Professionalism is a core value and expectation of all Duke School of Medicine faculty. As a community, each of us affirms and animates this value through our daily interactions with each other, our learners, our team members, our trainees, our patients, and the public. While professional behavior is the overwhelming norm, academic medicine is a highly complex, high-stakes work environment in which episodes that test the boundaries of professionalism can occur. As a community of faculty, it is necessary to have mechanisms to manage concerns about unprofessional behavior in a manner that is fair, balanced and respectful. This document addresses this need by providing a statement of values regarding professional behavior. It also outlines procedures for reporting concerns, and provides resources for discussing concerns.
All School of Medicine faculty are expected to uphold the highest standards for professional conduct and ethical behavior. Faculty are expected to treat everyone in the work environment with courtesy, respect, and dignity. Faculty are responsible for modeling professional conduct, for cultivating a respectful and inclusive work environment, and for responding to unprofessional behavior on the part of others. All faculty are expected to adhere to applicable Duke University and Duke University Health System policies and procedures.
Unprofessional behavior includes that which is intimidating, threatening, violent, inappropriate, illegal, dishonest or in violation of departmental, University or Health System standards or policy. To foster a just and safe community, unprofessional behavior will be addressed, with interventions aimed at promoting insight, accountability, and appropriate changes in behavior. Unprofessional behavior may result in sanctions, up to and including compensation reduction and the initiation of termination proceedings.
This Statement on Faculty Professionalism applies to all faculty of the School of Medicine, both Regular Rank and non-Regular Rank. It is relevant to all professional realms, including research, teaching, mentoring, administration and clinical care. However, because the School of Medicine does not, as an entity, provide clinical care, professionalism issues in the clinical care arena are governed by additional policies and procedures, including Duke University Hospital Medical Staff Bylaws, Clinical Peer Review Procedures, Medical Staff Code of Conduct, Integrity in Action, and DHIP Policies. Many can be found on the Duke Policy website.
This statement is not meant to replace any existing policy or resource (see Appendix A for list of resources). However, even with existing resources, there is a need for a more explicit and consistent approach to unprofessional behavior that is not clearly addressed by other mechanisms. This document is written in response to a request from SoM leadership to address this gap, and to develop a strategy for evaluating and recommending consequences for unprofessional faculty behavior, and ensuring consistency in how the School of Medicine addresses these issues.
Actions that embody professionalism in the academic medicine community have been described* and include these behaviors:
- Adheres to high ethical and moral standards
- Conducts academic work with integrity, including adhering to institutional and federal policies on responsible conduct of research and conflict of interest
- Demonstrates intellectual honesty
- Evinces core humanistic values, including honesty and integrity, caring and compassion, altruism and empathy, collegiality, respect for others, and trustworthiness
- Takes personal action to support equity and inclusion
- Is able to subordinate own interests to the interests of others when appropriate
- Exercises accountability individually and for colleagues
- Demonstrates a lifelong commitment to excellence
- Exhibits a commitment to scholarship and to advancing their field
- Deals appropriately with high levels of complexity and uncertainty
- Reflects upon actions and decisions
- Assures one’s own fitness for duty
None of these behaviors proscribes healthy discourse or thoughtful disagreement. This statement does not seek to homogenize the academic environment, but instead underscores our commitment to respectful behavior.
Examples of unprofessional behavior that might be addressed through this statement (and are not clearly covered by other resources) include inappropriate fiscal management, overtly disrespectful behavior, bullying subordinates, and engaging in questionable research practices that generally do not meet criteria for scientific misconduct, such as maintaining inadequate research records, especially for results relied on by others; appropriating research ideas or intellectual property of others; refusing to provide reasonable access to research materials or data that support published papers; releasing research results without sufficient data to allow peers to judge the validity of the results or reproduce the experiments; and neglecting to appropriately supervise others in work for which the faculty member is responsible.
*References: Swick HM. Toward a Normative Definition of Medical Professionalism. Academic Medicine 2000; 75(6) 612
Concerns about disruptive behavior are ideally raised directly with the offending person, as s/he may be unaware of how their behavior is affecting others. A suggested framework for providing this type of feedback is included in Appendix B. If this is unsafe or does not resolve the issue, the concern should be reported to the next level of institutional authority, such as the division chief, department chair or unit director. In addition, other resources are available, including School of Medicine leadership, the Compliance Offices, the Faculty Ombuds, the Student Ombuds, the Office for Institutional Equity and Duke Personal Assistance Service. These are listed in Appendix A below.
It is expected that most faculty behavioral issues will be resolved at the personal, division or department level. But when this is inappropriate, is unsuccessful, or when any party to the issue is uncomfortable with such an attempt, assistance from the Dean’s Office may be requested. Certain faculty matters, including some egregious or illegal behavior, may escalate directly to the Dean’s Office. Whenever possible, the Vice Dean for Faculty will work with the Department Chair or delegate to resolve or respond to the issue.
Concerns may also be reported through the Duke Health Integrity in Action and Speak Up Program Hotline. This line is available 24/7/365 to report any concerns, including concerns about unprofessional faculty conduct. Information from calls to this line is transferred in written form to the appropriate compliance office (either the Duke Office of Audit Risk and Compliance or the DUHS Compliance Office). Concerns are reviewed by a compliance officer, and when appropriate, referred to the relevant office(s) to follow up. Concerns about unprofessional faculty behavior that are received through this line will be referred, in most cases, to the Dean’s office. Follow up actions will be determined in consultation with the appropriate unit leader on a case by case basis. You may also use the online form Speak Up Reporting to report your concern anonymously.
Reports to the hotline and online form can be made anonymously. However, efforts to address disruptive behavior are generally more effective when the available details, including people affected, are as specific as possible. When it is safe to do so, reporters are encouraged to identify themselves, or provide a way they may be contacted to answer additional questions that may come up as the complaint is investigated. Callers to the hotline are always provided with a callback code and date so they may receive any additional information provided by the relevant compliance office and so they may provide additional information if needed. Those submitting a concern via the online form are encouraged to provide contact information should there be follow up questions.
We speak up when words, behaviors or actions are not consistent with our values. If you witness or are asked to participate in actions that are not consistent with our values, tell someone. Ask your supervisor or department head for advice.
Other Ways to Report Concerns:
- Duke Hospital Safety Reporting System https://intranet.dh.duke.edu/
- Duke University Hospital Patient Relations patientvisitorrelations@dm.duke.edu
919-681-2020
A centralized professionalism management resource with reporting options, tools and tips for leaders navigating professionalism concerns, and support for impacted parties is available on the Duke University Faculty Relations Website. This site is a combined effort of the School of Medicine and the wider University Campus. All content is NetID protected.
In addition, you can report a concern anytime via Duke’s Integrity in Action and Speak Up Program. Call 800-826-8109 to discuss your question or report your concern. The toll-free number is administered by a third party and can stay confidential and anonymous if you choose. This service is available 24 hours per day, 365 days per year. You may also use the online Speak Up Reporting form to report your concern anonymously.
Suggestions for providing feedback about unprofessional behavior.
Establish a time to meet privately with the person. During the meeting, use this guideline for the conversation.
- State that you wish to give some feedback and why.
- State the observed behavior.
- Share your interpretation of that behavior (what I take that to mean is . . .).
- Share the feeling attached to that interpretation (which makes me feel . . .).
- Invite a response (What are your thoughts about that?).
- Engage in a dialogue of next steps and future options, but do not necessarily come to a conclusion right now.
© 2012 Otto Krueger Associates (used with permission)