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AAMC 2014: How do you Shift Culture in a Difficult Circumstance?


What if you couldn’t discipline disruptive physician behavior toward medical students because they technically don't work for you? That’s what the University of Arizona Medical School is facing, as they deal with physician mentors not directly employed by the school.  Jennifer Allie talks about how they are dealing with this challenge without losing their input, and why the students are an integral part of the plan. 

Announcer: Broadcasting from the Algorithm's For Innovation Booth at the AAMC in Chicago. The Health Care Insider is on The Scope; University of Utah Health Sciences Radio.

Interviewer: Jennifer Allie is from The University of Arizona The College of Medicine in Phoenix. Let's talk about disruptive physician behavior. Is it an issue and what are you guys doing about it?

Allie: So we are in a distributive model where we probably have about 80% of our faculty are community-based faculty who are employed by other institutions. So when we're thinking about disruptive physician behavior and how we deal with professionalism for faculty we don't employ.

Interviewer: Yeah, because they are not your employees. You can't threaten them with firing them.

Allie: No, so how do you develop professional development for them? How do you start to shift the culture in institutions that you don't really exist within? Right?

Interviewer: It's hard enough to change the culture in your own organization.

Allie: Yes.

Interviewer: Let alone someone else's.

Allie: Yes, and you don't want to just tell them goodbye. These are valuable physicians. They are valuable educators and they are valuable partners to our medical education program.

Interviewer: So what are you doing? What's the solution to the problem?

Allie: Right now, we are working on trying to come up with ways to go out and do roadshows and embed professionalism as a value. Now for the medical students, they're getting it during their orientation. We're working on training the residents who are working with our medical students at these sites as well. And now trying to come up with professionalism modules that highlight professionalism in a positive manner, as a value that people can recognize as opposed to looking it as a punitive or disruptive. So we're trying to come up with some modules that look at it that way.

Interviewer: And when you say modules do you mean it's like online learning or what?

Allie: Yeah, because of our structure, it's really hard for us to have all 1100 faculty come up to The College of Medicine. We're located centrally downtown. And we have teaching hospitals spread across the metro Phoenix valley. So independent learning modules, we're working on a mobile app. We're looking at RHA similar type sessions where they're really quick 5-minute snip-its of what professionalism should look like and what it means.

Interviewer: Yeah.

Allie: So over the course of a couple years, we'll start to build. We're working with our professional resource office on StoryCorps approach. To getting stories of professionalism as modeled appropriately, as opposed to what it's not supposed to look like.

Interviewer: Now, do you think people will watch those, though?

Allie: We are hopeful and optimistic that if it's done correctly it'll be successful.

Interviewer: Because a lot of times it can be a challenge getting regular information out to people. Let alone something that is going to change behavior.

Allie: Yes, and if you actually do it in a way where they want to engage with it, it's emotional, you connect with them. They're going to be engaged and they are going to start to be reflective. I think we're all humanistic enough to see it in the right way, you can have those reflective moments. Sitting in the audience and watching House and all of those other vignettes come across, I think that we all had a humanistic moment where we think, "I've probably had a moment where I've acted inappropriately."

Interviewer: Yeah, and didn't even realize it. Your whole thing is that maybe the physicians don't realize, necessarily, what they're doing is wrong. But deep down, if they see, they will change.

Allie: We hope so. I'm hopeful that that's one way to start to move the needle and start to shift the culture.

Announcer: Sparking conversation to transform academic medicine. For more, stop by our booth at the AAMC or go to, University of Utah Health Sciences Radio

By: Scot Singpiel

Scot Singpiel is senior producer for