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Virtual Conference February 19,  2021

Professionalism and Trust in Health Care During a Crisis

The Academy for Professionalism in Health Care invites you to a virtual conference for health care professionals with over six hours of keynotes including Adina Kalet and Pat Werhane, interactive problem-solving and skills-building workshops, breakouts, networking, and a fireside chat with Fred Hafferty. 

 

If you paid for the in-person conference that was scheduled for April 2020 and canceled, you can attend this virtual conference and the one on June 11, 2021  free of charge. (You should have received an email regarding refunds.) For early bird fee, register before January 31, 2021. See fees below.

 

Conference Agenda – 11:30 to 6:00 p.m. ET

ET PT Agenda Who Type Topic
11:30 - 11:45 8:30 - 8:45 Networking
11:45 - 12:00 8:45 - 9:00 Welcome Elizabeth Kachur Program Chair
12:00 - 12:45 9:00 - 9:45 Keynote 1 Adina Kalet Keynote Can We Educate Physicians to Be Trustworthy? It Depends.
12:45 - 1:00 9:45 - 10:00 Break
1:00 - 2:00 10:00 - 11:00 Breakout -1 Kathleen Sparbel & Sarah Fitz & Kelly Rosenberger Problem Solving Enhancing Professionalism and Interpersonal Trust in the Health Professions in a Time of Crisis
1:00 - 2:00 10:00 - 11:00 Breakout - 2 Fabrice Jotterand & David Larson & Alicia Pilarski Problem Solving Professionalism, COVID-19, Moral Injury, and Burnout: What does bioethics have to do with it?
1:00 - 2:00 10:00 - 11:00 Breakout - 3 Lynne Kirk Problem Solving  ACGME Update & Problem Solving
1:00 - 2:00 10:00 - 11:00 Breakout - 4 Alison Whelan Problem Solving  AAMC Update & Problem Solving
2:00 - 2:15 11:00 - 11:15 Break
2:15 - 3:00 11:15 - 12:00 Keynote 2 Pat Werhane Keynote Organizational Ethics and Improving Patient Trust
3:00 - 4:00 12:00 - 1:00 Breakout - 5 Cynthia Sheppard Solomon & Glen Solomon Workshop Clinicians’ Advocacy Skills Training can Restore Patient Confidence workshop
3:00 - 4:00 12:00 - 1:00 Breakout - 6 Steven Smith Problem Solving The Uncertain Path: Building Inter-team Trust in Complex Decision Making
3:00 - 4:00 12:00 - 1:00 Breakout - 7 Education Track
Amy Caruso Brown Teaching health professions students to practice humility as a means to systemic change: A proposal for building trust and trustworthiness
Elizabeth Rider Learning to Trust One Another: What’s most important for training interprofessional faculty in humanism and Professionalism?
Stuart Finder & Virginia L. Bartlett The presumptions of trust and the practice of demonstrating trustworthiness: Lessons from a residency training program
3:00 - 4:00 12:00 - 1:00 Breakout - 8 Systems Track
Joseph Carrese Trust at stake – Advocating for an at-risk community: A case study
Tom Harter Aggressive Collection of Unpaid Medical Bills During COVID
Stefanie Ellison The inextricable link between professionalism and trust
3:00 - 4:00 12:00 - 1:00 Breakout - 9 Innovation Track
Mark Clark The role literature and the arts can play in fostering professionalism and trust in a time of crisis
Bryan Pilkington The futility of bravado: Medically inappropriate treatment is not the path to trust
Craig Klugman Teaching trust and professionalism through health humanities research
4:00 - 4:15 1:00 - 1:15 Break
4:15 - 5:15 1:15 - 2:15 Fireside Chat Fred Hafferty
5:15 - 5:30 2:15 - 2:30 Closing Remarks Elizabeth Kachur & Gerald Stapleton
5:30 -6:00 2:30 - 3:00 Committees Breakouts
5:30 - 6:00 2:30 - 3:00 Participant Feedback & Networking Elizabeth Kachur & Gerald Stapleton  

Keynote 1

Can We Educate Physicians to Be Trustworthy? It Depends.

