Residents' perceptions of their own professionalism and the professionalism of their learning environment

Developing an Instrument to Evaluate Undergraduate Healthcare Students' Professionalism

Professionalism is a multidimensional quality acquired over time. Undergraduate years lay a foundation for the development of professionalism. Tools monitoring the students' professional development are needed. Our tool development followed three phases: 1) identifying meaningful criteria for professionalism adapted to the education level, 2) developing an evaluation instrument in a process maximising construct validity, 3) testing the evaluation instrument in an interprofessional study. The evaluation instrument proved to be applicable in the field and it meets validity standards. Some differences between professions were found and discussed. Professionality starts to develop during the education, and early monitoring is important to support students' optimal development. The evaluation instrument supports both self- and expert evaluation of healthcare students' professional development.

Medical students' perception of professionalism climate in clinical settings

Medical professionalism has a crucial role in educating medical students. The role of professionalism in the clinical environment is therefore an important factor in medical education. This study attempts to evaluate the opinions of medical students in the teaching hospitals of Tehran University of Medical Sciences (TUMS) about the professionalism environment in this university.

A sample of 165 students filled out the Persian translation of UMKC-SOM (Climate of Professionalism Survey) questionnaire. This instrument evaluates students’ perspectives on the degree of adherence to professionalism by faculty, residents and other students.

The results of the study revealed that the total score of professionalism climate was 53.9 for faculty, 42.09 for residents, and 50.76 for students and the difference between these three groups was statistically significant (p-value < 0.01). Results of further analysis through post-hoc tests for multiple comparisons among the groups revealed that the students found their fellow students and faculty more professional than residents. The study also showed that the medical ethics course had no impact on perceptions observations (p-values > 0.05).

The study results also revealed that the students found their fellow students and faculty more professional than residents. This finding demonstrates the importance of teaching professionalism to residents since they serve as role models for students.

Further multicenter studies are needed to improve the professionalism climate in the medical teaching environment.

Development of a taxonomy of unprofessional behavior in clinical learning environments using learner-generated critical incidents

PURPOSE

Few studies have examined medical residents' and fellows' (trainees) direct experience of unprofessional behavior in clinical learning environments (CLE). The purpose of this study was to create a taxonomy of unprofessional behavior in CLEs using critical incidents gathered from trainees.

METHOD

In step 1 (data collection), the authors collected 382 critical incidents from trainees at more than a dozen CLEs over a six-year period (2013-2019). In step 2 (model generation), nine subject matter experts (SMEs) sorted the incidents into homogenous clusters and this structure was tested with principal components analysis (PCA). In step 3 (model evaluation), two new groups of SMEs each re-sorted half of the incidents into the PCA-derived categories.

RESULTS

A 13-component solution accounted for 62.46% of the variance in the critical incidents collected. The SMEs who re-sorted the critical incidents demonstrated good agreement with each other and with the 13-component PCA solution. The resulting taxonomy included 13 dimensions, with 48.7% of behaviors focused on displays of aggression or discriminatory conduct.

CONCLUSIONS

Critical incident methodology can provide unique insights into the dimensionality of unprofessional behavior in the CLE. Future research should leverage the taxonomy created to inform professionalism assessment development in the CLE.

Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018

BACKGROUND

Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.

METHODS

Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles.

RESULTS

3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism.

CONCLUSIONS

Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.

Trainees’ perception of education in communication and professionalism across two programs in two countries

Background:

Different health care systems impact on medical education.

Objective:

We aim to describe the differences and similarities in the perceptions of pediatric residents on education in professionalism and communication skills across two countries.

Methods:

We conducted a cross-sectional survey of pediatric residents in the United States and Singapore. A 108-item written questionnaire on perceptions regarding education in communication/professionalism was administered. A five-point Likert scale was used for each attribute in the survey. Quantitative analysis was performed using chi-square test.

