Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City, MO, USA.
Acad Emerg Med. 2011 Oct;18 Suppl 2:S97-103. doi: 10.1111/j.1553-2712.2011.01186.x.
The Accreditation Council for Graduate Medical Education requires residency training programs to teach and assess professionalism in residents; however, programs may struggle to successfully remediate residents not meeting professionalism standards. To assist programs with this complex issue, a Professionalism Remediation Task Force was formed by the Council of Emergency Medicine Residency Directors (CORD-EM), which surveyed program directors (PDs) concerning their experiences. The purpose of this study is to report survey results regarding the identification and rating of unprofessional behaviors and challenges in the evaluation and remediation of professionalism.
In June 2010, the task force sent an anonymous survey via the CORD-EM listserv to PDs with active EM programs.
Fifty percent (77/154) of eligible PDs responded to the survey. Most PDs rated the unprofessional behaviors of interpersonal/communication conflicts, lack of responsibility during patient care, lack of respect of coworkers, and reports of impairment as "critical"; repeated tardiness, incomplete work, poor ability to accept feedback, poor attitude, and repetitive unresponsiveness to aid colleagues were rated as "very serious"; frequent missed deadlines were "serious"; and repetitive failure to complete medical records was rated as "mildly serious." A resident with "less serious" professionalism issues was also felt to be likely to have "serious" or "critical" issues "often" (33.8% of respondents) or "always" (6.5%). The most common methods of assessment were clinical/advisor evaluations. However, existing assessment methods were described as inadequate in identifying serious professionalism issues by 50.7% of responding PDs. Unprofessionalism was most commonly discovered by unofficial faculty complaint (54.5%). Eighty percent report that professionalism is more difficult to remediate than other core competencies. Resident ownership of the problem was reported as most critical to remediation success (84.4%). PDs perceived the greatest challenges in residency remediation to be lack of resident insight or responsibility for the problem (45.2%) and personality/behavioral issues (32.9%).
Identification and remediation of professionalism in EM residents is challenging. A future goal is to create a system by which PDs can use standardized pathways as a guide to identify and remediate unprofessional conduct.
住院医师规范化培训要求住院医师培训项目教授和评估住院医师的专业精神；然而，项目可能难以成功纠正不符合专业标准的住院医师。为了帮助项目解决这个复杂的问题，由急诊医学住院医师规范化培训主任理事会（CORD-EM）成立了一个专业精神纠正特别工作组，该工作组就其经验对项目主任（PD）进行了调查。本研究的目的是报告关于识别和评估不专业行为以及在评估和纠正专业精神方面的挑战的调查结果。
在 2010 年 6 月，特别工作组通过 CORD-EM 邮件列表向有活跃急诊医学项目的 PD 发送了一份匿名调查。
50%（77/154）的合格 PD 对调查做出了回应。大多数 PD 对人际/沟通冲突、在患者护理期间缺乏责任心、不尊重同事以及报告受损等不专业行为进行了“严重”评级；经常迟到、工作不完整、接受反馈能力差、态度差和反复不响应同事援助被评为“非常严重”；经常错过最后期限被评为“严重”；经常未能完成病历被评为“轻微严重”。一位被认为有“不太严重”专业精神问题的住院医师也被认为“经常”（33.8%的受访者）或“总是”（6.5%）有“严重”或“关键”问题。最常见的评估方法是临床/顾问评估。然而，50.7%的 PD 表示，现有的评估方法在识别严重的专业精神问题方面不够充分。不专业行为最常通过非官方教员投诉（54.5%）发现。80%的人报告说，与其他核心能力相比，专业精神更难纠正。住院医师对问题的所有权被认为是纠正成功的关键（84.4%）。PD 认为住院医师纠正方面最大的挑战是缺乏住院医师的洞察力或对问题的责任感（45.2%）和个性/行为问题（32.9%）。
在急诊医学住院医师中识别和纠正专业精神是具有挑战性的。未来的目标是创建一个系统，使 PD 能够使用标准化途径作为识别和纠正不专业行为的指南。
