION: Professionalism and academic integrity are important components of dental education as they influence not just the present-day learning process, but also the practice of dentistry in future. This study evaluated self-reported professional lapses, academic dishonesty behaviours among peers and recommended sanctions for such lapses. MATERIALS AND METHODS: Dundee Polyprofessionalism Inventory I: Academic Integrity questionnaire was administered to BDS students of a private dental institution in Malaysia. Differences in the level of recommended sanctions were assessed by Mann-Whitney U and Kruskal-Wallis test. RESULTS: There was unanimous agreement that all 34 statements of lapses of academic integrity as unacceptable. The highest agreement (95.6%) was related to threatening or abusing university employees or students and involvement in paedophilic activities, whereas the lowest agreement was observed for getting or giving help for coursework against rules (47.3%). The most frequent behaviours observed among peers were lack of class punctuality (55.1%) and providing and receiving proxy attendance services (49.3%). About 36% admitted to not being punctual themselves, 26.8% for accepting or providing help for course work and 22.9% for receiving and providing proxy attendance. Female students displayed stricter recommended sanctions, with the most significant difference relating to joking disrespectfully about body parts (p < .001). More lenient recommended sanctions were observed among Year 1 students compared with other years, with the most significant difference (p < .001) observed for exchanging information about the exam, forging a signature, plagiarising and cut-pasting materials without acknowledgement. CONCLUSION: The majority of academic lapses were well comprehended. Significant differences were observed in sanctions imposed in terms of gender and year of study.

Implementation and Assessment of Mentoring and Professionalism in Training (MAP-IT): A Humanistic Curriculum as a Tool to Address Burnout in Surgical Residents.

OBJECTIVE: Mentoring and Professionalism in Training (MAP-IT), a humanistic mentorship program, has demonstrated positive impact in non-surgical fields. This study assesses the feasibility of implementing MAP-IT in surgical residency and adapts MAP-IT to include residents-as-teachers (RAT). We hypothesize that MAP-IT will benefit surgical residents by building humanistic teaching skills, increasing resilience, reducing burnout, and improving connectedness. DESIGN: MAP-IT was implemented monthly during protected educational time. Faculty surgeons who had previously completed MAP-IT served as facilitators. Small groups consisted of 12 trainees, two faculty facilitators, and one resident facilitator. Each session comprised 60 minutes of reflection, readings, and discussion surrounding humanistic mentoring skills. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Connor Davidson Resilience Scale (CD-RISC), and Humanistic Teaching Practices Effectiveness Questionnaire (HTPE) were administered before and after participation in MAP-IT. Qualitative interviews and surveys assessed residents' perspectives of the MAP-IT program. SETTING: MAP-IT was implemented at Northwell-North Shore/LIJ in Manhasset, NY in a general surgery residency program hosted by two tertiary care hospitals within a large health system. PARTICIPANTS: 55 residents participated as learners, five residents served as resident-facilitators, and 10 surgical faculty served as paired-facilitators of the MAP-IT course. RESULTS: 31.6% of residents had participated in a reflective medicine curriculum prior to MAP-IT, and these residents reported greater resilience and less burnout. This disparity was eliminated after participation in MAP-IT. Frequency of burnout was reduced from 64.1% to 46.1% after MAP-IT participation. Post-program, residents reported greater effectiveness in humanistic teaching practices when compared to baseline assessments. Quantitative and qualitative feedback demonstrated that MAP-IT was well received by resident participants and addressed a gap in their surgical training. CONCLUSIONS: A humanistic mentorship program involving RAT can be effectively implemented in surgical residency, is well-received by residents, and addresses a need surgical training by building skills and improving resident well-being.

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study.

INTRODUCTION: Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models. METHODS: From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring. RESULTS: The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them. CONCLUSION: Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

The Michigan Action Progress System (MAPS): Enhancing a Culture of Professionalism, Accountability, and Psychological Safety.

