Feb. 23, 2024
Professionalism in the Medical Profession: Challenges and Strategies
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In the intricate world of healthcare, we aim to guide you through the importance of being professional in medicine and medical professionalism Our panel hosted by Dr Gavin Nimon and comprised of Professor Ben Canny, Professor Gerry O'Callahan, Dr Maura Kenny and Dr. Patrick Kennewell give their opinions on how to navigate this tricky process. They converge on Aussie Med Ed podcast, sharing the formula for instilling professionalism in medical education and the real-world challenges that young doctors face in upholding these standards amid the high-pressure environment of hospital life.
Professionalism is a domain of the australian medical council medical education curriculum, and therefore we highlight the importance of self-awareness, effective communication, and the delicate balance between empathy and compassion. These pillars are not merely academic concepts but practical tools for maintaining the well-being of both patients and healthcare professionals. Experience the profound impact that adaptive communication styles and a culture of respect can have on patient outcomes and team dynamics, as our guests unveil the art of professional conduct that supports a robust healthcare system, and the art of providing feedback.
We tackle the sensitive issue of addressing unprofessional behavior and the role of mentorship, peer support, and the courageous act of self-reflection plays. Embrace the transformative potential of a genuine apology and learn how it can mend and fortify professional relationships. As we discuss cutting-edge strategies to cultivate professionalism, including the impactful role of peer feedback. join us for a journey into the heart of what it means to be not just a healthcare provider but a beacon of professionalism.
For article referenced by Professor Ben Canny on Medical Professionalism:
Clinical Medicine 2010, Vol 10, No 3: 246–7
Aussie Med Ed is sponsored by -HealthShare is a digital health company, that provides solutions for patients, General Practitioners and Specialists across Australia.
Aussie Med Ed is sponsored by Avant Medical Indemnity: They state that they offer holistic support to help the doctor practice safely and believe they have extensive cover that's continually evolving to meet your needs in the ever changing regulatory environment.
Transcript
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The medical profession involves different areas of medicine, both from learning how to examine a patient and assess them, as well as interacting with a patient and giving them advice and treatment options.
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One area of medicine that goes under the radar is professionalism, how to interact both with patients and with staff and other colleagues.
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It's a very important aspect of medicine.
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It's really important to actually maintain a professional attitude in a profession, and today we're going to learn more about it.
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Welcome to Aussie Med Ed.
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G'day and welcome to Aussie Med Ed, the Australian medical education podcast, designed with a pragmatic approach to medical conditions by interviewing specialists in the medical field.
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I'm Gavin Nimon, an orthopaedic surgeon based in Adelaide, and I'm broadcasting from Kaurna land.
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I'd like to remind you that this podcast podcast players and is also available as a video version on YouTube.
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I'd also like to remind you that if you enjoy this podcast, please subscribe or leave a review or give us a thumbs up as I really appreciate the support and it helps the channel grow.
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I'd like to start the podcast by acknowledging the traditional owners of the land on which this podcast is produced, the Kaurna people, and pay my respects to the Elders both past, present and emerging.
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I'd like to remind you that all the information presented today is just one opinion and that there are numerous ways of treating all medical conditions.
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Therefore, you should always seek advice from your health professionals in the area in which you live.
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Also, if you have any concerns about the information raised today, please Please speak to your GP or seek assistance from help organisations such as Lifeline in Australia.
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Well today, we're lucky enough to be joined by a panel of experts on our Aussie Med program.
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We're joined by Professor Ben Canny, Director of Medical Education from the University of Adelaide.
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Professor Gerry O'Callaghan, Intensivist and a Professor of Public Health.
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Dr.
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Maura Kenny, Director of Staff Wellbeing at the Royal Adelaide Hospital and Central Adelaide Local Healthcare Network.
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And resident Patrick Kennewell.
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A resident who's going to give his advice about interacting with patients and colleagues from a resident's perspective.
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Welcome to Aussie Med Ed, all four of you.
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Thank you very much for joining us on the panel.
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I'd like to start off with Professor Ben Canny.
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Perhaps you can tell us about how Adelaide Medical School deals with such an important topic.
