Master Professional Behaviors
for MCCQE Part 1

Core Concepts

Professional behaviors are the foundation of effective medical practice, ensuring patient trust, safety, and a functional healthcare system. They encompass a set of ethical principles, values, and duties expected of physicians in their interactions with patients, colleagues, the profession, and society. Key principles include:

• Altruism: Prioritizing the patient's well-being above self-interest.
• Accountability: Being responsible for one's actions and decisions, and holding oneself to the highest standards.
• Excellence: Commitment to lifelong learning, continuous improvement, and maintaining competence.
• Respect: Treating all individuals (patients, colleagues, staff) with dignity, empathy, and without discrimination.
• Integrity & Honesty: Upholding moral principles, being truthful, and avoiding conflicts of interest.
• Compassion: Showing empathy and understanding towards patients' suffering.
• Confidentiality: Protecting sensitive patient information, adhering to privacy laws (e.g., PIPEDA, provincial acts).
• Professional Boundaries: Maintaining appropriate professional relationships with patients, avoiding dual relationships or exploitation.
• Interprofessional Collaboration: Working effectively and respectfully with other healthcare professionals.

Clinical Presentation (Lapses in Professionalism)

• Breach of Confidentiality: Discussing patient cases in public, unauthorized access to records, inappropriate use of social media.
• Boundary Violations:
  • Sexual misconduct (explicit or implicit).
  • Financial exploitation (e.g., inappropriate billing, soliciting gifts, business relationships).
  • Personal relationships outside of professional context.
  • Sharing excessive personal information with patients.
• Dishonesty & Misrepresentation: Falsifying records, CV misrepresentation, inappropriate billing, failure to disclose errors.
• Disruptive Behavior: Anger outbursts, bullying, harassment, intimidation, creating a hostile work environment.
• Impairment: Practice affected by substance abuse, untreated mental illness, or other physical conditions.
• Poor Communication: Disrespectful language, lack of empathy, inadequate informed consent, not returning calls/pages.
• Lack of Accountability: Blaming others, not taking responsibility for mistakes, avoiding feedback.
• Discrimination: Based on race, gender, sexual orientation, religion, socioeconomic status, etc.
• Conflict of Interest: Situations where personal interests could influence professional judgment (e.g., industry ties, prescribing self/family).
• Social Media Misuse: Posting unprofessional content, sharing patient information, engaging in disrespectful online discourse.
• Chronic Lateness/Absenteeism: Unreliable presence or poor time management impacting patient care and team function.

Diagnosis (Identification of Lapses)

Lapses in professional behavior are identified through a multi-faceted approach rather than a single diagnostic test. The "gold standard" involves a comprehensive, unbiased investigation leveraging various data sources:

• Patient Complaints: Formal or informal feedback from patients or their families.
• Peer/Colleague Reports: Concerns raised by other healthcare professionals, nurses, or staff.
• Direct Observation: By supervisors, educators, or peers during clinical practice.
• 360-Degree Feedback: Structured evaluations from multiple sources (supervisors, peers, subordinates, patients).
• Chart Audits & Medical Record Reviews: To identify documentation errors, billing irregularities, or questionable decision-making.
• Incident Reports: Documentation of adverse events or unprofessional conduct within an institution.
• Regulatory Body Investigations: Formal inquiries by provincial Colleges of Physicians and Surgeons based on complaints or mandatory reports.

Assessment typically involves interviewing involved parties, reviewing relevant documentation, and deliberation by an impartial committee (e.g., hospital credentialing, professionalism committee, regulatory college). The focus is on the impact on patient care, safety, and public trust.

Management (First Line)

• Immediate Action (Severity Dependent):
  • Minor Lapses: Direct, timely, private feedback; coaching; mentorship; self-reflection activities.
  • Moderate Lapses: Formal warning; targeted education; remediation plan (e.g., communication skills training, ethics course); increased supervision.
  • Severe/Persistent Lapses: Removal from patient care; temporary suspension; referral to regulatory college for disciplinary action (e.g., license conditions, suspension, revocation).
• Protect Patient Safety: Ensure any ongoing risk to patients is immediately mitigated.
• Documentation: Meticulous record-keeping of incidents, feedback, and remedial actions.
• Support & Remediation: Provide access to resources (e.g., physician health programs for impairment, counseling, communication coaches) to support rehabilitation where appropriate.
• Duty to Report: Report significant concerns (e.g., impairment that poses patient risk, sexual abuse) to the provincial regulatory body as legally mandated.
• Fair Process: Ensure due process, transparency, and the opportunity for the physician to respond to allegations.
• System-Level Interventions: Address systemic factors that may contribute to unprofessional behavior (e.g., excessive workload, poor institutional culture).

Exam Red Flags