Professional Renewal Center, Lawrence, Kansas.
Wales Behavioral Assessment, Lawrence, Kansas.
Ann Thorac Surg. 2020 Feb;109(2):317-324. doi: 10.1016/j.athoracsur.2019.07.036. Epub 2019 Aug 31.
The literature on unprofessional behavior is reviewed. It is well accepted that unprofessional behavior, including a lack of civility and respect, can have a negative impact on patient safety and quality of care.
We used a focused review in the context of 20 years of experience of assessing, treating, and remediating unprofessional behavior. The review highlights that unprofessional behavior can stem from a variety of sources, including health, psychological/psychiatric issues, social functioning or support, or a combination of these. The review covers the challenges in the work environment and the relationship between outcome, as experienced by the physician, and the likelihood the physician will repeat or modify his or her behavior.
Based on the evidence provided in the review and our clinical and research experience, we offer a new framework for the assessment, treatment, and remediation of physicians with professionalism transgressions: the Environmentally Valid Learning Approach. The approach is related to and expands on Miller's Pyramid by adding bio-psycho-social functioning and professional identity to the Pyramid. It emphasizes the dynamic and environmental characteristics of professional identity.
Effective intervention is possible. Consideration of contributory factors, addressing/treating those factors, teaching/remediating skill deficiencies, and determining elements that need to be in place to foster implementation and maintenance of the developing skills are necessary components for successful resolution. The behavior is fully remediated when a self-sustaining alternative to the unprofessional behavior is established and the desired behavior becomes a permanent part of the physician's behavioral repertoire.
对不专业行为的文献进行了回顾。人们普遍认为，不专业行为，包括缺乏礼貌和尊重，会对患者安全和护理质量产生负面影响。
我们在评估、治疗和纠正不专业行为的 20 年经验的背景下进行了重点回顾。该综述强调，不专业行为可能源于多种来源，包括健康、心理/精神问题、社会功能或支持，或这些因素的组合。该综述涵盖了工作环境中的挑战以及医生体验到的结果之间的关系，以及医生重复或改变其行为的可能性。
基于综述中提供的证据和我们的临床和研究经验，我们提出了一个新的框架，用于评估、治疗和纠正有专业操守问题的医生：环境有效学习方法。该方法与米勒金字塔相关，并通过向金字塔中添加生物心理社会功能和专业身份来扩展它。它强调了专业身份的动态和环境特征。
有效的干预是可能的。考虑促成因素，解决/治疗这些因素，教授/纠正技能缺陷，并确定需要哪些要素来培养和维持发展中的技能，这些都是成功解决问题的必要组成部分。当建立起一种能够替代不专业行为的可持续行为，并且期望的行为成为医生行为模式的永久组成部分时，行为就得到了完全纠正。