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Thanks Gavin.
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Well, professionalism and leadership is an important domain of the Australian Medical Council, or AMC, defined graduate outcomes.
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And this actually comes in as domain number two and that's significant to think about that number because, , it represents the second highest number of graduate learning outcomes as defined under the AMC Graduate Learning Outcomes.
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And these tackle a range of issues to do with clinical and cultural competence and ethical conduct of doctors.
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So under that general framework, there are a range of skills, attitudes and behaviours that we're really interested in the students being able to incorporate, because they are in fact registered members of the profession from the time they enter medical school.
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And , these skills cover a whole diverse range of things.
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However at the school, we're probably as interested in what is the specific culture that makes up the profession, and therefore leads to professionalism.
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And a definition that we're keen to use, I came across it in an article written by John Funder and written by Peter Wright, who is a judge of the High Court of Ontario.
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And he wrote that a profession is a self disciplined group of individuals who hold themselves out as possessing special skills derived from education and training, which they are prepared to exercise primarily in the interests of others.
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So in addition to these skills and attitudes and behaviours that the AMC define for us, we are really interested in students being able to incorporate that culture and therefore us being able to produce a range of graduates who will be able to serve the community.
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Excellent so obviously entering a profession is a really important part of the process but once you become a professional and actually enter the profession.
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How does it actually lay out in real life?
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I'll pass that question over to Gerry O'Callaghan.
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thanks Gavin.
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, of course we all have a definition of professionalism that we like to use and,, the one that I guess I use on a day to day basis, is that medical professionalism signifies a set of values, behaviours and relationships that underpins The trust that the public has in us,, as practicing, doctors.
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So, to, I guess, put that in the context of working in a big busy public hospital, providing a range of services to the community, it, it really is reflected in how you interact with the other members of your team, how you interact with patients and their families and how you look after yourself and prepare yourself on a day to day basis for that interaction which we know requires us to work on ourselves and to maintain a currency of knowledge and to be prepared to be available not just to consumers, patients, and families but to be available to each other as colleagues when when other colleagues need our help and support in providing care and in making decisions and in looking after themselves.
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So really, being part of the profession is actually really important to have both medical knowledge, medical skills, but also being able to actually present yourself in the correct fashion.
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And I know from the legal perspective, you are judged as part of your peers.
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But there's a lot of stress to put on someone.
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I might put this to Patrick Kennewell, one of our residents here, and ask him how he actually copes with the stress of both being able to deal with their long hours, The difficulty and concerns about missing a diagnosis, but also behaving in a professional way.
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Is there difficulties that you may face, Patrick, that you can advise about as a young resident coming through the
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process?
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I I think becoming a junior doctor is often a challenging time for people as they move out of medical school, which is a very sort of controlled environment, and move into the workforce.
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And The way that people deal with the variable workload in different jobs, I think, um, often challenges people and everyone has different coping strategies for how they deal with things.
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I think, to give some broad tips for junior doctors coming into the profession I think one of the key things is being able to switch off when you're outside of work and ensuring that You know, you can take some time outside of work to do the things that you enjoyed to do before you started in the profession.
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And I think that's particularly valuable.
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One of the things that I think is really important that I tell all of the interns that join my team is that the hospital has 24 hour coverage.
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You've got support on site 24 hours who can help with sick patients.
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As an intern, you shouldn't be taking those sort of issues home with you.
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And so one of the things that I suggest for people entering internship is that they should not have the EMR app on their phone because that, you know, I think leads them to, can lead people to open that and want to check in on how their patients are doing 24 hours a day, when I think you need to sort of make that separation for, having time for yourself and having time to and having work time.
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I think for me as well getting out, in the sun is one of the very important things when you're outside of work, and so going out for walks and, doing some sporting activities as well that maybe aren't as formal and organised as what you did in medical school, that are a bit more flexible around your sort of working life, I think are really important too.
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So going to gym classes and those sorts of things I think are really important.
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A lot of things that my colleagues do in their off time to try and improve their wellbeing and help how they can, navigate their professionalism at work.
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Excellent tips
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there.
