Classification of Professionalism Concerns and Levels of Intervention

In general, members of the University of Alberta’s Faculty of Medicine & Dentistry (FoMD) are highly professional, rarely experiencing professional lapse. If lapses occur, these are mostly misunderstandings / miscommunication events or “oops” lapses due to stresses and tensions.

Please see J. Bolton’s What is Professionalism? for more information.

Our working definition of professional (March 2017)

  • Professionalism is the series of demonstrated behaviours and attitudes of FoMD members within their FoMD roles; the maintenance of composure amidst tensions arising from various components of their roles:

  • hospital work, teaching & learning, administrative, clinical care delivery, research, community, societal and personal

Professionalism ground rules and code of conduct

Many codes of conduct are followed by various areas and members within FoMD. There is much overlap between these various codes of conduct. The only code of conduct common to all FoMD members is the FoMD Code of Conduct (PDF) last updated in 2013:

  • Honest

  • Confidentiality

  • Respect for Others

  • Responsible Behaviour

  • Excellence

Classification of professionalism concerns

The FoMD’s Office of Professionalism has set a classification of professionalism concerns, modified with permission from J. Bolton, Office of Professionalism, University of Mexico.

1. Misunderstanding/miscommunication

  • When the incident is reviewed, a misunderstanding and/or miscommunication on the part of the person who filed the professionalism concern is likely

  • insight is demonstrated by the person named in report.

2. “Oops”

  • The individual knows the rules, and does generally follow them. On a rare occasion, he or she has a lapse and does not meet role expectations.

  • Insight is demonstrated, the person recognizes their error and professionalism perceived lapse or perceived interpretation of their demonstrated behaviour, and is remorseful.

3. “Can’t”         

  • The individual can’t fill role expectations because he or she does not know the rules of the role, or may not have the skills to enact them.

  • There may or may not be insight

  • The person is new to the culture, or does not understand the rules of the workplace. Therefore, the filed concern may be due to the person’s lack of knowledge of workplace rules

4. “Won’t”

  • The individual knows the rules of the role, and has the skills to enact them, but he or she chooses not to act according to those expectations

  • There is lack of regret, insight or remorse

  • The person named in the report holds the perspective that rules of the workplace don’t apply to him or her, or that the workplace rules are “wrong”

  • This may be indicative of “disruptive behaviour” in the workplace

If there are repeated “miscommunication/misunderstandings”, “oops” or “can’t” incidents, this may be indicative of underlying professionalism difficulties and/or wellness difficulties (“won’t professional behaviour,”) and may require further intervention and/or remediation or leader-developed action plan.

Levels of professionalism intervention

The FoMD’s Office of Professionalism has standardized an approach to professionalism interventions, allowing for professionalism lapses while still identifying problematic professionalism behaviours. These standards are modified from the Health Quality Council of Alberta.

i. Informal Conversations - for single incidents (“cup of coffee” conversations)

ii. Awareness/Pattern Interventions - patterns of incidents/behavior

iii. Professionalism Action Plans - if patterns persist, remediation or action plan of mentoring, tasks, goals, monitoring (undergraduate, postgraduate, department, program level)

iv. Imposition of Disciplinary Processes - failure of plans; formal investigations and actions:  University of Alberta Faculty Agreement; University of Alberta Discrimination, Harassment and Duty to Accommodate Policy; College of Physicians & Surgeons of Alberta (CPSA) Health Professions Act, Province of Alberta; Alberta Health Services Policy: Workplace Violence: Prevention and Response Policy; Medical Laboratory Technologists of Alberta, Complaints and Discipline; College of Registered Dental Hygienists of Alberta; Alberta College of Medical Diagnostic and Therapeutic Technologists; and Alberta Dentistry College (ADC), Health Professions Act.

In the instance of a potential egregious professionalism concern, where there is concern for serious potential impact to others (ie: colleagues, peers, learners, public, patients) with regards to safety, mistreatment, or harassment, these will be dealt with on a case-by-case basis. Appropriate formal bodies will be consulted, preserving confidentiality. Intervention will be guided by consultations with the appropriate formal bodies, with accelerated levels of intervention as appropriate.

This may include but is not restricted to:

  • Harassment (sexual, racial)

  • Discrimination

  • “Won’t” professionalism behaviour as per above classification with failure of remediation/leader-developed action plans

  • Level 3 or 4 disruptive behaviour (Health Quality Council of Alberta).