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

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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.

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Author information

Authors and Affiliations

  1. Johns Hopkins Bayview Medical Center, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neda Ratanawongsa MD, Eric E. Howell MD & David E. Kern MD, MPH

  2. Division of General Internal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Shari Bolen MD, MPH & Stephen D. Sisson MD

  3. University of Virginia School of Medicine, Charlottesville, VA, USA

    Dan Larriviere MD, JD

Authors
  1. Neda Ratanawongsa MD
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  2. Shari Bolen MD, MPH
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  3. Eric E. Howell MD
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  4. David E. Kern MD, MPH
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  5. Stephen D. Sisson MD
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  6. Dan Larriviere MD, JD
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Corresponding author

Correspondence to Neda Ratanawongsa MD.

Additional information

Funding for this project was provided by the Health Resources and Services Administration, Grant #5 D55HP00049-06-00, and the Innovative Curriculum Grant for Graduate Medical Education, Department of Graduate Medical Education, University of Virginia School of Medicine.

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Ratanawongsa, N., Bolen, S., Howell, E.E. et al. Residents’ perceptions of professionalism in training and practice: Barriers, promoters, and duty hour requirements. J Gen Intern Med 21, 758–763 (2006). https://doi.org/10.1111/j.1525-1497.2006.00496.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00496.x

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