Results:

Response rate was 65.9% (89/135). In the domain of professionalism, residents from both countries ranked shared decision making as the most important attribute (Singapore vs. USA: 26/50 (52.0%) vs. 19/39 (48.7%), p = 0.76). In contrast, there was a difference in ranking of the most important attribute in communication between the two countries, with dealing with difficult family and patient being most important for Singapore trainees (30/50(60.0%) vs. 8/39 (20.5%), p < 0.001). Direct observation and feedback and role modeling by seniors were the most common teaching methods in both centers. Main barriers in learning were high workload (55/89 (61.8%)) and time constraints (53/89 (59.6%)) in both countries. Promoters of teaching these competencies were similar, with role modeling by senior staff rated as most important.

Conclusions:

This investigation demonstrates more differences in the perception of how communication is taught compared to professionalism across two countries. Barriers and promoters to teaching were similar across these two countries, with role modeling being an important approach to teaching communication and professionalism across both countries.

Assessing medical professionalism: A systematic review of instruments and their measurement properties

BACKGROUND

Over the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments' measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.

METHODS

A systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990-2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument's usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee's criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments.

RESULTS

After screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar's instrument for nursing students, Nurse Practitioners' Roles and Competencies Scale, and Perceived Faculty Competency Inventory.

CONCLUSION

Although instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Does Psychological Safety Impact the Clinical Learning Environment for Resident Physicians? Results From the VA's Learners' Perceptions Survey

BACKGROUND

Psychological safety (PS) is the perception that it is safe to take interpersonal risks in the work environment. In teaching hospitals, PS may influence the clinical learning environment for trainees.

OBJECTIVE

We assessed whether resident physicians believe they are psychologically safe, and if PS is associated with how they rate satisfaction with their clinical learning experience.

METHODS

Data were extracted from the Learners' Perceptions Survey (LPS) of residents who rotated through a Department of Veterans Affairs health care facility for academic years 2011-2014. Predictors of PS and its association with resident satisfaction were adjusted to account for confounding and response rate biases using generalized linear models.

RESULTS

The 13 044 respondents who completed the LPS (30% response rate) were comparable to nonpediatric, non-obstetrics-gynecology residents enrolled in US residency programs. Among respondents, 11 599 (89%) agreed that ". . . members of the clinical team of which I was part are able to bring up problems and tough issues." Residents were more likely to report PS if they were male, were in a less complex clinical facility, in an other medicine or psychiatry specialty, or cared for patients who were aged, had multiple illnesses, or had social supports. Nonpsychiatric residents felt safer when treating patients with no concurrent mental health diagnoses. PS was strongly associated with how residents rated their satisfaction across 4 domains of their clinical learning experience (P < .001).

CONCLUSIONS

PS appears to be an important factor in resident satisfaction across 4 domains that evaluators of graduate medical education programs should consider when assessing clinical learning experiences.

Factors associated with mental health status of medical residents: a model-guided study

Residency is a stressful period in a physician's development, characterized by long work hours, time pressure, and excessive work load, that can exert negative effects on residents' mental health. Job burnout and negative work-home interference may play a major role in residents' mental health problems. The present study used the job demands-resources model as a theoretical framework to examine the way in which job demands (e.g., workload, emotional demands) and job resources (e.g., supervisor support, job autonomy) were associated with residents' mental health. From a pool of 290 medical residents, 264 (91 %) completed the questionnaires. Applying structural equation modeling techniques, the results showed that greater emotional exhaustion (β = -.65, SE = .09, p < .001) and more work-home interference (β = -.26, SE = .10, p < .05) were related to poor mental health. Specific job demands (i.e., high workload) and particular job resources (i.e., low opportunities for professional development and low supervisor support) were related to poor mental health not directly but only indirectly, via emotional exhaustion or work-home interference. Thus, through work-related emotional exhaustion, the impact of work conditions might be transmitted to and interfere with non-work related domains such as family life, as well as with domain-unspecific aspects of well-being, such as mental health and psychological distress. Implications of the results and suggestions for future research and practice are outlined.

