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

Abstract

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 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    ABIM Founation. American Board of Internal Medicine, ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136:243–6.Google Scholar
  2. 2.
    Blank L, Kimball HABIM Foundation, ACP Foundation, et al. Medical professionalism in the new millennium: a physician charter 15 months later. Ann Intern Med. 2003;138:839–41.PubMedGoogle Scholar
  3. 3.
    ACGME. ACGME Outcome Project. Available at: http://www.acgme.org/outcome/comp/compFull.asp#5. Accessed July 14, 2005. Chicago, IL: ACGME; 1999.Google Scholar
  4. 4.
    ACGME. Resident duty hours and the working environment. Available at: http://www.acgme.org/acWebsite/dutyHours/dh_Lang703.pdf. Accessed July 14, 2005. Chicago, IL: ACGME; 2003.Google Scholar
  5. 5.
    Larriviere D. Duty hours vs professional ethics: ACGME rules create conflicts. Neurology. 2004;63:E4–5.PubMedGoogle Scholar
  6. 6.
    Cohen-Gadol AA, Piepgras DG, Krishnamurthy S, Fessler RD. Resident duty hours reform: results of a national survey of the program directors and residents in neurosurgery training programs. Neurosurgery. 2005;56:398. 403; discussion 398–403.PubMedCrossRefGoogle Scholar
  7. 7.
    Eggly S, Brennan S, Wiese-Rometsch W. “Once when I was on call...,” theory versus reality in training for professionalism. Acad Med. 2005;80:371–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Brownell AK, Cote L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001;76:734–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Miller WL, Crabtree BF. Clinical research: a multimethod typology and qualitative roadmap. In: Miller WL, Crabtree BF, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks, CA: Sage Publications Inc.; 1999:21–3.Google Scholar
  10. 10.
    Hundert EM, Hafferty F, Christakis D. Characteristics of the informal curriculum and trainees’ ethical choices. Acad Med. 1996;71:624–42.PubMedCrossRefGoogle Scholar
  11. 11.
    Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Mareiniss DP. Decreasing GME training stress to foster residents’ professionalism. Acad Med. 2004;79:825–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Ginsburg S, Regehr G, Hatala R, et al. Context, conflict, and resolution: a new conceptual framework for evaluating professionalism. Acad Med. 2000;75(suppl. 10):S6-S11.PubMedCrossRefGoogle Scholar
  14. 14.
    Kellerman SE, Herold J. Physician response to surveys. A review of the literature. Am J Prev Med. 2001;20:61–7.PubMedCrossRefGoogle Scholar

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

Personalised recommendations