ROLE MODELLING:ROLE MODELLING:Making the Implicit ExplicitMaking the Implicit Explicit

Caroline Storr, Liliane Asseraf-Pasin, Andrea Moreault

We would like to acknowledge the Faculty Development Office: Dr. Richard Cruess & Dr. Sylvia Cruess

Reflection

• What is the most What is the most significant experience significant experience you have encountered you have encountered within your professional within your professional training and/or career training and/or career development?development?

““Individuals admired for theirIndividuals admired for their ways of being and acting as ways of being and acting as

professionals”professionals”CCôôttéé & Lecl & Leclèère: Academic Medicine, 2000re: Academic Medicine, 2000

WHO ARE ROLE MODELS?

• Role Modelling is at the heart of character formation• Knowledge and skills are essential, but putting them together in a competent and caring response to patients’ needs is learned in personal interaction and Role Modelling

Kenny, N. Academic Medicine 2003

Role Modelling• “Un modèle de rôle en médecine est un médecin qui,

dans le contexte de son exercice professionnel, influence l’apprentissage des externes et des résidents avec qui il est en contact.”

(Chamberland & Hivon, 2005)

• “The process whereby faculty members exhibit knowledge, attitudes, and skills, demonstrate and articulate expert thought processes, and manifest positive professional behaviours and characteristics”

(After Irby, J Med Ed, 1986)

Pedagogical modalities specific to clinical education

Clinical Teacher

Patient

Student

Supervision Role modelling

Chamberland & Hivon, 2005

• “Excellent role models will always inspire, teach by example, and excite admiration and emulation.”

PAICE, E. BMJ 2002

• “being a role model is what happens when you are busy doing other things”

John Lennon

ACTION!!!

What are some of the differences between a

Role Model and a Mentor?

• Mentorship differs from role modelling in that the mentor is actively engaged in an explicit two-way relationship with a junior colleague-a relationship that evolves and develops over time and can be terminated by either party

• A good mentor is a coach asking questions more often than giving answers

• Mentors have an active role in guiding their junior colleagues

PAICE, E. BMJ 2002

MENTORING

WHY DO ROLE MODELS MATTER?

Major Influence in the Creation of a Health Professional

– Part of the formal & informal curriculum (influenced by the hidden curriculum)– Can affect career choice– Significant influence on peers

Negative role modeling is common and can be destructive

WHY DO ROLE MODELS MATTER?

RESIDENTS: Less than 50% of teaching physicians are good role models

(Wright et al: NEJM, 1998)

Role ModelsRole Models• Are often unaware of what they are demonstratingAre often unaware of what they are demonstrating

• Model: Model: A BROAD RANGE OF ATTRIBUTESA BROAD RANGE OF ATTRIBUTES - expertise/clinical skills- expertise/clinical skills - humanism/self awareness, empathy, - humanism/self awareness, empathy,

respect respect - communication/patient & student- communication/patient & student - personal qualities/lifestyle- personal qualities/lifestyle - collaborative practice- collaborative practice - advocacy- advocacy

CompetenceCompetenceCommitmentCommitment

ConfidentialityConfidentialityAltruismAltruism

TrustworthyTrustworthy

Integrity / HonestyIntegrity / Honesty

Codes of ethicsCodes of ethicsMorality / Ethical Morality / Ethical

BehaviorBehaviorResponsibility to Responsibility to

professionprofession

Autonomy Autonomy

Self-regulationSelf-regulation

AssociationsAssociations

InstitutionsInstitutions

Responsibility Responsibility to societyto society

Team workTeam work

Caring/compassionCaring/compassion

InsightInsight

Openness/Openness/

transparencytransparencyRespect for the Respect for the healing functionhealing functionRespect patientRespect patientdignity/autonomydignity/autonomy

Presence/AccompanyPresence/Accompany

What Makes a What Makes a GoodGood Role Model? Role Model?• CompetenceCompetence• TIME: total hours & % of time spent teachingTIME: total hours & % of time spent teaching• Being aware of being a role modelBeing aware of being a role model• Being explicit about what is being modeled and Being explicit about what is being modeled and

whywhy• Communicating enthusiasmCommunicating enthusiasm• (Generalist vs specialist)(Generalist vs specialist)

Wright et al: NEJM,1998Wright et al: NEJM,1998CCôôttéé & Lecl & Leclèère: Acad Med, re: Acad Med,

20002000

What Makes a What Makes a GoodGood Role Model? Role Model?• Demonstrating sensitivity to student’s needsDemonstrating sensitivity to student’s needs• Being aware of power differenceBeing aware of power difference• Giving feedbackGiving feedback• Stressing importance of patient relationshipStressing importance of patient relationship• Stressing psychosocial aspects of medicineStressing psychosocial aspects of medicine• Reflecting and encouraging reflection in studentsReflecting and encouraging reflection in students• Institutional supportInstitutional support

Wright et al: NEJM,1998Wright et al: NEJM,1998 CCôôttéé & Lecl & Leclèère: Acad Med, 2000re: Acad Med, 2000

What Makes a What Makes a PoorPoor Role Model? Role Model?