Current state of professional and core competency in pediatric residency program at Shiraz University of Medical Sciences: A local survey

INTRODUCTION

Accreditation assesses performance, or capacity to perform, against predetermined standards. It typically combines external quality assurance, through a process of peers review, with elements of self-regulation through internal and self-directed assessment. This study is an attempt to identify the quality of pediatrics residency educational programs regarding predetermined standards.

METHODS

This descriptive-analytical evaluation study of applied type was conducted during 2010 and 2011 in the pediatrics department of Shiraz Medical School, Iran. The assessment process occurred in several phases; at first an assessment model for a residency educational development and a series of educational criteria and indices were created based on WFME Standards. Multiple methods including a self-assessment questionnaire and several checklists were used to collect data, whereas systematic site visit, peer review and document reviewing were conducted with survey team. Due to limitation of the statistical society, all faculty members (n=34) and residents (n=41) of the pediatric department were asked to complete the survey. At last, descriptive and deductive statistics data analysis was performed using SPSS version 14.

RESULTS

According to the records available in assessing program quality, it seems that the input criteria were desirable for the program based on the residents' viewpoints (86.6 %).There were proper physical facilities for them to meet the residency program goals.  The study indicated that the learning environment needed to be revised for the educational needs (Likert scale: 2.96±1.05). The peer evaluation team demonstrated achievement of mission fulfillment in the context of the objectives and indicators by meeting the desired themes.  In spite of some weaknesses in the process criteria, the criteria for output indicators were good according to the report (more than desired level of 75-80%).

CONCLUSION

Accreditation is an important step towards strengthening the quality of educational programs. According to this study the current status of the pediatrics department of Shiraz University of Medical Sciences was desirable leading to a satisfactory level in general. However, additional educational development will be needed in order to achieve a widespread change and improvement.

Aspectos generales y académicos de los* aspirantes y los* admitidos a la especialidad de pediatría de la Universidad Nacional de Colombia

<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Introducción: Existe escasa investigación local sobre el proceso de admisión a las especialidades medico-quirúrgicas. </span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Objetivos: Caracterizar a los aspirantes y admitidos al programa de Pediatría de la Universidad Nacional de Colombia-UNal.</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Material y Métodos: Se estudiaron aspirantes y admitidos al programa, cohortes 2009 a 2011. Se estimó la tasa de admisión y los factores relacionados con ella.</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Resultados: Se registraron 997 aspirantes, 773 por primera vez<strong style="mso-bidi-font-weight: normal;">. </strong><span style="mso-spacerun: yes;"> </span>Predominó el sexo femenino (71%) con mediana de 28 años y provenientes de Bogotá. La graduación ocurrió en la mitad, en instituciones públicas y, en un quinto en la Unal. Se convocó a entrevista a 125 (12.5%) y 42 fueron aceptados (4.2% de los Inscritos y 34% de los convocados a entrevista).</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">El promedio de calificación sobre 5, <span style="mso-spacerun: yes;"> </span>fue<span style="mso-spacerun: yes;">  </span>2.72 y 2.63 en la <em style="mso-bidi-font-style: normal;">Prueba Cognitiva</em> en la Prueba de <em style="mso-bidi-font-style: normal;">Inglés </em>respectivamente. En los preseleccionados pero no admitidos, la Calificación Final fue 3.19 y en los admitidos 3.54.</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Dentro de los admitidos predominaron la mujeres (60%) de 28 años, <span style="mso-spacerun: yes;"> </span>egresados de<span style="mso-spacerun: yes;">  </span>universidades públicas (88%). <span style="mso-spacerun: yes;"> </span>Robusta y significativamente, la <span style="mso-spacerun: yes;"> </span>admisión pudo ser predicha por la calificación en la <em style="mso-bidi-font-style: normal;">prueba cognitiva</em>, la calificación de la <em style="mso-bidi-font-style: normal;">Hoja de vida</em>, egresar de la Unal, <em style="mso-bidi-font-style: normal;">la calificación en la Entrevista</em>, el sexo masculino, tener menor edad y la calificación en la <em style="mso-bidi-font-style: normal;">prueba de inglés</em> (LR ji²(7)=307.93, Coeficiente-de-Determinación-CD:94.7%, p=0.0000). La Admisión es explicada, después de controlar por las demás variables, casi esclusivamente por la calificación en la <em style="mso-bidi-font-style: normal;">Prueba Cognitiva </em>(LR ji²(1)=300.53, CD:92.08%, p=0.0000).</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Conclusión</span></p><p class="MsoNormal" style="text-align: justify; text-justify: inter-ideograph; line-height: 200%;"><span style="font-size: 12.0pt; mso-bidi-font-size: 11.0pt; line-height: 200%; font-family: 'Verdana','sans-serif'; mso-ansi-language: ES-CO;" lang="ES-CO">Este trabajo muestra la consistencia y transparencia del proceso de admisión a la especialidad Pediatría de la Universidad Nacional de Colombia.</span></p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> 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Development and validation of a professionalism assessment scale for medical students

