Professionalism, PIP, & Early-Career Physicians

Interview with LAS Founder, Loren Deutsch, LCSW, MA, MEd 

There has been a gradual increase in referrals for professionalism and other core competencies from GME departments and self-referred individuals. The scenario below was posted on Reddit in 2024. It illustrates a familiar performance improvement plan for a second-year resident.

Professional Improvement Plan (PIP) from Reddit, 2024

What do you typically ask a new client (Resident) during the initial meeting?

“The first question we ask new clients is, ‘How are you doing?’ and then, ‘What brings you in?’ As one of our Residents explained, being cited for Professionalism felt like ‘a gut punch’ and as the subreddit indicates, it’s ‘a wakeup call.’ 

“To better understand what we’re seeing at LAS, it’s important to understand the problem from their perspective. When a Resident or Fellow is referred for coaching, I often ask whether there are any departmental factors, including ‘Have you been placed on a Professional Improvement Plan (PIP) or Remediation Plan?’ If so, I ask to review the paperwork and frame some of the next questions around Milestones and core competencies associated with professionalism. I want to understand which ACGME Milestones and Competencies are implicated.”

“Depending on the responses to these questions, some of the information becomes part of a shared spreadsheet with the client. This allows the two of us to clarify their understanding of the Milestones or Competencies and to begin designing incremental goals that respond to the PIP. These goals become part of an ongoing discussion and form a foundation for daily and weekly workflow. With written consent from the client, we may schedule periodic meetings among the Resident, their Mentor, the Program Director, and me.”

How would you define Professionalism in medicine or medical education?

“I think Professionalism speaks to patient safety, quality of healthcare, interactions with the patient and family, and the communication or direct involvement with other healthcare and administrative professionals in the work setting (e.g., hospital, clinic, or private office). The Accreditation Council for Graduate Medical Education (ACGME) requires early-career physicians to develop Professionalism skills, including communication, documentation, patient safety, evidence-based medical skills, and coordinated work in graduate medical education. Professionalism is one of six core competencies required in medical training.”

What are some of the main reasons that you see for creating a performance plan?

“Lately, I am seeing PIPs that emphasize professionalism, with concerns associated with patient safety and quality patient care. These factors are related to medical knowledge, medical skills, interpersonal communication, documentation, and inquiry, among other variables. When a Resident progresses through training, their responsibilities increase, and inherent to that, Residents are expected to perform them safely, accurately, and at an independent level. Despite many protective layers in training programs, designed to ensure safety and quality healthcare, PIPs seem concerned with whether a Resident can advance given a program’s support framework and timeframe.”

What are some factors that negatively impact Professionalism in training programs?

“There are many factors that impact professionalism in training programs, positively, negatively, and sometimes both. That’s an oversimplification. Some of the most prevalent include high acuity rates, competing demands for time, vague or unclear feedback, burnout, and mental health concerns, among others. However, it appears that internal communication is a common thread. I think these factors create opportunities to design and communicate protocols for training, feedback, and follow-up. Again, this is an oversimplification.”

How do PIPs get resolved? What are the next steps?

“After the initial consultation with the Resident (like an “H + P” without the “P”), we design and co-create an individual plan with measurable goals and a shared spreadsheet for daily and weekly workflow. The spreadsheet contains actionable steps, self-reflective processes, and progress tracking. These resources are shared with the Resident and are a key component of weekly, online coaching sessions and success outcomes. With the Resident’s consent, I also recommend meeting as a group (Resident, Program Director, Coordinator, Mentor, and me) to verify and set expectations, including the timeline. My goal is to engage all stakeholders, support the Resident, and discuss how to realistically implement the actionable steps needed to address the PIP so the Resident fulfills the requirements. This last step is critical”.

What general advice do you have for Residents with a PIP?

“It’s important to recognize the seriousness of a PIP. It is a legal document and has implications for professional development and a medical career. I also encourage Residents to organize all written feedback from their program as it pertains to a PIP and confirm all deadlines and topics detailed in the PIP document. I recommend contacting a mentor within the department to schedule regular meetings (weekly, bi-weekly, etc.) that can be used for feedback, practice, progress checking, etc., and select an outside coach to develop the actionable steps needed to fulfill the PIP and provide structure, support, and accountability.”

Professionalism, ACGME Milestones, and LAS Medical Coaching

Professionalism: National Report Findings 2016

ACGME Milestones by Specialty

ACGME Common Program Requirements

LAS Consulting Services and LAS Medical Coaching

Leadership: A Fundamental Yet Undervalued Skill in Healthcare, HMS

Questions? Call: 847-446-5822 or Email: Contactus@lorenacademic.com. We’re happy to talk with you and answer your questions.