Objective: A needs assessment survey instrument was designed to (1) identify the frequencies of selected professional and unprofessional behaviors among students, residents, and faculty over the past year, and (2) collect the baseline data. A four-step educational intervention is being implemented in an attempt to decrease the number of observed unprofessional behaviors and to increase the number of professional acts, as assessed by re-administration of the survey.
Description: We expanded the American Board of Internal Medicine (ABIM) professionalism survey1 to include new topics submitted by program directors and general medicine fellows based on their recent experiences with trainees. The resulting 20-item survey was given to all interns and junior and senior residents in a university-based internal medicine residency program in late June 1999. The respondents reported how often they had observed each of 20 behaviors among faculty, residents, and students in the past year using a five-point scale (none, 1–5, 6–10, 11–15, >15). The unprofessional behaviors observed frequently (more than five times) included making derogatory statements about other specialties, discussing patient care information in public places, and, for residents, referring to patients as “hits, gomers, etc.” Less frequent but still observable unprofessional behaviors included documenting history and physical examinations not actually performed, treating students poorly, lying to patients, and signing others' names. Professional behaviors observed frequently included, for faculty and residents, acting as role models, displaying and promoting professional behaviors, assisting residents in obtaining educational materials, and placing the needs of patients ahead of their own.
Although highly professional acts are common, the housestaff observed many unprofessional behaviors by students, other residents, and faculty members. Based on this information, a multifaceted intervention was developed that is targeted at both faculty and trainees. (1) Mentoring groups. Longitudinal groups of 12 interns meet with one faculty mentor monthly to discuss residency training, humanism, ethics, and professionalism. The critical-incident technique is used to foster introspection and discussion. These meetings present a safe forum for interns to discuss sensitive topics, and the curriculum is intended to create opinion-leader faculty awareness of professionalism issues. (2) Conference series. Four professionalism topics have been inserted into the training programs' curricula, to be presented by residents, fellows, and faculty. Also, results of this needs assessment will be distributed in a mandatory session for housestaff. (3) Grand rounds. A nationally prominent expert in professionalism has delivered an invited address. (4) Clinical evaluations. Student, resident, and faculty evaluation forms are being revised to contain an expanded professionalism component.
Discussion: After expanding a tested instrument on observed professional behavior, we found that while many role models exist, trainees had observed significant amounts of unprofessional behavior among fellow trainees and faculty. Few previous interventions had been targeted to faculty, residents, and students. We are implementing a program to decrease incidents of unprofessional behavior among students, residents, and attendings. The professional behavior instrument will be re-administered at the end of the 1999–2000 academic year to assess improvement.
1. Arnold EL, Blank LL, Race KE, Cipparone N. Can professionalism be measured? The development of a scale for use in the medical environment. Acad Med. 1998;73:1119–21.
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