Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
BMC Fam Pract. 2021 Dec 20;22(1):249. doi: 10.1186/s12875-021-01609-3.
Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied.
We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts.
Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined.
The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.
职业素养的缺失会对患者、医疗专业人员和社会产生深远的负面影响。培训期间的不专业行为与后期实践之间的联系需要及时识别和纠正。然而，在住院医师培训期间，缺乏描述不专业行为及其纠正的适当语言。因此，本探索性研究旨在调查根据监督员和教师的意见，哪些 GP 住院医师的行为被认为是不专业的，以及如何进行纠正。
我们对来自四个荷兰全科医生培训学院的 55 名广泛选定的监督员进行了八次半结构化焦点小组访谈。此外，我们还对八位指定的专业精神教师进行了单独的半结构化访谈。访谈录音逐字记录。数据分两步进行编码：初步归纳编码，然后使用最近开发的“四 I”模型中描述不专业行为的描述符进行二次演绎编码，作为敏感概念。
尽管参与者的职业地位不同，但我们还是确定了一个共同的概念，即准确识别和评估不专业行为。这两个群体都描述了多种不专业行为，可以成功地映射到“四 I”模型的描述符和类别上。“参与”和“互动”类别的行为被评估为轻度，并接受非正式的教学反馈。“内省”和“诚信”类别的行为被视为非常令人震惊，并接受严格的纠正。我们发现了两个新的行为群体；“神经衰竭投诉”和“朝九晚五心态”，需要添加到“四 I”模型中。不专业行为的诊断阶段通常始于监督员产生“警觉感”，这种警觉感被描述为“直觉”、“对教学的热情丧失”或“围绕住院医师的大惊小怪”。这种警觉感触发了纠正阶段。然而，诊断和纠正阶段似乎没有连续或明显的区别，而是交织在一起的。
识别和纠正住院医师不专业行为的过程似乎是交织在一起的。识别与缺乏内省或诚信有关的行为被认为是最重要的纠正内容。这项研究的结果为监督员和教师提供了一种描述住院医师不专业行为的适当语言，可以促进及时识别和纠正。