by Adina Kalet

 

In this talk, I will share work my colleagues and I have done to measure what we, medical educators, mean when we say that novice physicians can be entrusted to care for patients. I will assert that trustworthiness doesn’t reside wholly in the individual learner nor is it entirely in “eyes of the beholder.” Trust is a social construction. Trustworthiness is what we, collectively, say it is. Therefore, it is a negotiation and exists in the relationships among learner, teacher and patient, among others. Clinical competence “trust judgements” are idiosyncratic and highly context dependent. Physicians often don’t agree with each other or with patients about who is trustworthy. Luckily, trust judgements made by individuals with accumulated experience and wisdom, even without agreement with others, can still be highly valuable to learners and learning when combined with performance metrics and coaching. Yes, of course physicians can learn to be trustworthy, depending on what we mean. Stay tuned.

 

Adina Kalet, MD, MPH is the Steven and Shelagh Roell Endowed Chair, Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin. A general internist and medical education researcher, she has written extensively on communication skills, assessment, remediation, mentoring, professional identity formation and character development in medical education. She invites you to follow our work by reading the Kern Institute’s weekly Transformational Times  newsletters,  see our blog, follow us on Twitter @AKaletMD and consider reading the book she edited entitled Remediation in Medical Education at https://www.springer.com/us/book/9781461490241.


Keynote 2

Organizational Ethics and Improving Patient Trust

by Pat Werhane

 

Despite the overwhelmingly strong commitment of healthcare professionals to patient care, ameliorating disease, and reducing suffering, we are witnessing an increased distrust of healthcare organizations and thus their professional staffs. This increase in distrust has been exacerbated by the Covid-19 pandemic where fear of dying, inequalities in clinical availability, and worries about the alleged dangers of the vaccine have fueled this distrust. Media over-attention and fake news add to this problem. According to one source, “In the 1970s half of Americans said that most people [and most organizations] can trusted. Today that figure is less than one-third.” All of these elements (and there are others) have created moral distress among healthcare professionals and healthcare organizations, distress that, in turn, does not create a propitious environment for healthcare delivery.

 

In this presentation I shall outline some of these issues and then suggest that a more systematic approach to professional and organizational thinking can alleviate some of this distress, discourage distrust, and improve healthcare delivery.

 

Patricia H. Werhane, Professor Emerita, was formerly Ruffin Professor of Business Ethics at Darden School of Business, University of Virginia and Wicklander Chair in Business Ethics at DePaul University. Currently, a Fellow at the Center for Professional Responsibility at the Gies College of Business at the University of Illinois, she is the author or editor of many books and articles, most prominently in business ethics and organizational responsibility in health care.


Watch the Video

Breakout 1

Enhancing Professionalism and Interpersonal Trust

in the Health Professions During a Time of Crisis

by Kathleen J.H. Sparbel, Sarah Fitz, Kelly Rosenberger and Susan Corbridge


Healthcare providers and educators utilize national guidelines to direct professional behaviors in clinical practice and educate future clinicians. Socializing students to professional behavior and value expectations is central to developing ethical clinicians and enhancing trust within the health system and between the healthcare team and patients and families. However, crises such as the global pandemic create a ‘stress test’ within academic and health care systems. This challenges our abilities to teach and demonstrate professional principles, while also exemplifying the importance of professionalism as foundational guidance for healthcare educators and practitioners. Current evolving and chaotic clinical environments necessitate adhering to professional principles while exhibiting the role flexibility and collaboration essential to provide patient care and continue educating students. 

                              

In our presentation, we will discuss national professionalism guidelines for advanced practice nursing and how we have incorporated those principles within a Doctor of Nursing Practice curriculum. We will address how those principles and strategies across professions are challenged during a period of healthcare system stress, specifically how professionalism principles can be interpreted and applied in the setting of a global pandemic.  In collaboration with conference participants, we will explore how interactions between healthcare systems and professionals, within and between disciplines, between educators and students, and between patients and healthcare providers are influenced by professionalism, and how these interactions either enhance or create crises in trust. Furthermore, in collaboration, we will identify supportive strategies to build trust in academic and clinical situations during times of crisis, and additional opportunities for professional development in academe and practice. Through this presentation we will illustrate the importance of team-based care and components of professionalism, including mutual respect, collaboration and communication as integral to building trust and creating high performing teams. 

