THE PROFESSIONALISM CURRICULUM AS A CULTURAL CHANGE AGENT IN SURGICAL

RESIDENCY EDUCATION

THE PROFESSIONALISM CURRICULUM AS A CULTURAL CHANGE AGENT IN SURGICAL

RESIDENCY EDUCATION

Mark S. Hochberg, M.D., Adina Kalet, M.D., Sondra Zabar, M.D., Colleen Gillespie, PhD., Russell S. Berman, M.D., H. Leon Pachter, M.D. and the SPICE Study Group

Department of SurgeryNew York University School of Medicine

SPICE NATIONAL STUDY GROUPSurgical Professionalism and Interpersonal Communication Education

• Albert Einstein • American College of Surgeons • Association of American Medical • Chiba University (Japan) • Cleveland Clinic • Columbia University-College of Physicians and

Surgeons • Cornell • Creighton University • Dartmouth Medical School • Drexel Medical • Emory University • Florida International • Florida State University • Georgetown University Medical • Gold Foundation • Harvard/Beth Israel • Harvard/Brigham and • Hofstra University Medical • King Saud University (Riyadh, Saudi Arabia) • Johns Hopkins • Loyola University Medical • LSU Health Center • Macy Foundation • Maine Medical Center • McGill University • Medical College of Georgia • Michigan State University • Mount Sinai Medical Center • National Board of Medical Examiners • Northwestern University School of Medicine • Ottawa Medical Center • Rush University (Chicago) • Southern Illinois University

• SUNY/Downstate • Texas Tech Univ. Health Science Center • Tufts Medical School/Baystate • Tulane University • United States University of Health Sciences • University of Arizona • University of British Columbia (Canada) • University of California, Irvine • University of California San Francisco-Fresno • University of Florida School of Medicine • University of Georgia • University of Hawaii  • University of Illinois-Chicago • University of Illinois-Urbana • University of Kansas • University of Minnesota • University of Missouri-Columbia • University of Missouri-Kansas • University of New Mexico • University of North • University of North Dakota • University of Rochester • University of South • University of Southern California • University of Tennessee/Knoxville • University of Texas/San Antonio • University of Utah • University of Washington Medical School • University of Western Ontario (Canada) • Vanderbilt Medical School • Virginia Commonwealth University • Virginia Tech Medical School • Washington University St. Louis • Wayne State University

ACGME SIX CORE COMPETENCIES

1) Patient care

2) Medical knowledge

3) Practice based learning and improvement

4) Interpersonal and communication skills

5) Professionalism

6) Systems based practice

CHALLENGE FOR SURGEONS: #4 AND #5

WHEN WAS THE PROFESSIONALISM COMPETENCY MANDATED BY THE

ACGME/RRC?

• 1999• 2002• 2004• 2006

ER Transfer to Surgery

NYU PROFESSIONALISM SEMINAR TOPICS

1. Advanced Communication Skills for Surgical Practice

2. Admitting Mistakes - Ethical and Communication Issues

3. Delivering Bad News – Your Chance to Become a Master Surgeon    

4. Interdisciplinary Respect  -- Working as a Team   5. Working Across Language and Cultures: The Case

for Informed Consent      6. Medical malpractice and the Surgeon7. Stress of Surgical Practice – The Life You Save May

Be Your Own

OUR TWO QUESTIONS:

• Has professionalism education as mandated by the ACGME/RRC in 2002 taken hold?

• Is there any evidence that surgical residents’ professionalism skills have improved over time?

EVALUATION OF PROFESSIONALISM EDUCATION

• STUDY #1 Resident self-assessment of professionalism abilities –

annually over four years

• STUDY #2 Objective metrics of resident performance during

professionalism OSCEs as graded by standardized patients – annually over three years

• STUDY #3 SPICE Study Group national survey of 41 departments of surgery

STUDY #1 SUBJECTIVE METRICS

PGY 1 PGY 2 PGY 3 PGY 42.75

3.00

3.25

3.50

3.75

Perceived Professionalism Reported By Surgery Residents

Accountability

Ethics

Altruism

Excellence

Patient Sensitivity

Respect

Overall Professionalism PGY4 > PGY1 p=.016 (n=17-25/yr)

Pe

rce

ive

d P

rofe

ss

ion

alis

m (

Sc

ale

1-4

)

STUDY # 2 OBJECTIVE METRICS

• Studied one cohort of nine surgical residents over a three year period

• Each resident completed a six-station OSCE on professionalism each year

• The same set of OSCEs are administered as residents entered their PGY1, PGY2 and PGY3 years

• Standardized Patients varied over the years – all received similar training; rated each task as “well done”, “partially done” or “not done” by the resident

• 54 OSCEs per year; total 162 OSCEs over the three year study period

STUDY # 2 OBJECTIVE METRICS

PGY 1 PGY 2 PGY 330

35

40

45

50

Professionalism Score of One Cohort of Residents (n=9; 54 OSCEs/yr)

% W

ell

Do

ne

As

Ra

ted

by

SP

(45 ± 12) (35 ± 9) (41 ± 8)

PGY3 > PGY1 p = 0.12

STUDY #3 SPICE NATIONAL SURVEY

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Change in Professionalism Skills Over Five Yearsn=41

Worse Same BetterBetter > Worse p = .001

STUDY #3 SPICE NATIONAL SURVEY

90.2%

9.8%

Scheduled Professional-ism Sessions

n= 41

Yes No

17.1%

82.9%

Professionalism Training for Faculty

n= 41

Yes No

STUDY #3 SPICE NATIONAL SURVEY

Same Slightly Better Much Better0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

4.9%

12.2%

82.9%

Department Leadership's View Towards Pro-fessionalism Change: 2011 vs. 2006

n=41

Let’s go to the videotape

Ending Well

ER Transfer to Surgery: Take 2

FUNDING SUPPORT

• Josiah Macy, Jr. Foundation• Arthur Vining Davis Foundations

THANK YOU!

• Adina Kalet, MD adina.kalet@nyumc.org• Mark Hochberg, MD mark.hochberg@nyumc.org• Sondra Zabar, MD sondra.zabar@nyumc.org

Mostly NOT SignificantexceptEthics: PGY 2 < 4

N=9 N=8 N=7 N=4