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One of the problems though in entering medicine is that most people that do become down, go down the path to medical school and then become a doctor have got a personality that makes them perhaps triple A and more of a worrying and caring sort of nature, you'd hope.
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And certainly sometimes it's very hard to switch off.
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I might put the next question to Dr.
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Maura Kenny about How you cope with staff who are struggling with all the stresses, is there certain things or certain tips you can also come from the hospital that helps these staff in this scenario?
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Thank
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you Gavin it's such a good question.
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I think it's one that we've been really slow to address as a profession.
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In fact that flow of compassion has always been out to other people and not really back into ourselves and learning how to look after ourselves.
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With permission to look after ourselves, with permission to switch off our phones, with permission to not think about patients all the time, with permission, in fact, to say no when you need to say no.
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I don't think we're very good at healthy boundaries.
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But that kind of, that self care piece, if you look at the literature around what really facilitates staff wellbeing in a big organisation if you think about a circle with three pieces, three equal pieces, The personal resilience part, if you like, the personal self care, I prefer to think of it, is just one small part.
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If you really want to look after your staff and get the best out of them, you have to address the culture of the organisation, and the things that get in the way of people's efficiency of practice.
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Healthy teams, connected teams, compassionate teams, and things that don't massively get in the way of us being able to do our job.
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They actually account for more.
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of the outcome for people being able to stay healthy and professional then all of the exercise and the meditation in the world might do.
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I've found both one of the aspects of professionalism isn't actually just purely just dealing with staff but also actually helping the the person in the street or being involved in other good and respectful attitudes and activities such as helping someone on an aeroplane.
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The actual process of being professional gives you self reward and actually helps guide you towards a good approach.
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Do you think that's a good way of proceeding as well?
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This is the part about boundaries which I think we haven't really articulated particularly well when we educate and train and supervise our doctors.
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That if you think about the hidden curriculum of medicine, the hidden curriculum of professionalism, there's a bit of a hero martyr kind of approach that's It's not spoken about, but which is clearly modelled to us and it can lead to that sense of excessive responsibility for patients.
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You know, you're going on holiday, you're on the plane, you want to relax and switch off, somebody gets sick.
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Now, of course, we'll help if we can but, the thing is that it's actually really hard for us to ever say no.
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And there's something about, Learning that, to do that well, to do that wisely, needs to be talked about more.
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Because there is this kind of myth, I think, that if you say no, if you can't do things, people will think of you as not coping, you were never fit to be a doctor in the first place because you've had to say no to some things.
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And then it never ends, there's no end to what can be asked of you.
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So some of the work that, that I'm doing is around helping the profession learn how to Skillfully say no and enact good self care.
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But also to ensure that the organisation isn't inadvertently asking that of people as well.
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Because we were all, we all grew up kind of keeping the health profession going by working ridiculous hours sometimes.
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And that's just not bad, not, not good for anyone.
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Especially not for our patients.
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Because if we're tired and burnt out, then clinical outcomes suffer.
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I'll put it to Professor Ben Canny now about How it might come up through the medical ranks, through medical school.
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Do you think this culture of actually not saying no and trying to do as much as you can might start an early stage in the sense that maybe the curriculum is a bit too wide and makes it a lot of burden to people?
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Or do you think it's actually a matter of just learning what's important and just focusing on the keep it simple approach to learning medicine and not trying to get burnt out by learning the intricacies?
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Thank Gavin.
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We always have to deal with the reality that we live in a fairly competitive world and medical school remains a competitive world unfortunately, even though those of us who look at it and say it doesn't need to be.
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From a medical student point of view, there is that incredible tension about getting ahead and the like and so forth.
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But one of the things I'm really ambitious that we can do is we can Make sure that our students and therefore our graduates actually attain some psychological literacy and in psychological literacy they should develop the ability to recognise in themselves when help is required, when intervention is required, when saying no is the right thing to do, when they don't have the robustness and resilience and that should be a range of behaviours that carry with them no stigma whatsoever.
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In fact, we should be celebrating when someone does acquire those skills and abilities.
