How best to respond where doctors in
training face problems with professionalism
Professor Richard Hays
Dr Roger Worthington
YSM, April 2014
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Richard B Hays, PhD MD
Former dean, Faculty of Health Sciences and Medicine,
Bond University, Australia; Professor of Medical
Education, University of Tasmania
Roger P Worthington, PhD MA
Assistant (Adjunct) Professor of Medicine, Yale
University; Consultant advisor, Workforce Intelligence
and Planning, Ministry of Health, New Zealand
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Outline
Ø Following this introduction, we’ll split into
groups to discuss cases
Ø You may have some cases of your own
Ø However, we’ve brought some along for
you to consider
Ø We’ll reconvene as a single group after 40
mins for plenary discussion to identify
take-home messages and learning
outcomes
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Our work to date
Ø We have been collaborating on
professionalism and behavioural issues for
some years, running workshops and
giving talks
Ø Last week we ran a workshop in Ottawa
Ø Last year we published a book with our
findings, including case studies from the
USA, UK, Australia and New Zealand
Ø Contributing authors were senior medical
educators, including two faculty from YSM,
a Yale student, and a past chair of GMC
(UK) Education
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Our take on terminology
Professionalism: a concept that applies to a
category of persons, their attributes and
behaviors, in (and possibly out of) the
workplace
Unprofessionalism: behaviors that do not
conform to normative standards set by an
independently regulated profession, such as
medicine
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Behaviors
Ø Professionalism acquires meaning through
application; it is more than an abstract
concept
§  Individual health professionals behave in
certain ways; as persons they display a
range of different attributes
§  But it is institutions that have to respond
to the consequences of harmful,
inappropriate behaviors
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Types of problem behaviors
Unprofessional conduct comprises lapses in
judgment covering a spectrum of behaviors
a) A single isolated but serious incident of poor
behavior, possibly involving the police
b) Impaired judgment that impacts directly on
clinical performance, putting patients at risk
c) Consistent ‘low level noise’ with repeated
incidences, such as late attendance, poor
team-working, or dishonesty
NB These categories are not mutually
exclusive
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Consequences
Ø In serious cases, files have to be shared with
relevant authorities, and the outcome can be
career-ending
Ø At intermediate levels, where professional
misconduct is established through internal
disciplinary hearings, the result could be
sanctions, a period of suspension and/or
required additional training / supervision
Ø Remediation is the primary goal, balancing
public interest against justice for the
individuals concerned
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Information
Ø Information is rarely complete; panels may
have to act quickly (to protect others) and
make decisions based on limited information
Ø In our experience, cases are rarely open and
shut
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Special factors to consider
1.  To what extent do local legal frameworks
affect outcomes?
2.  To what extent do local cultural expectations
exert an influence?
3.  Is there a unique element to your case that
you would like to share with others?
______
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