Understanding Unprofessionalism in Residents

Factors leading to lapses in professional behaviour of Gynae residents in Pakistan: a study reflecting through the lenses of patients and family, consultants and residents

INTRODUCTION

Professional behaviour is the first manifestation of professionalism. In teaching hospitals, the residents can be considered vulnerable to lapses in professional behaviour when they fail to meet the set standards of professionalism. Residents of some specialties are more at risk of lapses in professional behaviour due to the demanding nature of work. Research focusing on the behaviour of residents in the field of Gynae and the underlying factors contributing to such behaviour is notably lacking in the literature. Additionally, there is a gap in understanding the perspectives of patients from Pakistan on this matter, as it remains unexplored thus far, which constitutes the central focus of this study. An increase in complaints lodged against Gynae resident's professional behaviour in Pakistan Citizen Portal (PCP) was observed. Therefore, an exploratory qualitative study was conducted to investigate the factors and rationales contributing to the lapses in resident's professional behaviour. The study collected the viewpoints of three stakeholder groups: patients and their families, consultants and residents. The study was conducted in three phases. First, the document analysis of written complaints was conducted, followed by face-to-face interviews (11 per group) conducted by trained researchers from an independent 3rd party. Finally, the interview data was transcribed, coded and analysed. In total 15 themes were identified from the interviews with 3 stakeholders, which were then categorized and resulted in 6 overlapping themes. The most prevalent lapse reported by all 3 stakeholders was poor verbal behaviour of residents.

CONCLUSION

The highly ranked factors contributing to triggering the situation were associated with workplace challenges, well-being of residents, limited resources, patients and family characteristics, patients' expectations, lack of administrative and paramedic support, cultural factors and challenges specific to Gynae specialty. Another intriguing and emerging theme was related to the characteristics of patients and attendants which helped in understanding the causes and implications of conflicting environments. The value of competency also emphasized that can be accomplished by training and mentoring systems. The thorough examination of these factors by key stakeholders aided in accurately analysing the issue, its causes, and possible solutions. The study's findings will assist higher authorities in implementing corrective actions and offering evidence-based guidance to policymakers to improve healthcare system.

Surgeons and Professionalism: Where We Are and Where We Need to Go

Surgeons are famously decisive, assertive, and confident. Unfortunately, we also often have a reputation for being blunt, harsh, and unprofessional. Unprofessional behaviors are unacceptable, and we believe that they are a symptom of surgeon distress and burnout. Unprofessional behaviors should be prevented, but equally importantly, so should the stressors that drive them. This is critically important for the future of our profession.

Universal Well-Being Assessment Associated With Increased Resident Utilization of Mental Health Resources and Decrease in Professionalism Breaches

BACKGROUND

A previous study showed that residents felt a universal well-being visit to a Faculty Staff Assistance Program (FSAP) would increase self-initiated visits. It is unknown whether such program is associated with more self-initiated visits, improved professionalism, or positive well-being measures.

OBJECTIVE

We measured internal medicine (IM) resident-initiated visits before and after the universal well-being FSAP intervention to assess for increased utilization of FSAP services and effect on professionalism and well-being measures.

METHODS

Universally scheduled, resident-initiated, program-mandated FSAP visits for IM residents at West Virginia University were counted for years 2014-2019. Professionalism reports of all residents and IM residents were tallied. A Mann-Kendall trend test was used to estimate slope of trends. Burnout and compassion satisfaction (CS) scores were assessed from 2017-2020.

RESULTS

Residents opted-out of 8 of 239 (3.3%) universally scheduled FSAP visits. Resident-initiated visits significantly increased from 0 in 2014-2015 to 23 in 2018-2019 (slope = 6.5; P = .027; 95% CI [1.0, 8.0]). Program-mandated visits significantly decreased from 12 in 2014-2015 to 3 in 2018-2019 (slope = -2.4; P = .027; 95% CI [-3.0, -1.0]). IM-attributed professionalism reports significantly decreased from 17 of 62 (31%) in 2014 to 1 of 62 (1.6%) in 2019 (slope = -5.7%; P = .024; 95% CI [-11.6%, -0.6%]). Burnout scores remained in the low range (≤ 22) and CS scores in the average-high range (38.7-42) from 2017-2020.

CONCLUSIONS

A universal well-being FSAP program increased resident utilization of mental health resources and was associated with fewer professionalism breaches.