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So we're striving in our curriculum to be able to provide students with the opportunities to develop that insight because we want them to be healthy, because we want them to keep on doing things in the interests of others.
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And if they're not healthy, that can't happen.
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If we look at professionalism And we've talked about different concepts of professionalism.
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What really makes up a professional individual?
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What are the individual aspects of it?
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And perhaps I could just ask for two different concepts from the panel and see what people think.
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It's not just about being courteous and being respectful and doing the best, but also looking after themselves.
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Let's make up the different things that would also make you proud to be a profession.
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Professor Gerry O'Callaghan.
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So, there's a lot of of work that's been done over the years in defining, if you like, the characteristics or the competencies that make up a well rounded, holistically professional, um, doctor, surgeon, healthcare professional.
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And there's a number of different frameworks that are often referred to the most The most widely used is one called CanMades which came from Canada.
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But the kind of competencies or characteristics that, of an individual that are described are they're respectful to other people.
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They have a high degree of technical and cognitive competence.
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Self awareness, and I think the self awareness is important because that speaks to self regulation and it also speaks to the privilege of being a profession who are regulated as individual and autonomous practitioners.
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They're good in teams, they're effective communicators, and they're available.
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They're present in discussions and they're available to their colleagues, to consumers, and they're available to the community, that the choices that we make as professionals.
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In how we spend our time in our education, meet the health needs of the community and the population.
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And as a profession in our kind of broader sense as a profession that we we address the challenges of the social determinants of health, the challenges of our community in meeting and designing and planning for the health needs of the
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population.
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Brilliant summary there.
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I wonder if Dr.
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Mora Canny would actually add anything to that.
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Is there anything else you would think that would actually add to a definition or how someone should behave as a professional person?
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I think I'd like to say something about compassion and what the research is teaching us about compassion.
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Compassion is different from empathy.
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Often you hear the term compassion fatigue, which is actually a misnomer.
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People get empathic distress, which, and empathy is where you're really attuned to the suffering of someone else, but you haven't.
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necessarily got the skills or the resources to do something to help, and that's what burns people out.
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Whereas when you train people in compassion, and they're trainable skills, and they're not difficult, and there's a script as well you actually get better patient outcomes, but it's also protective for the doctor too.
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And there's something about learning about the flow of compassion.
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So there's the flow of compassion out.
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There's also allowing compassion to come back in, that means asking for or accepting help from other people.
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And then there's the compassion we might give to ourselves.
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Learning how to be aware, learning how to notice when we're not going so well, when our resilience has dropped, when our capacity to manage things has dropped, and when we need some help or we need some time out or we need something.
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Specific.
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I think it's really important to know and remember that healthcare professionals and doctors especially are more resilient than the general population by definition.
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They wouldn't have got to where they were if they weren't resilient.
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So it's not a failure of resilience which is often what people think it is.
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It's just circumstances are such or the demands are too high and too long for them to keep coping.
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So the self awareness has to be not a judgmental self awareness but a compassionate self awareness.
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If that makes sense.
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Very much and that's an excellent thought provoking aspect as well.
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Patrick, perhaps you can just outline more a bit.
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Anything else you'd like to add to the whole, how you'd like to behave as a professional person, working in a profession that you're very proud of?
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Yeah, thank you, Gavin.
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I think, as a junior doctor, we see professionalism demonstrated through the way that people interact with their patients and how they interact with their peers.
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And I think this really shapes how you view someone's professionalism.
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The situation that I see quite often is When someone picks up the phone to phone through a consult for another, for a patient on their team.
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And the attitude of the doctor on the other end of the line often can determine how effective that consult is.
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And, when people are quite sharp or quite brief or don't understand that people would have a different level of knowledge in their specialty.
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You find that you get worse patient outcomes, and the junior doctor who might be making that phone call would be less likely to make that phone call again in the future whereas when someone's understanding and teaches and shows some compassion and provides useful input, you're going to be far more likely to engage that service again in the future, and I think the same goes in the hospital setting when you're dealing with as a junior doctor dealing with nursing staff and allied health staff as well.
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And about how you deliver care in a holistic model.