OBJECTIVE: To prioritize trainee well-being, promote professionalism, and allow individuals to raise concerns without fear of retribution, one surgical department created an innovative process by which individuals can raise concerns and obtain subsequent support. DESIGN AND SETTING: The University of Michigan Department of Surgery implemented the Michigan Action Progress System (MAPS) in February 2021. PARTICIPANTS: General Surgery residents, faculty, and staff voluntarily participate in MAPS. RESULTS: Since implementation, there have been 26 entries into MAPS. Petitioners included students (10, 38%), residents and fellows (7, 27%), staff (1, 4%), faculty (1, 4%), and anonymous petitioners (7, 27%). Concerns regarding racism (1, 4%), bullying (11, 52%), gender discrimination (1, 4%), and other incidents (8, 38%) were addressed though MAPS. CONCLUSIONS: We have successfully implemented an innovative system that focuses on the needs of the user, consolidates handling of concerns, and emphasizes transparency, documentation, education, and improvement to promote a culture of professionalism and accountability.

Predicting Performance at Graduation From Early ACGME Milestone Ratings: Longitudinal Learning Analytics in Professionalism and Communication in Vascular Surgery.

OBJECTIVE: Program directors in surgical disciplines need more tools from the ACGME to help them use Milestone ratings to improve trainees' performance. This is especially true in competencies that are notoriously difficult to measure, such as professionalism (PROF) and interpersonal and communication skills (ICS). It is now widely understood that skills in these two areas have direct impact on patient care outcomes. This study investigated the potential for generating early predictors of final Milestone ratings within the PROF and ICS competency categories. DESIGN: This retrospective cohort study utilized Milestone ratings from all ACGME-accredited vascular surgery training programs, covering residents and fellows who completed training in June 2019. The outcome measure studied was the rate of achieving the recommended graduation target of Milestone Level 4 (possible range: 1-5), while the predictors were the Milestone ratings attained at earlier stages of training. Predictive probability values (PPVs) were calculated for each of the 3 PROF and two ICS sub-competencies to estimate the probability of trainees not reaching the recommended graduation target based on their previous Milestone ratings. SETTING: All ACGME-accredited vascular surgery training programs within the United States. PARTICIPANTS: All trainees completing a 2 year vascular surgery fellowship (VSF) in June 2019 (n = 119) or a 5 year integrated vascular surgery residency (IVSR) in June 2019 (n = 52) were included in the analyses. RESULTS: The overall rate of failing to achieve the recommended graduation target across all PROF and ICS sub-competencies ranged from 7.7% to 21.8% of all trainees. For trainees with a Milestone rating at ≤ 2.5 with 1 year remaining in their training program, the predictive probability of not achieving the recommended graduation target ranged from 37.0% to 71.5% across sub-competencies, with the highest risks observed under PROF for "Administrative Tasks" (71.5%) and under ICS for "Communication with the Healthcare Team" (56.7%). CONCLUSIONS: As many as 1 in 4 vascular surgery trainees did not achieve the ACGME vascular surgery Milestones targets for graduation in at least one of the PROF and ICS sub-competencies. Biannual ACGME Milestone assessment ratings of PROF and ICS during early training can be used to predict achievement of competency targets at time of graduation. Early clues to problems in PROF and ICS enable programs to address potential deficits early in training to ensure competency in these essential non-technical skills prior to entering unsupervised practice.

Surgical Professionalism, the White Owl, and Tar Heel Basketball.

The University of North Carolina (UNC) has storied traditions beyond its champion Tar Heel basketball teams. One of its best-and least known off campus-is the white owl, today a lapel pin given to chief residents in surgery at Memorial Hospital in Chapel Hill. Former residents in anesthesia and surgery at the San Francisco General Hospital (SFGH) remember it as a stuffed owl that anesthesia residents brought into the operating room whenever there was an appendectomy for appendicitis and the appendix was normal, an operation familiarly called a negative appendectomy. Standing at the table closing the incision their surgical counterpart endured the imagined smirks of the anesthesiologists behind their masks and the scrub techs and circulating nurses who also knew of the bird's significance. Alumni of the SFGH training programs also remember it as evidence of the good-natured repartee between anesthesia and surgery, teams that worked hard at all hours to serve the injured and disadvantaged populations of the city. In retrospect, the white owl signifies owning one's decisions and mistakes, an essential aspect of surgical professionalism.