Hickson Gerald B, Pichert James W, Webb Lynn E, Gabbe Steven G
Department of Medical Education and Administration, Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Acad Med. 2007 Nov;82(11):1040-8. doi: 10.1097/ACM.0b013e31815761ee.
Vanderbilt University School of Medicine (VUSM) employs several strategies for teaching professionalism. This article, however, reviews VUSM's alternative, complementary approach: identifying, measuring, and addressing unprofessional behaviors. The key to this alternative approach is a supportive infrastructure that includes VUSM leadership's commitment to addressing unprofessional/disruptive behaviors, a model to guide intervention, supportive institutional policies, surveillance tools for capturing patients' and staff members' allegations, review processes, multilevel training, and resources for addressing disruptive behavior.Our model for addressing disruptive behavior focuses on four graduated interventions: informal conversations for single incidents, nonpunitive "awareness" interventions when data reveal patterns, leader-developed action plans if patterns persist, and imposition of disciplinary processes if the plans fail. Every physician needs skills for conducting informal interventions with peers; therefore, these are taught throughout VUSM's curriculum. Physician leaders receive skills training for conducting higher-level interventions. No single strategy fits every situation, so we teach a balance beam approach to understanding and weighing the pros and cons of alternative intervention-related communications. Understanding common excuses, rationalizations, denials, and barriers to change prepares physicians to appropriately, consistently, and professionally address the real issues. Failing to address unprofessional behavior simply promotes more of it. Besides being the right thing to do, addressing unprofessional behavior can yield improved staff satisfaction and retention, enhanced reputation, professionals who model the curriculum as taught, improved patient safety and risk-management experience, and better, more productive work environments.
范德堡大学医学院（VUSM）采用了多种策略来教授职业素养。然而，本文回顾了VUSM另一种补充性的方法：识别、衡量并处理不专业行为。这种替代性方法的关键在于一个支持性的基础架构，其中包括VUSM领导层致力于处理不专业/破坏性行为、一个指导干预的模型、支持性的机构政策、用于收集患者和工作人员指控的监督工具、审查流程、多层次培训以及处理破坏性行为的资源。我们处理破坏性行为的模型侧重于四种递进式干预措施：针对单一事件的非正式谈话、当数据显示出模式时进行非惩罚性的“意识”干预、如果模式持续存在则由领导制定行动计划，以及如果计划失败则实施纪律处分程序。每位医生都需要具备与同行进行非正式干预的技能；因此，这些技能在VUSM的整个课程中都会教授。医生领导者会接受进行更高层次干预的技能培训。没有一种单一的策略适用于所有情况，所以我们教授一种平衡的方法来理解和权衡与替代性干预相关沟通的利弊。了解常见的借口、合理化解释、否认以及变革的障碍，能让医生做好准备，以恰当、一致且专业的方式处理实际问题。对不专业行为不加以处理只会助长更多此类行为。处理不专业行为不仅是正确的做法，还能带来更高的员工满意度和留用率、提升声誉、培养践行所学课程的专业人员、改善患者安全和风险管理体验，以及营造更好、更高效的工作环境。