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Understanding that everyone comes from a different background, and has a different level of knowledge.
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And appreciating their concerns and being able to communicate effectively with them to achieve the best outcomes for our patients.
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Which we're, is what we're all there for.
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Excellent.
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Excellent sort of thoughts there.
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Professor Ben Canney, what aspects of a medical student coming through as a doctor would make you extremely proud to see them acting in a professional way?
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What are the particular things on top of what we've already said that are really important aspects that you hope they come through with?
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Thanks Gavin.
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This is a bit of a challenge because the previous descriptions have been outstanding.
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The thing I'd like to add, however, is I'll use the word respect and I want to, I want The graduates and the profession to be respectful of the incredible privilege one is given as a medical professional.
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Those privileges extend in a protein of ways.
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You do have people's life in your hands.
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You do have the ability to interact with people and change their perspectives on what they're doing and help them.
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You are entitled.
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to the most sensitive information.
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And that's a real privilege.
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For me what I want the profession to be able to do is to maintain that deep respect and to use that privilege to advance their not only their own lives, but the lives of the community.
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And The great thing about medicine is you can do that by doing your job well.
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And that's just a rare and unique opportunity.
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Brilliant thoughts.
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One aspect though, obviously all of us want to try and be the best we can possibly be.
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But certainly under stress, it would not be unusual for someone to err as human.
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And obviously we want to be respectful, courteous, be in control.
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When under stress, sometimes things can go awry.
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What are the individual coping mechanisms, forgetting about the team approach and going for a walk, of course, which are obviously general preventative measures, almost, to try and prevent these things happening, but what about the individual coping mechanism in that particular stressful scenario?
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This is probably a very good question for Professor Gerry Callaghan as an intensivist.
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I'll pass it on to him, how he copes.
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I think in terms of my practice, there's a couple of things I'd like to say.
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In terms of managing stress I've had the privilege of being, a department and divisional head and being an executive director of medical services.
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What I have observed and what the evidence tells us is that The drivers of stress in our workforce are primarily as a consequence of systems which are poorly designed and get in the way of how they do their work.
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So one of the, one of my responses as an individual to things that I find stressful has been to work in these kind of operational roles, to work in, at clinical quality improvement and system design.
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Because many of those And issues are very solvable and actually make a big difference to the experience of the workforce.
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And to my experience as an intensive care specialist.
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And that helps enormously.
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And the way that is described is intentionally designed systems which produce highly reliable care.
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And that is a big challenge for us to think about in the next 10 years as our systems become more.
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Digitized, more automated, and more complicated.
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And the treatments that we offer to patients become increasingly complex.
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In terms of my practice, I have to say exercise is extremely important.
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The intensive care is very much a team based activity.
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Intensive care specialists have a leadership role in leading that care in the interdisciplinary team.
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And in order to do that effectively one needs to manage the burden of stress and prepare yourself for work and I find that exercise is very helpful.
00:22:50.680 --> 00:22:52.500
Thanks for that, Gerry, that's brilliant.
00:22:52.880 --> 00:22:56.480
More though perhaps individual coping mechanisms in that stressful scenario.
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If I put through one, one perhaps, one little technique I tend to use when I'm in theatre and if I'm struggling at a different part of the operation, I'll usually ask the nurses who are watching intently.
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to go and get the equipment that I might need for the next step if I can't get through it.
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It has the benefit of actually being ready to go to that next step if needed.
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It also has the extra benefit of actually taking their eyes off me so I can actually relax and focus on what I'm doing.
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That's my little technique of actually struggling through a difficult part of an operation if I'm in that scenario.
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There are other little techniques that you might want to use that are, that might be more beneficial on the ward scenario or other situations.
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So maybe just to add to the things that have already been mentioned that are really important I think what you're describing is just taking a moment to come back in to the present moment without being watched or observed.
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There's no doubt that mindfulness practice has a really strong evidence base for reducing stress and helping us recalibrate and come back to some kind of baseline again.
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I'm a mindfulness teacher and have a meditation practice of my own, which has been vital for me to not just survive, but thrive in this challenging and wonderful career.
