Professional Development: Part 1--Professional Behaviors

   It is 3:17 a.m. You've finally made it back to the station after seven consecutive runs. The last three dispatches were for a "cut finger," a "sick person" and a "fall." Not one of the last three people you took to the hospital was really very sick or significantly injured. To top it off, the ED staff was none too pleased to see you again and again and again.

   You tried to eat your dinner, reheated for the third time, but it seemed nasty. Disgusted, you tossed it in the trash, plate and all. Now you're lying in your bunk finally beginning to relax. As you start to drift off into sleep, the tones come over the PA, and your pager beeps. What's the first thing that goes through your mind?

   Have you had nights like that? I have, and I remember what I thought and sometimes said out loud. You couldn't print it here, but if you've had similar experiences, you can pretty accurately imagine how I felt and the words I used. It wasn't right, but it did express the way I felt at that moment.

   When you arrive on scene, you're met at the door by a woman in pajamas and a robe who looks 60ish. She is very upset. She says, "Please, my Roscoe is really sick, and I think he's gonna die!" When you get in the house, you find Roscoe is a 15-year-old canine of indeterminate breed. How do you respond?

   Unfortunately, it might go something like this: "Why did you call us out here for this? Someone might be having a heart attack and need us, and we'd be here with your mutt! Hon, we don't take care of dogs. Don't call 9-1-1 again for this situation--this is not an emergency!"

   EMS practitioners face challenges of this nature on a regular basis. How should we respond to this sort of call for help? It is true, we are not trained to take care of dogs, but there are other, better ways to react than the way described above. It's up to you to choose how you will respond.

   They never told me in paramedic school that the job would sometimes be like this. However, it is, and likely always will be. I was lucky--I had been responding as a volunteer EMT-B for more than a year before going to paramedic school, so I had a good idea of what I was getting into. These days I meet paramedic students who have never run in ambulances as basic providers before going to on to become paramedics. I think they may really believe they're only going to respond to life-threatening medical emergencies or major trauma calls. That's just not the way things are.

EMS Stands for Service

   EMS is really all about service. What we provide is a service--we respond to calls for help. Sometimes it will be a code, sometimes a major car wreck, but more often than not it will be more like the call to help Roscoe. The important thing for the patient and for us is how we respond to incidents of this nature. What should we do when faced with a situation like the call to help Roscoe? We might not have learned about this sort of situation or practiced how to deal with it in school. Where can we turn? What can we do to help us choose the best response?

   I think we could use some specific guidance. People like you and me, who have chosen to serve in EMS, have a moral and ethical obligation to behave in ways that serve the needs of others and reflect positively upon ourselves, our organizations and the whole discipline of EMS. This is not easy. In fact, it's a constant struggle that takes significant time, concentration and effort. The choices we make and the manner in which we behave are a constant reflection of our professionalism.

   In this year's Professional Development series, I plan to examine professionalism through professional behaviors as they apply to EMS practitioners--what they are, why it's important to understand them--and discuss methodologies we can use to evaluate performance in these behaviors. I will draw upon discussions concerning professionalism in medicine and healthcare, distill the information, theories and ideas, then adapt them to our discipline.

Defining Professionalism

   What is professionalism? Some general definitions will help us understand. Here is the first definition presented in the online American Heritage Dictionary entry for professionalism:

   1. Professional status, methods, character or standards.¹

   Here is the first definition the online Merriam-Webster dictionary provides:

   1. The conduct, aims or qualities that characterize or mark a profession or a professional person.²

   These definitions help us begin to understand professionalism in the context of professional behavior. The definition at www.businessdictionary.com sheds more light: Meticulous adherence to undeviating courtesy, honesty and responsibility in one's dealings with customers and associates, plus a level of excellence that goes over and above the commercial considerations and legal requirements.³

   These give us a starting point, but we need more information specific to our practice. What are our professional behaviors? What behaviors constitute professionalism in medicine and particularly in EMS?

