Emergency Medicine Directors’ Perceptions on Professionalism: A Council of Emergency Medicine Residency Directors Survey

Authors

  • Christine Sullivan MD,

    1. From the Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center (CS), Kansas City, MO; the Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School (TM), Newark, NJ; the Department of Emergency Medicine, UCSF–Fresno Medical Education Program (JC), Fresno, CA; the Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital (JLS), Providence, RI; and the Department of Emergency Medicine, Maricopa Medical Center (EDK), Phoenix, AZ.
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  • Tiffany Murano MD,

    1. From the Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center (CS), Kansas City, MO; the Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School (TM), Newark, NJ; the Department of Emergency Medicine, UCSF–Fresno Medical Education Program (JC), Fresno, CA; the Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital (JLS), Providence, RI; and the Department of Emergency Medicine, Maricopa Medical Center (EDK), Phoenix, AZ.
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  • Jim Comes MD,

    1. From the Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center (CS), Kansas City, MO; the Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School (TM), Newark, NJ; the Department of Emergency Medicine, UCSF–Fresno Medical Education Program (JC), Fresno, CA; the Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital (JLS), Providence, RI; and the Department of Emergency Medicine, Maricopa Medical Center (EDK), Phoenix, AZ.
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  • Jessica L. Smith MD,

    1. From the Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center (CS), Kansas City, MO; the Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School (TM), Newark, NJ; the Department of Emergency Medicine, UCSF–Fresno Medical Education Program (JC), Fresno, CA; the Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital (JLS), Providence, RI; and the Department of Emergency Medicine, Maricopa Medical Center (EDK), Phoenix, AZ.
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  • Eric D. Katz MD

    1. From the Department of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center (CS), Kansas City, MO; the Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School (TM), Newark, NJ; the Department of Emergency Medicine, UCSF–Fresno Medical Education Program (JC), Fresno, CA; the Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital (JLS), Providence, RI; and the Department of Emergency Medicine, Maricopa Medical Center (EDK), Phoenix, AZ.
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  • Presented at the Society for Academic Emergency Medicine annual meeting, Boston, MA, June 2011.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Nicole M. DeIorio, MD.

Address for correspondence and reprints: Christine Sullivan, MD; e-mail: Christine.Sullivan@tmcmed.org.

Abstract

ACADEMIC EMERGENCY MEDICINE 2011; 18:S97–S103 © 2011 by the Society for Academic Emergency Medicine

Abstract

Objectives:  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.

Methods:  In June 2010, the task force sent an anonymous survey via the CORD-EM listserv to PDs with active EM programs.

Results:  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%).

Conclusions:  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.

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