GME Best Practices: Teaching residents professionalism with the PACC model

The PACC Model (Person – Act Committed – Circumstances – Consequences) was developed and presented at the ACGME Workshop SES090 as “Breaches of Professionalism. What will you do?” Creators of the model are Woodson S. Jones, MD, Dean, San Antonio Uniformed Services Health Education Consortium (SAUHEC); Lois Bready, MD, Vice Dean for GME, University of Texas Health Science Center, San Antonio, TX; Jennifer Thompson, MD, MPH, Associate Chief of Staff/Education Orlando, VA Medical Center; M. Phillip Luber, MD, Associate Dean for GME, University of Texas Health Science Center, San Antonio, TX; and William Hannah, MD, Associate Dean for GME, SAUSHEC.

This ACGME Workshop was designed for mid- and senior-level educators faced with making challenging value based decisions on what actions to take after a trainee has demonstrated unprofessional conduct. Dr. Joseph Wiedemer, program director of Penn State Health’s Family and Community Medicine Residency in State College, adapted the model to teach professionalism to residents.

He based this on the work that professionalism is a developable skill, just as all core competencies are. (Lucey C, Souba W. Perspective: the problem with the problem of professionalism. Acad Med. 2010 Jun;85(6):1018-24. doi: 10.1097/ACM.0b013e3181dbe51f)

In the PACC Model:

• Person: Who is the resident? In what year of training are they? Which rotation were they on?
• Act committed: What did they do?
• Circumstances: What is going on in the resident’s personal and professional life?
• Consequences: What would you do? How do you handle this?

Following this model, Wiedemer does the following:

• Person: Present a scenario where there may have been a breach of Professionalism. To begin, the group has a brief vignette of the resident. “This a female PGY-2 resident who is on the fourth week of her night float rotation.”
• Act committed: Present a scenario of an act they committed. “The resident failed to return pages from the ICU nurses station on the last week of the rotation. This resulted in delays of care for patients in the ICU.” Wiedemer said he usually makes up scenarios depending on what he wants to teach or using experiences he has had.
• Circumstances: Present circumstances that are going on in the resident’s personal and professional life. “The resident has been excellent until the middle of this year, when it was noted that she was delayed in doing her administrative work. She completed notes later, and withdrew from other residents.” Wiedemer said he continues from there, again, depending on what he wants to have a discussion about. Perhaps the resident is using drugs, going through personal relationship turmoil, is depressed or some other factor.
• Consequences: Wiedemer divides the room into three groups: chief resident, program director and DIO. He might assign other roles such as HR or compliance or risk, depending on the scenario. He then asks each group to decide what the consequences are for the resident in the scenario. How would they handle this situation? What values did they consider when deciding the consequences?

Wiedemer said he has found that most discussions result in residents having a different perspective on their own actions, and they see how their actions are perceived by others. They also recognize the impact of their values on their decisions in the consequences.

Finally, one presentation had a scenario in which a resident was contemplating suicide. At the end of the presentation, Wiedemer included the National Suicide Hotline number, and all of the residents put the number into their phone contacts.

Internal users can view a PowerPoint on this topic in the GME Best Practices folder on the network drive.

With questions, contact Dr. Joseph Wiedemer at jwiedemer@pennstatehealth.psu.edu.

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