 

Kathleen J.H. Sparbel, PhD, FNP-BC is a Clinical Associate Professor and Director of the Quad Cities and Peoria Campuses of the University of Illinois College of Nursing (UIC CON). Sarah Fitz, DNP, APRN, AGNP-BC is a Clinical Assistant Professor, Biobehavioral Nursing Science, UIC CON; Kelly Rosenberger, DNP, APRN, CNM, WHNP-BC, FAANP is a Clinical Assistant Professor and Director of the Rockford Campus for the UIC CON. Susan Corbridge, PhD, APRN, ACNP-BC, FAAN, FAANP is the Executive Associate Dean, College of Nursing and a Clinical Professor at UIC CON. She also is a Clinical Professor at UIC Department of Medicine.


Breakout 2

 Professionalism, COVID-19, Moral Injury, and Burnout:

What does bioethics have to do with it?

by David L. Larson, Fabrice Jotterand and Alicia Pilarski

 

Today, healthcare providers, at all levels, but particularly physicians, are in an identity crisis that has moral implications. This has only been magnified by the recent global events related to COVID-19. The institutions and organizations that support and direct our medical providers are mounting efforts to study and remedy the problem, but physician burnout and dissatisfaction with the profession continues to trend upwards. Responses to this problem at both the graduate and post graduate level, make the prevention and early identification of stress and burnout a priority of physicians and the hospitals in which they work. Regardless, questions remain as to the reasons this situation has emerged in just a generation of physicians. In addition, it is not clear whether the dissatisfaction among physicians has always been present and what factors have resulted in compromising the joy of practicing medicine.

 

In this short session, we identify the historical shift that occurred in the second half of the 20th century from medical ethics to the emergence of bioethics in the 1960’s; this has presented moral and professional challenges to all physicians today. This transition, unexpectedly, has gradually reconfigured the practice of medicine and resulted in moral injury to both trainees and their faculty, the products of which are stress, burnout, depression, disillusionment with medicine and even suicide. For this reason, the medical profession needs to reconsider its ideological foundations and develop a new vision grounded on a moral philosophy of medicine. In this presentation, we argue that a philosophical examination of the nature of medical practice can provide the means to help physicians be more reflective and able to deal with today’s challenges to professionalism, thereby restoring trust in the patient-physician relationship. We will also offer a practicing stakeholder (e.g. a front-line emergency medicine physician) view of how a philosophy of medicine provides a framework to develop a perspective of clinical practice grounded in practical wisdom and critically thinking about decisions made in patient care.

 

David L. Larson, MD, is Professor Emeritus-Plastic Surgery at the Medical College of Wisconsin and ACGME Accreditation Field Representative; Fabrice Jotterand, PhD, MA, is a Professor of Bioethics and Medical Humanities and Director of the Graduate Program in Bioethics at the Institute for Bioethics and Medical Humanities and on Faculty at the Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin; and Alicia Pilarski, DO, is Associate Professor and Associate Program Director in the Department of Emergency Medicine and Faculty at the Kern Institute for the Transformation of Medical Education at the Medical College of Wisconsin.

 

Breakout 5

 

Clinicians’ Advocacy Training Can Restore Patient Confidence WORKSHOP

By Cynthia Sheppard Solomon and Glen D. Solomon

Objective: Attendee will learn of the REPEAT educational program visualizing how REPEAT can restore patient trust. REPEAT is an acronym for a special skill set.

Through our experiences teaching about and treating tobacco use disorder, we have identified a number of helpful skills that can assist the health care professional in offering patients better outcomes. Through their awareness of their expectations and worries, while acknowledging they have choices among pathways forward, patients can benefit from this clinical partnership. We offer an acronym to remind clinicians of this skill set to be applied when working through patient obstacles such as substance abuse, weight gain and obesity, tobacco use or vaping, and should be REPEATed at each visit. The workshop will entail cases to establish and reinforce the six REPEAT concepts, including Reassure, Evaluate, Patient-centered discussion, Establish alliance, and Treat. Using techniques such as motivational interviewing, providing patients safe harbor from added guilt and stress, discussions with the health care professional can benefit patient outcomes.

