As a first year medical student I wrote in my portfolio that I believe the core values of professionalism are: always striving to do one’s best, always being accountable for one’s actions, and lastly, always being honest with one’s abilities, strengths, weaknesses, and mistakes. I elaborated everyone will make mistakes, but by being accountable for one’s actions and being honest about shortcomings, people can more easily move on from mistakes and difficulties. I also noted that people may have different values they find more important based on their life experiences, expectations of others, and personalities. Hence, the idea of professionalism may be different based on people’s own value systems. I indicated that professionalism is critical in health care. I recognized that as health care providers we must be altruistic, respectful, and empathetic to our patients. I wrote that professionalism does not stop there. We must be honest with our shortcomings and mistakes. We must go from patient room to patient room giving each patient the same level of professionalism we gave the last, even at the end of a 14 hour shift.
As I look back at my definition of professionalism I had three and a half years ago, I find that I agree with my initial definition. I was surprised that I had written that as what I thought professionalism. That is because I think when most people think of professionalism they think of being on time, being honest, communicating effectively, and working hard. But even before medical school, I knew professionalism was so much more than that. My experiences throughout medical school have expanded on my M1 definition. I have been put in situations that tested what I think professionalism, and I have learned a lot along the way.
Prior to medical school, I took two gap years where I did bench research and worked as a medical scribe in an Urgent Care, ED, and Family Practice. I was promoted to chief scribe during this time and was responsible for hiring/firing as well as managing a group of 20 scribes. I had a lot of growth in terms of professionalism during that time. Throughout my time as scribe, I had an inner mantra that it was my job to provide the best documentation I could to assist the providers so they could give optimal care. I had to rise above distractions. However, I did not always do this. I remember several times where I would spend time talking with ancillary staff, when I could have been perfecting my notes. When I was promoted to chief scribe, I realized that I needed to lead by doing. How could I have a talk with a scribe about professional behavior when I wasn’t always professional? I shared my mantra with my fellow scribes and we met monthly to discuss obstacles to doing our best work. I believe my experiences working prior to medical school helped me have a leg up in professionalism once I started medical school.
During the first two years of medical school I focused less on professionalism, and more on acquiring medical knowledge. The first two years I worked on professionalism by following the OSUCOM honor code, being present and productive during LG/LP, and working hard at my studies.
There were three events that occurred during my third year rotations that encouraged me to grow professionally. Third year I found more emotionally difficult than the first two years of medical school because I worked with people from completely different backgrounds with completely different personalities. I had to learn how to navigate through all of that, while maintaining professionalism.
In one instance, I had to put my feelings aside to maintain professionalism. The intern I worked with had a very different personality than I. While I am blunt and say what I mean, he often said vague things to see if I could do what he wanted me to do without prompt. He also was under immense pressure on a difficult rotation while being sleep deprived. One day we had several patients with bad outcomes. He had gotten yelled at by the attending (I did not know this). I had been sitting around for an hour waiting for direction. I had attempted to update the handoffs and checked in on my patients. There were no more cases left to go to. When the intern came in I asked what I could do to help on the floor. He became very frustrated and raised in voice at me for about 20 minutes. He talked about how he thinks medical students in the US are coddled and we don’t do enough work (he went to medical school in another country). He said I was not doing all he thought I should do. He was frustrated that I needed direction. This was really hard for me to hear, especially since it was my second rotation of third year. And I did not think he was acting in a professional manner. But instead of getting defensive I tried to see if there was some truth to what he was saying. I decided that I needed to remain professional and not take things so personally. I told him if he did like my performance, I would love to have a conversation about it so I can do better. I asked him to not raise his voice at me. He instantly calmed down and we had a productive conversation. I explained to him that since it was the beginning of my third year, I had so much to learn. I explained that I want to help as much as a I can but he needs to be clear with expectations. If he showed me how to do something once, I could then do that task from now on.
That conversation was difficult for me. I went home in a bad mood and struggled to sleep that night. But I knew I had to be professional and when I went in the next morning, I maintained positive. I did the tasks he had asked me to do, and he later came up to me and said he was really proud of me. Sure, he was not professional the day before, but I was not going to hold that against him. We all lose our tempers sometimes and it is so easy to take our frustrations out on others.
