Journal of General Internal Medicine

, Volume 21, Issue 7, pp 758–763

Residents’ perceptions of professionalism in training and practice: Barriers, promoters, and duty hour requirements

  • Neda Ratanawongsa
  • Shari Bolen
  • Eric E. Howell
  • David E. Kern
  • Stephen D. Sisson
  • Dan Larriviere
Original Articles


BACKGROUND: The Accreditation Council for Graduate Medical Education duty hour requirements may affect residents’ understanding and practice of professionalism.

OBJECTIVE: We explored residents’ perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements.

DESIGN: Anonymous cross-sectional survey.

PARTICIPANTS: Internal medicine, neurology, and family practice residents at 3 teaching hospitals (n=312).

MEASUREMENTS: Using Likert scales and open-ended questions, the questionnaire explored the following: residents’ attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism.

RESULTS: One hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing profession-alism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork.

CONCLUSIONS: Residents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.

Key words

medical education residency professionalism work hours 


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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Neda Ratanawongsa
    • 1
  • Shari Bolen
    • 2
  • Eric E. Howell
    • 1
  • David E. Kern
    • 1
  • Stephen D. Sisson
    • 2
  • Dan Larriviere
    • 3
  1. 1.Johns Hopkins Bayview Medical Center, Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of General Internal Medicine, Johns Hopkins HospitalJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.University of Virginia School of MedicineCharlottesvilleUSA

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