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And I've taught it to many healthcare professionals, and one of them said to me, he was a surgeon, a bit like what you've described, he said that when something goes wrong in an operation, like it's a moment of high tension, like it's a really urgent situation, he takes a nanosecond to feel his feet on the floor and take one breath out.
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Just to re center, and then he'll go in and be able to do what he needs to do.
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As opposed to all of the stories that start up oh this is going to go terrible, what's going to happen, this is really bad, oh my god, oh my god.
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These kind of thoughts that really interfere with our ability to concentrate and focus and do our job well.
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So, that mindfulness practice of just coming back to the present moment, using feet on the floor, the breath for a moment we know is effective.
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And I can personally attest to that myself.
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Yeah.
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Brilliant.
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Perhaps if I can add to that as well for junior doctors, I think that one of the most helpful things is making sure that you take, you know, 10, 15, 20 minutes to have a lunch break in the middle of the day, being on the wards in a, an environment where you're trying to complete jobs while being called about new jobs that need to be completed can be quite stressful and something that I think that was really good when it was instituted was a sort of half hour paging freeze unless there were sort of emergencies that needed to be attended to so that the junior doctors could take a break from their day.
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You know, do a bit of mindfulness and get a meal with some of their colleagues and sort of share some thoughts on how their morning had gone as well.
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And so I think that's really important.
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And if you're in an environment where, or a team where that can't be facilitated, I think, perhaps an intern handing their pager to their resident for a half hour so they can duck out and get some lunch or something like that, can make a really big difference in those sort type of situations.
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And particularly if you've gone through something stressful like a, a met call that hasn't gone what.
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Or as planned, then, taking a 5 to 10 minute breather and handing your pager or your phone to someone else to answer some calls for you.
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I think people are always happy to do that and it's a really good sort of strategy to deal with those high stress moments.
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And Gavin, what I'd add from my perspective, and one could argue that how can the world of medical education be stressful?
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And certainly the time scale is somewhat glacial compared to the requirements in a clinical environment.
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What I find when deluged with, let's say, lots of decision making pressures is that, um, it's important to try and recognise what are the urgent decisions as distinct from the important decisions.
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And further, what extra data might I be able to gather to help me make a decision?
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And very often the really important decisions aren't urgent and they do have some ability of time to be able to arrive at a better decision making place for yourself armed with more data.
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I think that is applicable to many instances in clinical medicine as well.
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Not the acute Metcalls and the like and so forth, but there'll be lots of opportunity to employ that sort of strategy.
00:27:11.414 --> 00:27:11.954
Brilliant.
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What about though when you do come across someone who does behave unprofessional, someone who you actually have respected or you actually don't mind, how do you actually go about talking to them and actually pointing it out to them?
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There are obviously different techniques to use this on and there may be different scenarios you can think of.
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But perhaps we'll start off with, we'll start with Maura maybe, about what the options are for dealing with a person in that scenario and how it actually can escalate further down the track if that's not working.
00:27:43.309 --> 00:28:00.039
You know, this is a really difficult thing to be able to do well to manage conflict like that to manage somebody else's unprofessional communication and particularly if there's a power imbalance or a, you're a junior in the hierarchy to somebody who's been rude to you, you don't have a lot of power to really address it with that person.
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In fact, you're probably likely not to do that.
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Because it might jeopardize other elements of your career development.
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So if that's the case, it's really important that you can go and talk to someone, the importance of peer support, not just like Patrick's saying about handing over your pager, but seeking out somebody in the organization who's a mentor or a supporter, where you can just debrief, be supported, be validated.
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And then, you can decide what, if anything, you're going to do next.
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And obviously there's a whole other piece around how we deal with professional behaviours in organisations, which we might get to later, but if you don't have the capacity in the moment, and after all, how many of us are able to come on with a really calm, wise response to somebody who's behaving unprofessionally to us, it's quite a big ask then sometimes you just stay quiet, go away, get some support, and then decide after that how you're going to respond.
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Fair enough.
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What about the opposite scenario?
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What about if you feel you've behaved unprofessional when in the light of day you realise you regret what you've said and how you behaved?
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