Teaching Tips & Tools - Professionalism and Collaborator Strategies

Professionalism and Collaborator Strategies

Issues within the professional domain involve behavioral conduct and ethical practice. Issues within collaborator refers to challenges around building relationships with colleagues and other coworkers on the healthcare team. Some FLAGS in these areas can include:

  • Frequent misunderstandings or miscommunications noted
  • Strained relationships (with patients, with colleagues, with peers)
  • Others (staff and residents) avoid working with the resident
  • Behavioural cues (avoidance, lateness, absence, negative, etc.)

The following key documents are important to reference, and have the learner review, should there be any concerns around professionalism:

UofC Cumming School of Medicine Policies

CMA Policies

CPSA Policies

 

CanMEDS Coaching

Non-medical expert CanMEDS roles can be addressed through one of our qualified CanMEDS coaches, who specialize in one-on-one consulting with residents around issues in communication, collaboration, and professionalism. To request access to a CanMEDS coach, contact the PGME office. Only learners on remediation or probation have access to coaching. 

Strategies

In addition, the following strategies can help address specific issues:

  1. Recognizing Limitations, Asking for Help

    Resident Patient or On-Call Log: Until the resident has demonstrated a development of insight into their limitation, the resident can be asked to maintain a logbook of ALL cases which will be reviewed regularly with their supervisor. The learner will be required to document all cases that were addressed while on call including important details such as: Time and Date, Referring Doctor, Patient name and PHRN, problem identified, advice given to the patient, justified reason for management decision, requisite discussion and sign-off with senior staff person. The log should be reviewed and submitted after each call rotation until the learner has demonstrated sufficient competency and built trust in managing in this area.

    Forced Follow-Up Questions: Require the resident to approach their preceptor daily with at least one new question around something they were unsure about or did not know. Have learners maintain a catalogue of new questions and see if they can identify patterns of deficit.

  1. Demonstrating Respect, Respectful Interactions

    CMPA Good Practices Guide: The Good Practices Guide are a series on online modules covering a wide variety of CanMEDS topics. Under the “Professionalism” module, there are sections on “Behaviour” and “Dealing with Conflict” for the learner to review.

    AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops related to the roles and responsibilities of a healthcare professional through My Learning Link. Through this, there is an online modules called “Respect in the Workplace” which focuses on organizational values and expectations around building respect.

    The University of Calgary also has a “Respect in the Workplace” module that all enrolled students have access to complete.

  1. Accountability, Professional Responsibility

    Setting Expectations: Learners should review in advance of each rotation the rotational objectives as well as the program’s overall objectives of training. They should mark the areas in which they need to work, in relation to the remediation plan, and discuss these with their remedial preceptor at the start of each rotation or block. It is important to establish clear expectations, set clear goals, and have a good understanding of what success looks like for that rotation. Opening a channel of communication right from the start and disclosing difficulties is highly recommended and encouraged.

    Extension: Developing an “Expectations Contract”: Resident should review the expectations of training around intrinsic CanMEDS roles as well as the above listed Ethics and Professionalism documents and develop to sign an “Expectations Contract” around behavior. This should be reviewed with and signed off by the Program director prior to starting Remediation.

    Behaviour Mapping Exercise: The learner can be assigned to complete a mapping exercise that links their observed behavior (they can review comments & feedback or their learning contract for examples) as a breach to expected behaviors of a physician as outlined in our professionalism policy, CanMEDS responsibilities, and codes of conduct. In a format of their choosing (i.e. an essay, a flow chart, a table, etc.) learners should map up to 5 listed examples by:

    1. Identifying how the behavior was flagged as a professionalism concern
    2. What about their actions and/or behaviors contributed to the escalation the situation
    3. Why/how this was interpreted or identified as inappropriate by others involved in the scenario
    4. Identify 3 strategies that you could use to try and mitigate the occurrence of future similar situations

    After the initial mapping exercise is complete, learners can be asked to maintaining a log of any incidents of difficulties or miscommunications. The learner will discuss these incidents with a mentor or coach in the same format that applied in the above mapping exercise. Learners should try and keep track of the strategies they try to employ to mitigate conflict in the log as well.

    Personal Apologies: If the learner had a difficult encounter resulting in damaged relationships with colleagues and co-workers, they should consider issuing a personal verbal or written apology.

    Facilitated Debrief: If the learner had a difficult encounter resulting in damaged relationships with colleagues and co-workers, the program could also consider arranged a facilitated debrief sessions between all parties involved in a particularly offending incident. The learner should hear all sides, demonstrate understanding as to why the behavior was offensive or unacceptable (i.e. through a reflection) and could also consider issuing a formal apology.

    Sign-In/Sign-Out, Attendance Taking: For a learner who has issues with lateness and absence, it is recommended that for a period of time during remediation, the learner be required to sign-in and sign-out of all mandatory educational sessions and/or rotations to track tracking attendance and bring awareness to the behavior. Any lateness or absences but communicated immediately, indicating the cause of the delay or absence, in advance to their rotational preceptor or program administrator. If absence is due to illness, a note may be requested.

  1. Confidentiality & Consent

    CMPA eLearning: The CMPA offers e-learning modules focusing on appropriate documentation, confidentiality and consent, and negligence. These would be good modules for the learner to review as part of their learning plan. Additionally, Good Practices Guide has a consent section in the “Communication” module.

    Social Media Cases: The resident will be asked to research and write about 3 examples of the improper use of social media. They can review the CPSA Advice to the profession (Social Media) document, the University of Calgary Professional Standards for Faculty Members and Learners, and the PGME Operating Standard on Appropriate Use of Social Media. They are then asked to comment on how their own behavior was in breach of these expectations in a reflective paper.

  1. Inter- and Intra- Professional Interactions

    CMPA Good Practices Guide: The Good Practices Guide are a series on online modules covering a wide variety of CanMEDS topics. Under the “Teams” module has a number of sections focusing on teamwork. Additionally, the “Communication” module has a section on “Team Communication”.

    AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops through MyLearningLink related to the roles and responsibilities of a healthcare professional. A workshop called “Communication Cornerstone – Back to Basics” focuses on interpersonal communication skills as well as being more clear and concise. There is also an online modules “Collaborative Practice” focusing on the team-based approach to healthcare. Finally, there is a 3-day workshop called “Enhancing Team Effectiveness” which focuses on personal behaviours.

    Video Review Exercise: The resident could be asked to find and review some clinical teaching videos online demonstrating good and exaggerations of bad communication. They could then write comparison assignment noting which characteristics they might demonstrate in their own communication, which can be previewed with a coach or mentor, and reflect on how this communication style can be perceived negatively by others. Check the resource page for a list of video resources.

    A Day In their Shoes: Should a learner require a better understanding of the roles and responsibilities of different health-care members, and how each person on the health-care team contributes, it might be possible to arrange for a couple of “shadow” days in which the learner functions as a different member of the health-care team.

    Healthcare Teams Reflective Assignment: Have the learner consider all the different health professionals and staff in which they work with and make a list that a) describes that person’s role and their patient-care goals, b) how that person directly supports the resident in their role and, c) anticipate challenges they might face in the future and how to mitigate these. The purpose of the exercise is to recognize that everyone plays an important on the healthcare team and they all share a common-goal of serving in the patient’s best-interest.

  1. Conflict Resolution and Communication Style

    PGME Workshops: The PGME offers a number of workshops on conflict resolution which run frequently for different programs. Remedial residents are invited to attend any of these offerings, should they align with the remedial period. Contact our workshops for more information and availability.

    Facilitated Debrief: If the learner had a difficult encounter resulting in damaged relationships with colleagues and co-workers, the program could also consider arranged a facilitated debrief sessions between all parties involved in a particularly offending incident. The learner should hear all sides, demonstrate understanding as to why the behavior was offensive or unacceptable (i.e. through a reflection) and could also consider issuing a formal apology.

    AHS My Learning Link Courses: Alberta Health Services Offers a number of workshops related to the roles and responsibilities of a healthcare professional through My Learning Link. Through this, there is an online modules called “Enhancing Team Effectiveness” which focuses on understanding personal behaviors that can detract from effectiveness. There is also an online module called “Collaborative Practice Introduction” which should be completed before the workshop.