OBJECTIVE

To develop and validate a scale for the assessment of professionalism in medical students based on students' perceptions of and attitudes towards professionalism in medicine.

METHODS

This was a mixed methods study with undergraduate medical students. Two focus groups were carried out with 12 students, followed by a transcript analysis (grounded theory method with open coding). Then, a 3-round Delphi with 20 family medicine experts was carried out. A psychometric assessment of the scale was performed with a group of 449 students. The items of the Professionalism Assessment Scale could be answered on a five-point Likert scale.

RESULTS

After the focus groups, the first version of the PAS consisted of 56 items and after the Delphi study, 30 items remained. The final sample for quantitative study consisted of 122 students (27.2% response rate). There were 95 (77.9%) female students in the sample. The mean age of the sample was 22.1 ± 2.1 years. After the principal component analysis, we removed 8 items and produced the final version of the PAS (22 items). The Cronbach's alpha of the scale was 0.88. Factor analysis revealed three factors: empathy and humanism, professional relationships and development and responsibility.

CONCLUSIONS

The new Professionalism Assessment Scale proved to be valid and reliable. It can be used for the assessment of professionalism in undergraduate medical students.

The Perceptions of Professionalism by 1(st) and 5(th) Grade Medical Students

INTRODUCTION

Professionalism is essential for the development of mature physicians but not much education is devoted to that theme.

AIM

We aimed to determine the views of undergraduate medical students on medical professionalism.

METHODS

This was a qualitative study, based on focus groups of the first and fifth-year undergraduate medical students. Transcripts of the focus groups were independently evaluated by two researches. Segments of transcripts, identified as important, were marked as verbatims. A grounded theory method with open coding was applied. A list of codes was developed and reviewed by both researchers until the consensus was reached. Then, the codes were reviewed and put into the categories and dimensions.

RESULTS

Students recognized 10 main medical professionalism dimensions (empathy, respect, responsibility, autonomy, trust, communication, difference between professional and private life, team work, partnership) and two dimensions associated with it (physician's characteristics, external factors). Slight change of the attitudes towards a more self-centred future physicians' figure was observed in the fifth-year medical students.

CONCLUSION

The students have an appropriate picture of the physicians' figure even at the beginning of their medical studies but still needs an education in professionalism. It seems that the fifth-year students perceive physicians as more self-centred when compared to their first-year colleagues.

Accounting for professionalism: an innovative point system to assess resident professionalism

BACKGROUND

Professionalism is a core competency for residency required by the Accreditation Council of Graduate Medical Education. We sought a means to objectively assess professionalism among internal medicine and transitional year residents.

INNOVATION

We established a point system to document unprofessional behaviors demonstrated by internal medicine and transitional year residents along with opportunities to redeem such negative points by deliberate positive professional acts. The intent of the policy is to assist residents in becoming aware of what constitutes unprofessional behavior and to provide opportunities for remediation by accruing positive points. A committee of core faculty and department leadership including the program director and clinic nurse manager determines professionalism points assigned. Negative points might be awarded for tardiness to mandatory or volunteered for events without a valid excuse, late evaluations or other paperwork required by the department, non-attendance at meetings prepaid by the department, and inappropriate use of personal days or leave. Examples of actions through which positive points can be gained to erase negative points include delivery of a mentored pre-conference talk, noon conference, medical student case/shelf review session, or a written reflection.

