Rationale and Objectives
Professionalism can be challenging to teach during residency training. We undertook this study to evaluate the impact of a case-based, reflective practice (RP) curriculum on the attitudes of radiology residents about professionalism.
Materials and Methods
We developed a case-based radiology-specific RP curriculum focused on topics related to professionalism and ethics. This year-long curriculum was comprised of six individual sessions and was attended by radiology residents. We assessed the program using the Penn State College of Medicine Professionalism Questionnaire, a validated instrument designed to assess attitudes toward professionalism, with anonymous responses collected before and after completion of the 1-year curriculum. We also obtained feedback on individual sessions.
Results
Our curriculum affected the professional attitudes of residents in 7 of 36 sample items on the professionalism questionnaire ( P <0.05), when analyzed as unpaired data. When stratified into seven specific elements of professionalism, significant differences in resident response were identified in the areas of accountability, honor and integrity, enrichment, and duty. Furthermore, residents generally agreed that the individual sessions were meaningful and were important to their future careers (3.8–4.4 on a five-point scale).
Conclusions
A case-based, RP curriculum centered about professionalism offers a unique practical approach to expose residents to the concepts of professionalism and ethics in a small group setting. Based on a widely used validated survey instrument, our results indicate that this method raises resident awareness about professionalism and impacts the way in which residents think about this topic and their eventual career.
Over the past two decades, there has been an increased focus on professionalism within the medical community. The Physician Charter , one of the most widely referenced publications about medical professionalism, states that “Professionalism is the basis of medicine’s contract with society.” The increased emphasis placed on professional patient-centered care has been noticeable in many fields including radiology. Major organizations such as the American Board of Radiology (ABR), Radiologic Society of North America (RSNA), and American College of Radiology have jointly made strides to educate radiologists about professionalism and ethics . Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) has mandated the incorporation of professionalism into residency training as one of the six core competencies .
There is no single validated, reliable instrument to measure professionalism . Nevertheless, the ACGME requires that training programs ensure that residents “demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles” . Because the definition of professionalism continues to evolve, teaching professionalism can be challenging. In addition, professionalism is not a competency that is readily quantifiable and therefore necessitates a more qualitative approach. In an effort to teach and evaluate professionalism, most residency training programs have integrated multiple approaches into the curriculum. These primarily include dedicated lectures, role modeling, and multisource feedback from peers, attending physicians, patients, technologists, nurses, and other support staff . Recently, a group of family physicians developed a comprehensive list of appropriate and inappropriate observable behaviors related to professionalism that would permit specific formative feedback to occur in the clinical environment . They recognize that professionalism is a complex topic best learned in a clinical context, where conflicts with value-based expectations can be recognized, discussed, and resolved. In practice, however, this approach may be challenging to effectively implement in training programs as residents work with a wide array of subspecialists and different services. However, it may be possible to incorporate these expectations and values into small group sessions, where reflection on clinical scenarios permits a valuable discussion about professional behavior.
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Materials and methods
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Results
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Table 1
Participant Survey Responses, Preintervention Versus Postintervention
Elements of Professionalism Preintervention ∗ % Postintervention ∗ % Comparing Groups † Comparing Paired Data ‡ Accountability Assumes leadership 22 76 23 77 0.835 1.000 Recognizes own limits 28 97 29 97 0.853 0.480 Adaptable 25 86 29 970.002 0.248 Practices cost-effectively 17 59 20 67 0.357 0.505 Collaborative/respectful 29 97 25 83 0.050 0.221 Maintains competence 24 83 24 80 0.683 0.617 Receptive to criticism 27 93 22 730.018 0.221 Enrichment Supports others’ professional development 23 77 23 77 1.000 0.752 Provides feedback 20 67 19 63 0.705 1.000 Attends conferences 16 53 23 770.003 0.070 Seeks self-improvement 28 93 28 93 1.000 0.480 Promotes junior faculty 18 60 24 800.006 0.181 Teaches others 24 80 26 87 0.283 0.683 Equity Practices to standards 25 86 26 87 0.845 1.000 Promotes justice 23 79 25 83 0.549 1.000 Appreciates differences 29 97 28 93 0.464 1.000 Respects others 28 93 30 100 0.517 0.480 Honor and integrity Values research evidence 26 87 28 93 0.143 0.617 Assumes personal responsibility 27 93 27 90 0.564 0.480 Truthful 29 100 26 870.037 0.480 Maintains professional relationships 30 100 29 97 0.309 1.000 Advocates patient interests over self-interest 26 90 25 83 0.359 1.000 Reliable 29 97 29 97 1.000 N/A Upright 29 97 29 97 1.000 N/A Conscientious 27 90 29 970.042 0.480 Altruism Compassionate 28 97 28 93 0.480 N/A Empathetic 27 93 27 90 0.564 1.000 Service-oriented 22 73 25 83 0.142 0.505 Duty Participates in corrective action processes 11 37 16 53 0.067 0.228 Does not advance one’s own career above another’s 27 90 29 970.042 0.617 Reports errors 27 93 27 90 0.564 0.617 Discloses conflicts of interest 25 86 26 87 0.845 0.683 Respects patient autonomy 27 93 29 97 0.286 0.480 Promotes confidentiality 27 93 27 90 0.564 1.000 Respect Avoid offensive speech 28 93 25 83 0.142 0.371 Professionally attired 21 72 23 77 0.574 0.683
Individual item statements are summarized from full Penn State Survey.
Bolded values: P <0.05 indicates significance.
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Table 2
Resident Attitudes Toward Individual Professionalism Sessions
Session This Session Added to My Understanding of Professionalism I Will Apply What I Learned in This Session to Residency This Session is Important to My Future Career 1 3.70 (1.06, 2–5) 4.10 (0.99, 2–5) 4.40 (0.70, 3–5) 2 3.90 (0.74, 2–5) 4.70 (0.48, 4–5) 4.30 (0.48, 4–5) 3 3.92 (0.64, 3–5) 3.62 (1.04, 1–5) 4.00 (0.96, 2–5) 4 3.63 (1.06, 2–5) 3.50 (1.06, 2–4) 4.13 (0.35, 4–5) 5 4.00 (0.82, 3–5) 4.00 (0.82, 3–5) 3.83 (0.75, 3–5) 6 3.67 (0.78, 2–5) 3.92 (0.79, 3–5) 4.08 (0.79, 3–5)
Five-point Likert scale (1, strongly disagree to 5, strongly agree). Results are expressed as mean (standard deviation, range).
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Discussion
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Acknowledgments
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Appendix
Session on the impaired or incompetent colleague
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Questions for thought: Should you ask to read out with a different attending? Should you find an abdominal attending to help read out the CT portion of the test (but they do not really want to do so since they do not like how the CT was performed)? Who should you talk to about this?
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Questions for thought: What is your responsibility to ensure quality of interpretations? Should locums tenens radiologists be held to a different standard than full-time employees of a hospital? Are you obligated to report this event to the Board of Medicine?
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Questions for thought: Should you have proceeded ahead? How could you have told your attending that you were not comfortable going ahead? Can you do this and if so, how?
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Questions for thought: What should you do? Should you talk to her directly about this or to whom should you speak? Are there any resources to help you to figure out what to do?
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Questions for thought: What should you do? Should you confront him directly? What resources are available to you and to Dr. S.? If you do not report your concerns, are you liable if any harm comes to a patient because of Dr. S’s problem?
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