Sometimes You Can't Make it on Your Own: The Impact of a Professionalism Curriculum on the Behaviors, Attitudes, and Values of an Academic Plastic Surgery Practice

Abstract

Introduction: Professionalism is now recognized as a core competency for graduate medical education and maintenance of certification. However, few models exist in plastic surgery that define, teach, and assess professionalism as a competency. the purpose of this project was to evaluate the effectiveness of a professionalism program in an academic plastic surgery practice. Methods: We created and conducted a 6-week, 12-hour course for health care professionals in plastic surgery (faculty, residents, nurses, medical students). Teaching methods included didactic lectures, journal club, small group discussions, and book review (Forgive and Remember, by Charles Bosk). Topics included 1) Professionalism in Our Culture, 2) Leadership Styles, 3) Modeling Professional Behavior, 4) Leading Your Team, 5) Managing Oneself, and 6) Leading While You Work. Using Kirkpatrick methodology to assess perception of the course (Level 1 data), learning of the material (Level 2 data), effect on behavior (Level 3 data), and impact on the organization (Level 4 data), we compiled participant questionnaires, scores from pre- and post-tests, and such metrics as incidence of sentinel events (defined as infractions requiring involvement by senior administrators), number of patient complaints reported to Patient Relations, and patient satisfaction (Press-Gainey surveys), for the 6 months before and after the course. Results: 30 health care professionals participated in a 6-week course, designed to improve professionalism in plastic surgery. Level 1 data: Although only 54.4% of respondents felt that the course was a “good use of my time,” 72.7% agreed that the course “will help me become a better professional” and 81.8% “would recommend the course to others.” Level 2 data: Post-test scores increased from 48% to 70% (p<0.05), and the ability to recall all 6 competencies increased from 22% to 73% (p<0.01). Level 3 data: the number of sentinel events in our division decreased from 12 to 3. After the course, one resident was placed on probation and resigned, and two other employees left the division after being counseled on issues of professionalism. Interestingly, these participants did very well on the post-test but were not considered to be “team players.” Level 4 data: Patient complaints decreased from 14 to 8, and patient satisfaction increased from 85.5% to 90.5%. Conclusions: A focused curriculum in professionalism may improve the knowledge of participants and overall behavior of the group, but may not affect individual attitudes. Nevertheless, efforts toward assessing, teaching, and influencing professionalism in plastic surgery are very valuable and should be pursued by educators, to help satisfy GME/MOC requirements and to improve the performance of the organization.