RESULTS

Between 2009 and 2012, 83 residents have trained in our program. Seventeen categorical internal medicine and two transitional year residents have been assigned points. A total of 55 negative points have been assigned and 19 points have been remediated. There appears to be a trend of fewer negative points and more positive points being assigned over each of the past three academic years.

CONCLUSION

Commitment to personal professional behavior is a lifelong process that residents must commit to during their training. A professionalism policy, which employs a point system, has been instituted in our programs and may be a novel tool to promote awareness and underscore the merits of the professionalism competency.

The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?

BACKGROUND

Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior.

METHODS

Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions.

RESULTS

76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork.

CONCLUSION

Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

Promoting professionalism via a video-based educational workshop for academic hospitalists and housestaff

BACKGROUND

Unprofessional behavior can compromise care and detract from the hospital learning environment. Discrepancy between professional behaviors formally taught and what is witnessed has become increasingly evident.

METHODS

With funding from the American Board of Internal Medicine Foundation, a workshop was developed to address unprofessional behaviors related to inpatient care previously identified in a multi-institution survey. The aims were to utilize video-based education to illustrate unprofessional behaviors, how faculty play a role in promoting such behaviors, and facilitate reflection regarding motivation for and prevention of these behaviors. Hospitalists and housestaff at 3 Chicago-area academic hospitals and 1 community teaching affiliate participated. Videos were debriefed, identifying barriers to professional behavior and improvement strategies. A postworkshop survey assessed beliefs on behaviors and intent to change practice.

RESULTS

Forty-four (53%) faculty and 244 (68%) residents (postgraduate year 1 and greater) participated. The workshop was well received, with 89% reporting it "useful and effective." Two-thirds expressed intent to change behavior. Most (86%) believed videos were realistic and effective. Those who perceived videos as "very realistic" were more likely to report intent to change behavior (93% vs 53%, P = 0.01).

CONCLUSIONS

Video-based education is a feasible way to promote reflection and address unprofessional behaviors among providers and may positively impact the learning environment.

A literature review of professionalism in surgical education: suggested components for development of a curriculum

BACKGROUND

While it is evident that a surgeon must master medical knowledge and technical skill, there are other "soft skills" that are essential to a successful surgeon. One of these skills is professionalism. The challenge in surgical education lies in developing an effective professionalism curriculum and a related method of evaluation.

OBJECTIVE

Our review updates the literature and provides recommendations for improving instruction and evaluation of professionalism.

DESIGN

A literature review was conducted using PubMed, Google Scholar, and Web of Knowledge. We restricted our search to documents published from 2009 to 2012 that address methods of teaching and tools for assessing professionalism in surgical education.

RESULTS

Sixty-three documents were reviewed, with 14 fitting our search criteria for professionalism in surgical education completely. Other articles focused on the topics of professionalism in surgery, medical professionalism, and professionalism education in medical specialties other than surgery.

CONCLUSIONS

Development of a professionalism curriculum for surgical residents might begin with defining professionalism in terms of tangible behaviors. The program might also include a precurriculum preparatory course and simulation-based training. Residency programs must also maintain professionalism among its faculty. Assessment in the form of multisource feedback that is consistent with observable behavioral definitions of professionalism should also be considered in evaluating resident professionalism.

Participation in unprofessional behaviors among hospitalists: a multicenter study

BACKGROUND

Unprofessional behaviors undermine the hospital learning environment and quality of patient care.

OBJECTIVE

To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists.

DESIGN

Observational survey study.

SETTING

Three academic health centers.

SUBJECTS

Hospitalists.

MEASUREMENTS

Observation, participation in, and perceptions of unprofessional behaviors.

RESULTS

Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (β = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (β = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (β = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (β = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site.

CONCLUSION

While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.

New measures to establish the evidence base for medical education: identifying educationally sensitive patient outcomes

Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations.