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Leadership & Professionalism:

Practical Tools in the Workplace


for Residency Training Officers

Erlyn A. Sana, PhD


<erlynsana@yahoo.com.ph>
The resident’s workplace: the ward
The resident’s workplace: the OPD
The Ob-Gyn resident’s workplace
1. Obstetrics Admission 1. Conference Rooms
Section (OBAS) 2. Library
2. Consultation Room 3. Lecture Halls
3. Labor Room 4. Classrooms with peers
4. Delivery Room and/or consultants
5. Operating Room 5. Call room
6. Intensive Maternal
Unit
The Ob-Gyn resident’s teaching-
learning milieu

Resident:
learner

Physical
environment
TOs
Teacher:
consultant

Society Patient
Professional roles & general terminal
competencies expected of residents
Integration of Basic, Clinical
Clinician & Surgical Knowledge
Skills

Organizational
Educator Facilitating
competence

Researcher
Leadership &
Use of evidence for Conduct of
decision making research
Professionalism
Manager Organization Management

Social mobilizer Advocacy Networking


Professionalism
• Those sets of values that sustain the interest of
the patient above one’s own self-interest,
• Entails a wide range of attitudes and behaviours
such as altruism, humility, commitment to
excellence, duty & commitment to service,
honour & respect for others, integrity &
compassion, and accountability to patients,
colleagues and society
• American Board of Internal Medicine (CPA
Bulletin, 2002)
Leadership
• The process through which an individual
attempts to intentionally influence another
individual or a group in order to accomplish a
goal.
• Locus of leadership: a person
• Focus of leadership: other individual or groups
• Most critical element: influence
• Shortell and Kaluzny, 1997
Leadership traits
• Personal: integrity, courage, discipline, loyalty,
a sense of justice, sacrifice, honor,
unselfishness, tact, decisiveness, reliability,
moral character & enthusiasm
• Leadership skills and techniques
• Intellectual breadth
• Intellectual depth
• Resident Leadership Webinar
The trouble with attitudes
as learning outcomes:

When we follow codes of


conduct or rules of decorum,
we are often just play acting,
acting appropriately in outer
conduct, irrespective of what
is in our hearts.

Sherman, 2005 ; cited in


Rees, & Knight, Acad Med, 2007
The Affective Domain of Learning
(Krathwohl, et al., 1960)

Characterization

Organization
Consistency
Valuing

Responding

Receiving
Practical tools to teach leadership
& professionalism
Workplace Approaches to teach
1. Clinical environment • Clinical (experiential)
(Accreditation Council for teaching-learning
Graduate Medical Education, – Teaching
Actual clinical work
: facilitating,
2004) – Bedside teaching
explaining, clarifying,
– closing
Rounds consciously by
–the experiential learning
Endorsements
cycle, inculcating,
– Audits
indoctrination, role
modelling, and values
clarification
Practical tools to teach leadership
& professionalism
Workplace Approaches to teach
2. Classrooms and other 1. Lectures
related settings 2. Simulations
(Accreditation Council for 3. Teaching : facilitating,
Cooperative and team
Graduate Medical explaining, clarifying,
learning
Education, 2004) closing consciously by
4. Independent
the experientialstudy
learning
5. cycle, inculcating,
Discussions and seminars
indoctrination, role
modelling, and values
clarification
The experiential learning
cycle (Kolb, 1984)

Concrete Experience
(Affective)

Testing implications Observations &


of concepts in new Reflections (Perceptual)
situations (Behavioral)

Formation of abstract
Concepts & generalizations
(Symbolic)
The Ob-Gyn resident’s teaching-
learning milieu

Resident:
learner

Physical Teacher:
environment consultant

Society Patient
Values clarification
(Raths, 1960)
1. Choosing: Asking residents about the choices
they made in given circumstances
2. Prizing : asking residents if they are satisfied
with their choices
3. Acting: asking and observing residents if they
can publicly affirm their choices
Food chain in Ward X (Sana, 2001)
(By order of harassment)
NA
Consultant
Manong
Fellow
Bantay
SR Resident
Pasyente
JR Resident
Clerks
Intern
Germs
Nurse
Consultants’ personal attitudes and
effects to residents (Morada, 2003)

• Facilitating learning • Inhibiting learning


Competence Temper/mood
Approachability Inconsistency
Respectability Discouraging
Confidence Ingratitude
Orderliness Anxiety
Caring Impulsiveness
Assessment
(Best and Khan, 1989)

• The collection of data, organizing


them to measure how the learners
have achieved the expected levels of
competencies as a result of
instruction
The Nature of Assessment
Standard
Constructs of
leadership &
professionalism
Applying the
Standard
Measurement

Collecting relevant data


Constructing tests
Making questionnaires
Determining who accomplishes tools
When and for how much (content valid)
Valid raters of attitudes
(Henerson, et al, 1987)

Raters When appropriate


Self When raters understand the questions
asked; are aware of the information
asked; can answer honestly
Others Opposite of above
Records When records can be accessed;
complete
When to assess

Before instruction: Diagnostic

During instruction: formative

After instruction: summative


Types of Assessment used for leadership
& professionalism (Norcini & Burch, 2007)
Bases of Diagnostic Formative Summative
comparison

Timing Before instruction During After

Frequency Usually once Frequent Once at the end of


@ term
Usual Role playing, oral Mini-CEX, OSCE, DOPS,
instruments examination, DOPS, CbD, Mini-CEX, Oral
OSCE MSF Examination
Purpose for To determine To monitor To determine final
students readiness progress grade
Purpose for To guide teaching To improve To test
teachers teaching effectiveness
Innovations in clinical evaluations
(Norcini & Burch, 2007)
Simulated /Controlled Naturalistic / Work place

1. Objective Structured 1. Case based discussion


Clinical Examination
(OSCE) 2. Direct Observation of
Procedural Skills (DOPS)
Value of feedback
2. Objective Structured
Assessment of Technical 3. Structured Clinical
The teaching-learning
Skills (OSATS) environment
Operative Test (SCOT)
3. OSOE The(Oral environment
Examination) for assessment
4. Mini-CEX
4. OSPE (Practical
Examination) (www.hcat.nhs.uk)
The Ob-Gyn resident’s teaching-
learning milieu

Resident:
learner

Physical Teacher:
environment consultant

Society Patient

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