Cynthia Sheppard Solomon, RPh, FASCP, CTTS, NCTTP, is a Clinical Assistant Professor in the Department of IM and Neurology at Wright State University-Boonshoft School of Medicine and Glen D. Solomon, MD, MACP, is a Professor and Chairman of Internal Medicine and Neurology at Wright State University-Boonshoft School of Medicine in Dayton, Ohio.

 

Breakout 7

 

The Presumptions of Trust and the Practice of Demonstrating Trustworthiness:

Lessons from a Residency Training Program

by Stuart G. Finder and Virginia L. Bartlett

 

Trust has long been recognized as fundamental to the social contract between physicians and their patients. Ingredient to such trust is that physicians be capable of not only identifying evidence-based effective interventions for patients’ underlying illnesses, injuries or health conditions, but that they do so as guided by patients’ goals, values and preferences. As such, trust serves as a crucial root for being responsible in clinical practice. Presuming trust without demonstrating trustworthiness, however, creates challenges for actually being responsible when caring for patients. 

 

In our presentation, we explore such challenges as framed by what we have learned from an innovative educational initiative we lead for resident physicians in General Internal Medicine and physicians completing a variety of critical care fellowship programs. Specifically, after a brief overview of this innovative educational initiative, we will share and interrogate two startling recognitions highlighting presumptions of trust and the practice of trustworthiness. The first is that trainees often begin their practice relying heavily on the presumption of trust, yet have difficulty understanding that trustworthiness must actually be demonstrated in patient encounters. Second, trainees often reveal a significant lack of trust in themselves for having goals of care conversations with nearly half focusing on their inability to deploy or demonstrate expertise in such conversations as the basis for that lack of trust. 

 

We then explore how conflating expertise with trust undermines trustworthiness – but how this problematic may be successfully addressed with and then by trainees as part of their education.

 

Stuart G. Finder, PhD, is Director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles, where he also serves as a Professor of Surgery and of Biomedical Science; he also holds an appointment as Adjunct Professor of Medicine at the David Geffen School of Medicine at UCLA. Virginia L. Bartlett, PhD, is the Assistant Director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles, where she also is an Assistant Professor of Biomedical Science.

Watch the Video

Breakout 9

 

The Medical Humanities Have Been Used Instrumentally to Teach Trust and Professional Virtues: It’s Time to See Health Humanities as Inherently Important

by Craig M. Klugman

 

Trust is the linchpin to the patient-health care provider relationship. Trust is a multi-faceted virtue that depends on the competence of a health care worker to have the skills and knowledge available to treat the patient; but it also is found in how these groups relate to one another. Such professionalism skills are often taught through the humanities—literature, graphic medicine, museum art, theater, and other disciplines to engage medical and health students. In this capacity, the humanities play an instrumental role – they are a medium toward teaching lessons such as communication, empathy, observation, and critical dialogue. Reading a poem teaches someone to slow down, to pay attention to words, to find the context of the patient’s story that could effect clinical decision-making. Looking at art teaches comfort with ambiguity as well as observation and communication skills.

 

In this presentation, I will explore this movement from medical to health humanities including the idea that studying the humanities is inherently important not just as a means to a skill but for the practice itself. The field of health humanities is a research discipline in its own right, using research methods from disciplines in the humanities, fine arts, and social sciences, but also creating unique transdisciplinary approaches. Health humanities sees health as more than just medical care, focuses on the application (what lessons can we take from studying poetry for dealing with our current lives), and seeks to increase social justice. Such research aims to understand the human experience of illness and health whether as a healer, patient, or family member, rather than just teaching specific skills to medical students.

 

Craig M. Klugman, Ph.D. is a professor of health humanities and bioethics at DePaul University and also serves on the ethics committee at Northwestern Memorial Hospital.