I had another experience with a resident that questioned my own professionalism. On labor and delivery we had a patient who had a bad outcome with one of her twins. She had to have a STAT C-section. Because she already had an epidural placed, she was not placed under general anesthesia. In the chaos of preparing for the STAT, the patient was crying and was asking what was going on. Everyone was so busy preparing, no one was answering her. I had no role in preparing for the STAT so I went to the patient’s side. I explained they were doing a C-section to get Baby B out as quickly as they could. She asked what they were currently doing to her and I explained they were putting a catheter in her bladder. I held her hand throughout the procedure. When Baby B came out, she was not doing well and was rushed to the NICU. The father of the baby went with her. The patient just lay there crying. I continued to hold her hand and rub her head. The nurse brought Baby A over. I held baby A next to the mother so she could cuddle her. We talked about how Baby A looked just like her and how beautiful she was.
After the section, the senior resident called me out in the work room and said it was unprofessional to talk to patients during a bad outcome and that I could get in a lot of trouble as a medical student for doing that. I was shocked! I thought I was doing the right thing! I asked what I had said that was unprofessional and she said it didn’t matter what I said but that I should not talk to patients during a bad outcome. The rest of the night I was not invited to and deliveries by this resident. I felt awful. I felt like I had done something wrong to a patient, which was never my intention.
A few hours later, the intern came up to me. He said he disagreed with the resident and felt I did the right thing. I was comforting the patient without giving any false hope or saying incorrect things. I was thoroughly confused. I still do not know if I was in the right or the wrong. But what the experience made me do was to re-evaluate how I viewed professionalism. I realized that different people had different definitions of it, but the best interest should always be for the patient. Since that experience, when I am involved with a situation that is a less than ideal outcome, I ask myself if me interacting with the patient is harmful or good. I evaluate my own skill-level with dealing with this types of situations since this incident. Into my fourth year, I continue to learn I hope as I spend more time with patients, I learn the fine line between comforting and inappropriate interference. I think it is important to ask myself if I am reacting to my own emotions rather than the patient’s emotions? Am I trying to help the patient the way he/she/they want to be helped, or am I helping the way I would want to be helped? I know I will continue to work on this delicate balance throughout residency and into my career.
The third encounter I found formative professionally during third year occurred during my pediatrics rotation. I was on a rotation with a student who was known to be “difficult” to work with. Many other students had discussed it, but I had never experienced it. When I realized I was going to be on a rotation with this student, I decided to go into it with an open mind. Often time when a person is labeled as “difficult,” he/she is misunderstood. I was not going to judge until I gave the student a chance.
However, as the rotation went on, this particular student became harder and harder to work with. They refused to share patients, interrupted presentations, was inappropriate with the residents and patients. At one point she yelled at myself and the other medical students on the service for something she did not think was fair in front of the entire team (attending and fellow included). I was so shocked and angered by this. All I wanted to do was yell back! I tried to talk reasonably with this student, but it was not well-received. I an the end, I decided to let it go. I was kind to this student and continued to be professional with him/her throughout the day. I was also very surprised the residents and attending did not intervene. After having the weekend to cool off, I approached this student and explained that while her feelings may have been valid, she could not speak to fellow students like that. It makes the entire team look bad when we are disrespectful to each other. This student did not appreciate what I said, but I felt like I needed to say it because it is up to everyone to keep the team running smoothly. Everyone has different opinions, views, and feelings; but, at the end of the day we all have to work together to deliver good patient care. If someone is impeding that, it needs to be addressed, even if it is very uncomfortable.
Learning these skills of dealing with “difficult” people is good to do because we will all work with different people. If I was doing something that others felt was unprofessional, I would hope they would tactfully bring it to my attention as well. A lot of times people do not realize what they are doing is perceived as unprofessional by others.
In my fourth year I worked with 4 different interns during my Mini-I. They could not have been more different in terms of their expectations and communication style. The same went for the two attendings I worked with on that rotation. With my prior experience during third year of working with so many interns, residents, fellows, and attendings, I was able to learn people’s expectations and styles. I catered my presentations and style to each person to keep the team running smoothly. I learned from each person what I think works and doesn’t work well on a team, and I will apply this to teams I work with as a leader in the future.
Prior to medical school, my most formative experiences as a scribe were when I had empathy and compassion for my patients. In order to have compassion for people, you must also respect them. I took this and expanded on it during my third year. Taking the time to connect with my patients was easier as a third year because I had more time with them. This will be difficult to carry into residency as I will have larger patient loads (that will continue to increase). I plan to work on this by creating relationships with my patients. I try to find some common ground, use humor, or relate with family members to create a fast yet strong relationship with my patients. I want my patients to know that as their provider, I care what happens to them, and I want what is best for my patients.
Excerpt from my Gen Med 7 Evaluation. An example of how I use compassion to always put my patients first.