   To answer this question I'll turn to two documents: Dr. Herbert M. Swick's 2000 article "Toward a Normative Definition of Medical Professionalism," and the "professional behavior evaluation" included in the 1998 EMT-P National Standard Curriculum. These two documents will provide the foundation framework for the series.

   Swick says medical professionalism is composed of certain behaviors. Medical professionals:

• Subordinate personal interests to the interests of others;
• Adhere to high ethical and moral standards;
• Respond to societies' needs, reflecting a social contract with the communities served;
• Demonstrate core humanistic values: honesty, integrity, caring, compassion, altruism, empathy, respect for others and trustworthiness;
• Exercise accountability for themselves and for colleagues;
• Demonstrate a continuing commitment to excellence;
• Exhibit a commitment to scholarship and advancing their field;
• Deal with high levels of complexity and uncertainty;
• Reflect upon actions and decisions.⁴

   NHTSA's Paramedic National Standard Curriculum lists the following professional behaviors:

• Integrity
• Empathy
• Self-motivation
• Appearance and personal hygiene
• Self-confidence
• Communications
• Time management
• Teamwork and diplomacy
• Respect
• Patient advocacy
• Careful delivery of service.⁵

   We will be discussing these behaviors, the performance of skills that mainly reside in the affective domain of learning, and performance related to emotion, motivation and attitude. These aspects of EMS practice are critically important. However, they are difficult to teach and measure. Because of these difficulties, affective domain performance is hard to assess and evaluate. As a consequence, the behavioral components of our practice receive much less attention than do knowledge and skills.

   In my experience, patients and families who complain about EMS practitioners most often complain about attitude. Even though most people really know little about medicine and even less about EMS, every person knows when they are dealing with an EMS practitioner who is rude, inconsiderate, apathetic or distracted. Complaints can arise from a practitioner's posture, tone of voice or facial expression. There is little or nothing in the NHTSA EMT-B or EMT-P curricula that addresses these aspects of our practice.

   We need to correct this. We need to spend more time and effort making certain we are competent in the domain of attitude, as well as the domains of knowledge and skills.

   Some of you may be asking, "Why?" Others may be asking, "How?" Over the next year I hope to help answer those questions. Each month we will examine one of Swick's professional behaviors, define it, assess its importance to EMS practice, link it to the behaviors of the EMT-P NSC and other sources, then discuss how we may be able to practice, teach and evaluate the behavior.

   Next month we will examine Swick's first professional behavior: the subordination of personal interests to the interests of others.

References

1. American Heritage Dictionary of the English Language, 4th ed. https://dictionary.reference.com/browse/professionalism.

2. Merriam-Webster Online Dictionary. www.merriam-webster.com/dictionary/professionalism.

3. BusinessDictionary.com. www.businessdictionary.com/definition/professionalism.html.

4. Swick H. Toward a normative definition of medical professionalism. Acad Med 75(6): 612–616, June 2000.

5. NHTSA. Emergency Medical Technician-Paramedic National Standard Curriculum. www.nhtsa.dot.gov/people/injury/ems/EMT-P/index.html.

Professionalism Resources

• NAEMT Position Statement on Professionalism of EMS Workers: www.naemt.org/Libraries/NAEMT%20Documents/EMS%20Professionalism.sflb
• Peer Evaluation of the Professional Behaviors of Emergency Medical Technicians: Brown WE, Jr., Margolis G, Levine R. Preh Dis Med 20(2): 107-14, Mar-Apr 2005.
• What's Your Level of Professionalism?: Paris DA, EMSResponder.com, www.emsresponder.com/article/article.jsp?id=1980&siteSection=7
• National Board of Medical Examiners Assessment of Professional Behaviors: https://professionalbehaviors.nbme.org
• Michigan State University College of Human Medicine Professional Behavior Expectations: https://mdadmissions.msu.edu/main/probehavior.htm

Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. He has participated in EMS leadership, management and educational development initiatives at the local, state and national levels. Contact him at m-touch@comcast.net.