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 professionalism (July 2020)

Professionalism is the behavior by which we demonstrate that we are worthy of the trust bestowed upon us by the public, because we are working for the public good*. Professionalism is demonstrated by a series of behaviors and attitudes expected of FoMD members within their FoMD roles, that upholds the highest standards of ethical conduct, integrity, respect and accountability. These require social and communicative competence to integrate multiple competing priorities in complex and uncertain environments. This will define how we handle ourselves in different situations, such as teaching, learning, mentoring, research, clinical care, administration and community engagement.

*Swick HM. 2000. Towards a normative definition of medical professionalism. Acad. Med. 75:612-616.

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 Professionalism Values for FoMD Members applies to all.

  • Honesty, integrity & confidentiality
  • Respect & civility
  • Responsible behaviour
  • Excellence & inquiry

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"
    • When the situation is reviewed, it appears that the individual generally knows the social rules of the workplace and role expectations, they have the skills to enact the rules, and to behave within rule expectations. However, they appear to be choosing to break the rules, or feel that the rules do not apply to them, or that the workplace rules are wrong. They demonstrate unprofessional behaviours, are disruptive and/or mistreat others. The Subject of the concern generally does not have insight, remorse or regret.
    • The Subject is supported in remediation/coaching plans and/or disciplinary interventions.
    • If there are repeated "miscommunication/misunderstandings", "oops" or "can't" incidents, this is likely "won't professional behaviour," and may require further intervention and/or remediation or leader-developed action plan.
    • 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.
  5. Egregious professionalism behaviour
    • Where there is concern for serious potential impact to others (ie: colleagues, peers, learners, public, patients) with regards to safety, mistreatment, or harassment.
    • These are dealt with on a case-by-case basis.
    • Appropriate formal bodies are 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)

Note: Concerns around racism will be classified, dealt with and intervened with separately and differently, although it is recognized that events of unprofessional behaviours, mistreatment, harassment and discrimination can be centred around and include racism. For more information, please read the FoMD Commitment to Action Against Racism »

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 derived from the Vanderbilt Graduated Intervention (Hickson et al, Acad Med 2007) & Health Quality Council of Alberta Guidelines).

    1. Level 1: Informal, "Cup of Coffee" conversations for single, isolated incidents.
    2. Level 2: Non-punitive "awareness" interventions for apparent patterns of behaviour or incidents.
    3. Level 3: Remediation at the department or program level if the pattern persists. Remediation includes:
      • Action plans to mentor, complete tasks, meet goals, and for monitoring developed by the individual's supervisor
      • Guided professionalism/teaching remediation plans with a mentor/coach
      • May include removal from learners during the plan with monitoring
    4. Level 4: Investigation and disciplinary processes if the plans above have failed or there is immediate concern for harm to others. This will often involve a teaching suspension during the investigation. The Triage Committee has a duty to report possible egregious concern to our formal institutions for formal investigations and disciplinary sanctions. These institutions include:
      • University of Alberta
      • Alberta Health Services
      • College of Physicians and Surgeons of Alberta
      • Alberta Dental Association
      • College of Medical Laboratory Technologists of Alberta
      • Alberta College of Medical Diagnostic and Therapeutic Technologists
      • College of Registered Dental Hygienists of Alberta

In the instance of a potential egregious professionalism concern (see above for full definition), where there is concern for serious potential impact to others (i.e., colleagues, peers, learners, public, patients) with regards to safety, mistreatment, or harassment, these will be dealt with on a case-by-case basis. 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).

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.

Formal investigations through these institutions include:

  • 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.