Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements

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 professionalism 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.

FIGURE 1

Percent of residents who rated highly* the importance of practicing and teaching, the current degree of teaching, and the ease of incorporating 13 principles of professionalism.^†‡ *High, ≥6 on a 7-point scale, where 1 = not at all and 7 = extremely. ^†Thirteen principles: altruism, respect, sensitivity, accountability, confidentiality, communication and shared decision making, integrity, compassion and empathy, duty, competence, managing conflicts of interest, self-awareness, and commitment to excellence and ongoing professional development. These were defined for respondents (Appendix). ^‡For principles with responses demonstrating no significant differences by 95% confidence intervals (CI), responses were combined into 1 variable “most principles” to simplify presentation. Responses displayed as separate principles are significantly different (P < 0.05) from the category “most principles,” as demonstrated by nonoverlapping 95% CI