• DisrespectDisrespect- - patients/students/team memberspatients/students/team members

• InsensitivityInsensitivity- - patients/students/team patients/students/team membersmembers

• Professional dissatisfactionProfessional dissatisfaction

• Lack of collegialityLack of collegiality

• Culture accepting of poor relationshipsCulture accepting of poor relationships• Lack of institutional supportLack of institutional support

Barriers to Barriers to GoodGood Role Modeling Role Modeling

• Time/overworkTime/overwork• ImpatienceImpatience• Overly opinionatedOverly opinionated• Hostile attitudeHostile attitude

• Lack of enthusiasmLack of enthusiasm• Poor interpersonal Poor interpersonal

skillsskills• Impersonal approachImpersonal approach• Too reserved/quietToo reserved/quiet

NO ONE IS A GOOD ROLE MODELNO ONE IS A GOOD ROLE MODELALL OF THE TIMEALL OF THE TIME

HEALTH PROFESSIONALS HEALTH PROFESSIONALS CAN IMPROVE CAN IMPROVE

AS ROLE MODELSAS ROLE MODELS

Behaviors Can ChangeBehaviors Can Change Skeff: NEJM,1998Skeff: NEJM,1998

ReflectiveRole modeling

Threshold Level

BARRIERSinstitutionalPersonal

Qualities

Teaching Skills

High Order

Clinical

Skills

Excellent Clinical Skills

After Wright et al: CMAJ, 2002After Wright et al: CMAJ, 2002

CONCEPTUAL MODEL

BARRIERSpersonal

1. Apprenticeship model• Learning through participation in an

environment, where « ways of being » are modeled.

• Allows one to observe:– How knowledge and skills are applied to real

situations, unique to the profession. – How behaviours and knowledge (as well as the

consequences of these) are used in context.

2. Situated learning• Learning that occurs in the context of

practice, including knowledge, skills, and social norms.

• Professionals learn from participating in, and gradually being absorbed into, communities of practice.

• “Learn to talk from talk”• The process becomes an integral and

inseparable aspect of social practice.

3. Observational Learning (Bandura)

• Learning occurs in an environment of constant, dynamic, reciprocal interaction among people, their behaviour and the environment.

• Students learn behaviours and ways of being that look successful to them in light of their own goals and experience and the rewards they see present in the environment.

4. Reflective practice (Schön)

• The process of intentionally turning thoughtful practice into a potential learning experience.

• Reflection helps the model to make explicit the moral and other judgmental standards by which they guide and judge their behaviour.

4. Reflective practice (Schön) Reflection and Role Modeling Reflection and Role Modeling

• Reflection Reflection ININ Action Action: while performing an : while performing an act/role, explain what is being doneact/role, explain what is being done

• Reflection Reflection ONON Action Action: after Performing the : after Performing the act/role, reflect with the student(s) on the act/role, reflect with the student(s) on the impact of the action on the patient, student, impact of the action on the patient, student, and selfand self

• Reflection Reflection FORFOR Action Action: discuss what has been : discuss what has been learned for the futurelearned for the future

Lachman & Pawlina: Clin Anat, 2006Lachman & Pawlina: Clin Anat, 2006

5. Ethics Education

• The systematic reflection about what we do, believe, and value can contribute powerfully to understanding how we frame and resolve medical ethical dilemmas and how, in reality, professional character is formed.

TAKE HOME MESSAGETAKE HOME MESSAGE• Attention - to the patientAttention - to the patient - to the student- to the student• Retention - use Socratic methods to involve Retention - use Socratic methods to involve

the student and promote retentionthe student and promote retention• Production - getting the student to use Production - getting the student to use

knowledge in order to embed itknowledge in order to embed it• Motivation - make the event enjoyableMotivation - make the event enjoyable (Bandura: 1986(Bandura: 1986))

ALL TEACHERS ARE ALL TEACHERS ARE ALWAYSALWAYS ROLE ROLE MODELS FOR STUDENTS,MODELS FOR STUDENTS,

GOOD, BAD, or INDIFFERENTGOOD, BAD, or INDIFFERENT

ALTHOUGH WE CAN’T ALWAYS BE ALTHOUGH WE CAN’T ALWAYS BE “PERFECT”“PERFECT”

THE GOAL IS TO BE CONSISTENTLY GOODTHE GOAL IS TO BE CONSISTENTLY GOOD