    CMA/Joule Inc: “Introduction to Effective Communication” is a self-led, online course that teaches reflection on communication style and how it affects interactions with others. Introduction to effective communication (online, self-led) | Joule / CMA eStore

  1. Cultural Competence and Discrimination

    Behaviour Mapping Exercise: The learner can be assigned to complete a mapping exercise that links their observed behavior (they can review comments & feedback or their learning contract for examples) as a breach to expected behaviors of a physician as outlined in our professionalism policy, CanMEDS responsibilities, and codes of conduct. In a format of their choosing (i.e. an essay, a flow chart, a table, etc.) learners should map up to 5 listed examples by:

    1. Identifying how the behavior was flagged as a professionalism concern
    2. What about their actions and/or behaviors contributed to the escalation the situation
    3. Why/how this was interpreted or identified as inappropriate by others involved in the scenario
    4. Identify 3 strategies that you could use to try and mitigate the occurrence of future similar situations

    After the initial mapping exercise is complete, learners can be asked to maintaining a log of any incidents of difficulties or miscommunications. The learner will discuss these incidents with a mentor or coach in the same format that applied in the above mapping exercise. Learners should try and keep track of the strategies they try to employ to mitigate conflict in the log as well.

    Personal Apologies: If the learner had a difficult encounter resulting in damaged relationships with colleagues and co-workers, they should consider issuing a personal verbal or written apology.

    Facilitated Debrief: If the learner had a difficult encounter resulting in damaged relationships with colleagues and co-workers, the program could also consider arranged a facilitated debrief sessions between all parties involved in a particularly offending incident. The learner should hear all sides, demonstrate understanding as to why the behavior was offensive or unacceptable (i.e. through a reflection) and could also consider issuing a formal apology.

    AHS My Learning Link Courses: Alberta Health Services Offers a number of courses addressing discrimination through My Learning Link. Examples include Indigenous Awareness and Sensitivity, LGBTQ2S+ Welcoming Care, and Patient-Centred Care Through a Diversity Lens.

    Alberta Civil Liberties Research Centre: Complete self-assessment prompts http://www.aclrc.com/self-assesment and review with a preceptor, supervisor, or coach.

    Open Labyrinth Virtual Patients and Learners: Open Labyrinth provides a number of open-sources virtual cases which can be used by learners and preceptors. On module called “Cultural Competencies” highlights some of the challenging scenarios leaners and preceptors might go through when there are cultural differences and misunderstandings.

    Write a Patient Story: Have the learner develop their own case or story around a patient, and write the story from the perspective and voice of the patient themselves to stimulate empathy and understanding.

     

Assessment

There are a number of tools available for the assessment of the Medical Expert Competency such as:

  • Field notes (Family Medicine) or Encounter Cards
  • Journaling and Reflective Assignments
  • OSCE (Observed Structured Clinical Examinations) & Simulations
  • ITERs (In-Training Evaluation Reports)
  • Multisource Feedback (i.e. 360-Evaluations, Patient Surveys)
  • The Mini-CEX (Clinical Evaluation Exercise)
  • The P-MEX (Professionalism Mini-Evaluation Exercise)

Please refer to the “CanMEDS Teaching and Assessment Tools Guide” and the “CanMEDS Assessment Tools Handbook” for a comprehensive list, as well as access to tools. A sample of some of the guide is available online. A full copy of the guide can be obtained here.

Resources

The following are some specific recourses that have been helpful in the remediation of Professionalism and Collaboration:

  1. The REFLECT Rubric for assessing reflective writing
  2. University of Ottawa P-MEX Evaluation Forms and Guidelines
  3. UOttawa Professionalism Module
  4. The UK Foundation Program Mini-CEX Guidance for Assessors
  5. CMPA Good Practices Guide Modules
  6. The Mind-Tools Toolkit features a number of useful resources

For more extensive list of resources, please visit the Recommended Resources Page.

***To contribute ideas and grow this resource, PLEASE CONSIDER MAKING A SUBMISSION to pdassist@ucalgary.ca***