Joan Sargeant PhD Head, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada ABMS Conference 2016 Looking

Transcription

1 MSF: A Diagnostic for Professional Behaviors? And if So, What s the Treatment? Joan Sargeant PhD Head, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada ABMS Conference 2016 Looking more closely at Professionalism Sept 27,

2 Disclaimer/ Conflict of interest I ve received no industry support for this work Other influences Research funding from national and professional organizations to study MSF, self-assessment and feedback (~ 15 yr research program) A member of our provincial medical regulator s Physician Assessment Committee (>10 yrs) A member of the Medical Council of Canada s national MCC-360 Advisory and Research committees

3 Objectives Very quickly to 1. Identify professional behaviors which can be assessed by MSF 2. Discuss physicians responses to their MSF data/report, and factors which influence these 3. Identify strategies to enhance data acceptance and use for improvement.

4 MSF in Medicine - Feedback on Observable Behaviors Medical colleagues Self-assessment Co-workers Patients

5 Multi-Source Feedback What professional behaviors? Who can best assess them?

6 Co-worker and Medical Colleague Questionnaire Items on Professionalism Performance Statement Communicates effectively with patients Verbal communication with other health professionals is effective Written communication with other health professionals is effective Respects the professional knowledge and skills of co-workers Shows compassion to patients and their families Is non-judgemental of patients and their families Is courteous to patients and their families Respects the rights of patients to make informed decisions Accepts responsibility for professional actions Accepts responsibility for patient care Collaborates well with co-workers Manages personal stress Strongly Disagree Disagree Neutral Agree Strongly Agree Based upon the NSPAR Co-Worker Questionnaire (revised)

7 2. Physicians response to their MSF data/report, and factors which influence this

8 Tension: When Performance Data/ Feedback Disconfirm our own Self-assessments of How we re Doing MSF research Nova Scotia MSF pilot and research (Sargeant et al ) Initial quantitative pilot study led to 4 more qualitative studies Why? Most surprising early finding Physicians agreement with their MSF scores was positively correlated to the score itself. What does this mean for giving, accepting and using feedback?

9 Performance Assessment Feedback: Tensions A meta-analysis of 600 performance appraisal feedback intervention studies found that: 1/3 of participants improved 1/3 of participants stayed the same 1/3 of participants decreased performance (Kluger, DeNisi 1996)

10 Performance Assessment Feedback: Tensions Based on What We Now Know about Self-Assessment Negative/ disconfirming feedback: Was not seen as accurate or useful and tended not to be used Led to distress and demotivation (Kluger, DeNisi 1996; Litzelman 1998; Brett, Atwater, 2001; Sargeant et al 2006)

11 Why Negative Feedback May Evoke Emotional Responses and Be Rejected Three levels of performance goals: 1. Self 2. Task 3. Task Learning Feedback effectiveness diminishes as attention moves away from task and toward self (Kluger & DeNisi, 1996)

12 Factors Influencing Physician Acceptance and Use of Performance Feedback System supports or lack of Awareness/ access to support and learning resources Nature of the feedback Emotional reactions to feedback Self-assessment/ own perceptions of performance Professional culture and context Reflection, internal processing Beliefs about ability to change, and motivation Feedback process Assessment process, beliefs re credibility (Sargeant et al 2005,2006; Ivers 2012) 12

13 3. Identify strategies to enhance data acceptance and use for improvement.

14 Using Assessment Data and Feedback for Performance Improvement Was thought of as a behaviourist interaction; i.e. stimulus-response 1. Assessing performance 2. Providing feedback on performance 3. Using feedback for learning and improvement

15 Process of Using Performance Feedback (MSF) For Improvement Facilitated feedback and coaching 1. Assessing performance (self and external) 2. Providing and receiving feedback on performance 3.New activity: Reflect on feedback and assimilate with self-assessment 4.New activity: Decide and plan to use feedback for learning and improvement

16 Model for Facilitating Reflective Performance Feedback (Sargeant et al, 2015) 4 Stage Facilitated Reflective Feedback Model (R2C2) Build Relationship and Rapport Explore Reaction Explore Content Coach for Change

17 Summary: MSF for diagnosing and treating professional behavior It s sensitive work so plan carefully Identify observable behaviors Select reviewers who can observe them Provide facilitated feedback and coaching on the data Provide resources for improvement

18 Your thoughts? Thank you, and please feel free to contact me

19 References MSF compiled reference list ( J Sargeant, J Lockyer) Gawande A. Personal best: Top athletes and singers have coaches should you? The New Yorker;2011, Oct 2. nde Heen S, Stone D. Managing Yourself- Finding the coaching in criticism: The right way to receive feedback. HBR. Jan Feb 2014; Sargeant J, Lockyer J, Mann K, Holmboe E, Silver I, Armson H, Driessen E, MacLeod T, Yen W, Ross K, Power M. Facilitated reflective performance feedback: Developing an evidence and theory-based model. Acad Med, (12): Sargeant J, Armson H, Chesluk B, Dornan T, Eva K, Holmboe E, Lockyer J, Loney E, Mann K, van der Vleuten C. The processes and dimensions of informed self-assessment: a conceptual model. Acad Med Jul;85(7):