With Dr. Andi Marmor
Join us as we talk with Andi Marmor, MD (UCSF) as we dive deep into professionalism in health professions education. We define professionalism, discuss assessment, and review concrete methods for approaching a professionalism conversation. Learn to use the SOAP framework you are already familiar with from your clinical work to help address a professionalism concern in a learner!
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Dr. Andi Marmor is a pediatrician, medical educator, coach and faculty developer. She is clinically based at SF General, and teaches at UCSF School of Medicine. She loves learning from and teaching absolutely all levels of learner, from her daughter’s 4th grade class to fellow faculty.
Professionalism at its core is a set of shared values that our profession should uphold, regardless of our varied backgrounds and beliefs.
While these values have a tendency to remain relatively consistent, they represent a subjective set of shared values that have evolved over time due to the changing backgrounds of individuals within our profession.
Dr. Marmor notes that it is important to acknowledge the negative connotations associated with the concept of professionalism in medicine. Professionalism has historically been used to exclude members of marginalized groups from the medical profession. It is imperative to recognize that our assessment of professionalism is prone to bias, thus minority and underrepresented populations are more likely to experience challenges and disciplinary actions (Alexis 2020).
When looking to assess professionalism in learners, it is helpful to identify behavioral domains that can be objectively observed. Dr. Marmor endorses using the framework of professional behavior outlined by Wilkinson et al. which includes the following domains (Wilkinson 2009):
Translating broad domains into specific competencies (expected specific observable behaviors) can help with assessment. Some professionalism domains are easy to translate into competencies, for example reliability is easily measured (were notes closed on time, did the learner show up to sessions). Others are more challenging to translate into competencies such as patient interactions.
Dr. Marmor notes that one challenge is that these domains can be in conflict with one another. For example, seeing a patient that has multiple concerns that need to be addressed may cause conflict between interacting with patients and interacting with colleagues that are waiting for you to start rounding. Importantly, learners are at a disadvantage when it comes to making decisions when these domains are in conflict due to lack of power in the medical hierarchy and lack of experience in navigating these situations.
Another noteworthy caveat is that lapses in professionalism are inevitable. It is critical that we normalize lapses in professionalism for our students and allow our learners to make mistakes.
Dr. Marmor outlines her SOAP structure for framing a conversation with a learner about issues pertaining to professionalism.
Objective: bring in the professionalism domains
Jake is a second year medical student meeting with Dr. Marmor, his longitudinal coach, as a check-in during one of their intercession weeks. Jake recently had an encounter with a group facilitator that rubbed him the wrong way, and he is meeting with you to debrief the situation. Prior to the session, Jake had not read any of the prep material. During the encounter, Jake felt he was asked a targeted question by the group facilitator, and he abruptly left the small group.
Remember that Jake is coming to Dr. Marmor first in this scenario which gives her an opening to have this conversation.
Dr. Marmor states the same framework can be applied in conversations with a resident: try to set aside assumptions that residents are more knowledgeable and try to apply the same level of openness and compassion to residents as with medical students (disclaimer: these are for minor lapses in professionalism).
Document! Document the concern(s) and your feedback conversation in the learner’s evaluation, ideally. Include the date you talked to the student and what was discussed. The purpose of this documentation is to help future mentors or others in leadership positions evaluate learner progress or identify a pattern in behaviors.
There is a difference in being professional and in assessing professionalism. As assessors, we need to be aware of where we are coming from and that the definition of professionalism is based on a certain historical version of the medical profession.
Have the conversation! If you see something, say something. The SOAP framework will help you prepare for the conversation, with a focus on assessing insight and adaptability, and build the plan from there.
Listeners will appreciate the complexity of defining, teaching, and assessing professionalism in medicine.
After listening to this episode listeners will…
Andi Marmor, MD reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Marmor A, Kryzhanovskaya E, Heublein M. “#31 Taking a Fresh, SOAP-y Approach to Professionalism . The Curbsiders Teach Podcast. https://thecurbsiders.com/teach. May 16, 2023
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