The Futility of Bravado: Medically Inappropriate Treatment is Not the Path to Trust
by Bryan Pilkington

 

Requests for care by family members and loved ones that offers no physiological benefit for the patient can place healthcare professionals in a challenging situation, pitting the aims of their profession – to act in the best interest of the patient – against a request from those who speak for the very person toward whom their practice is aimed. Though medically inappropriate (or futile) treatment is not a new challenge for healthcare professionals, discussion of this type of treatment has been revived of late. Some have argued that this type of treatment may be ethically justified because of its psychological benefits for a patient’s the family. Others have argued, with respect to other excesses that, e.g., medical over-testing, may be justified in particular populations whose members have faced racial discrimination in healthcare as a way to remedy distrust. Contrary to increasing trends in these directions, I argue that treatment which does not physiologically benefit the patient should not be performed. This is not for the usual Kantian-informed, autonomy-based prohibitions on using  patients as a means to satisfy the ends of their families, but rather because, even if such treatment assuages a patient’s loved ones, taken in total, these practices undermine trust in the healthcare professions. Relationships of trust are formed or, in the case of discrimination, re-formed, through honest, authentically empathetic dialogue and not through the brash displays of futile treatment. Just as their defective counterparts – show codes and sham codes – rightfully face ethical scrutiny, so should the excesses of inappropriate treatment.

Bryan Pilkington, PhD, is associate professor in the School of Health and Medical Science at Seton Hall University and associate professor in the Hackensack Meridian School of Medicine, he also holds appoints in the College of Nursing and Department of Philosophy.


The Renewal of Generosity and the Evolution of Trust

by Mark Clark

 

Two days before Thanksgiving of 2020, my 98-year old mother lost her life to COVID-19. Unlike a great many others around our country and the world, I was given the opportunity to be at her side in those last hours. Her nurses, I have said to my students, vested me in a protective gown, face-shield, N-95 mask, latex gloves, hair net, and booties—robed me as reverently as altar girls would a priest, extending to him the stole, cincture, and chasuble called for in his ritual journey to the realm of the sacred. That evening of her last day, my mother struggled and was clearly in pain. I, the youngest of her six children, held her hand, leaned over her bed and hummed in her ear a lullaby she’d sung to me when I was a child. She grew quiet and calm, and drifted off to sleep, never to wake again. The nurses waited there at the foot of the bed, silent, reverent, absorbed in the beauty of life and love to which they had relinquished control. They did not need to be there, those nurses—one of them, Sydney, was an hour beyond the end of her shift.

 

The week after my mother died, more than 13,000 of our countrymen lost their lives. A tragic year this past one has been. My mother’s nurses provided me with a reminder of something we all need to recall and trust—of history’s timeless lesson that the greatest answer we human beings have to tragedy is companionship, kindness, and a generosity of spirit that not only allows life’s unfolding but relishes the beauty of it doing so.

 

In this session, I want to consider the ethical and exemplary professionalism of my mother’s nurses in relation to Arthur Frank’s call for The Renewal of Generosity and the re-fashioning of the metaphorical model of caregiving from provider-client to host and guest. I contend that such a re-fashioning is essential to the cultivation of trust between physicians and patients, and that endeavors of professional identity formation in medical education ought to include the promotion of habits that lead to the development of generous character. Specifically, I want to consider two of Frank’s recommended “exercises” to develop one’s capacity for generosity and suggest pedagogical strategies – by means of audience participation – through which such exercises might be integrated in a medical school curriculum. These strategies will involve engagements with fine art and with creative expression. Following the participation in the activity, the session audience will reflect together on the ways that such educational experience enhances generosity, which, in turn, promotes trust between physicians and patients.

 

Mark Clark, PhD, is an Associate Professor of Medical Humanities at the University of the Incarnate Word’s School of Osteopathic Medicine (in San Antonio). As a member of the institution’s founding faculty, he helped design a new medical school curriculum that integrates the Medical Humanities to promote Professional Identity Formation and enrich the study of Bioethics.

The fee for this virtual conference is:

Members                            $95 before 1/31; $125 after 1/31

Non-members                  $110 before 1/31; $150 after 1/31 (for information about membership www.academy-professionalism.org > click on Join Today)

Students & Residents    $25