CONTEXT: Unprofessional behaviors in medical school predict high stakes consequences for practicing physicians, yet little is known about specific behaviors associated with professionalism during residency. OBJECTIVE: To identify behaviors that distinguish highly professional residents from their peers. DESIGN, SETTING, AND PARTICIPANTS: Comparative study of 148 first-year internal medicine residents at Mayo Clinic from July 1, 2004, through June 30, 2007. MAIN OUTCOME MEASURES: Professionalism as determined by multiple observation-based assessments by peers, senior residents, faculty, medical students, and nonphysician professionals over 1 year. Highly professional residents were defined as those who received a total professionalism score at the 80th percentile or higher of observation-based assessments on a 5-point scale (1, needs improvement; 5, exceptional). They were compared with residents who received professionalism scores below the 80th percentile according to In-Training Examination (ITE) scores, Mini-Clinical Evaluation Exercise (mini-CEX) scores, conscientious behaviors (percentage of completed evaluations and conference attendance), and receipt of a warning or probation from the residency program. RESULTS: The median total professionalism score among highly professional residents was 4.39 (interquartile range [IQR], 4.32-4.44) vs 4.07 (IQR, 3.91-4.17) among comparison residents. Highly professional residents achieved higher median scores on the ITE (65.5; IQR, 60.5-73.0 vs 63.0; IQR, 59.0-67.0; P = .03) and on the mini-CEX (3.95; IQR, 3.63-4.20 vs 3.69; IQR, 3.36-3.90; P = .002), and they completed a greater percentage of required evaluations (95.6%; IQR, 88.1%-99.0% vs 86.1%; IQR, 70.6%-95.0%; P < .001) compared with residents with lower professionalism scores. In multivariate analysis, a professionalism score in the top 20% of residents was independently associated with ITE scores (odds ratio [OR] per 1-point increase, 1.07; 95% confidence interval [CI], 1.01-1.14; P = .046), mini-CEX scores (OR, 4.64; 95% CI, 1.23-17.48; P = .02), and completion of evaluations (OR, 1.07; 95% CI, 1.01-1.13; P = .02). Six of the 8 residents who received a warning or probation had total professionalism scores in the bottom 20% of residents. CONCLUSION: Observation-based assessments of professionalism were associated with residents' knowledge, clinical skills, and conscientious behaviors.
CONTEXT: Unprofessional behaviors in medical school predict high stakes consequences for practicing physicians, yet little is known about specific behaviors associated with professionalism during residency. OBJECTIVE: To identify behaviors that distinguish highly professional residents from their peers. DESIGN, SETTING, AND PARTICIPANTS: Comparative study of 148 first-year internal medicine residents at Mayo Clinic from July 1, 2004, through June 30, 2007. MAIN OUTCOME MEASURES: Professionalism as determined by multiple observation-based assessments by peers, senior residents, faculty, medical students, and nonphysician professionals over 1 year. Highly professional residents were defined as those who received a total professionalism score at the 80th percentile or higher of observation-based assessments on a 5-point scale (1, needs improvement; 5, exceptional). They were compared with residents who received professionalism scores below the 80th percentile according to In-Training Examination (ITE) scores, Mini-Clinical Evaluation Exercise (mini-CEX) scores, conscientious behaviors (percentage of completed evaluations and conference attendance), and receipt of a warning or probation from the residency program. RESULTS: The median total professionalism score among highly professional residents was 4.39 (interquartile range [IQR], 4.32-4.44) vs 4.07 (IQR, 3.91-4.17) among comparison residents. Highly professional residents achieved higher median scores on the ITE (65.5; IQR, 60.5-73.0 vs 63.0; IQR, 59.0-67.0; P = .03) and on the mini-CEX (3.95; IQR, 3.63-4.20 vs 3.69; IQR, 3.36-3.90; P = .002), and they completed a greater percentage of required evaluations (95.6%; IQR, 88.1%-99.0% vs 86.1%; IQR, 70.6%-95.0%; P < .001) compared with residents with lower professionalism scores. In multivariate analysis, a professionalism score in the top 20% of residents was independently associated with ITE scores (odds ratio [OR] per 1-point increase, 1.07; 95% confidence interval [CI], 1.01-1.14; P = .046), mini-CEX scores (OR, 4.64; 95% CI, 1.23-17.48; P = .02), and completion of evaluations (OR, 1.07; 95% CI, 1.01-1.13; P = .02). Six of the 8 residents who received a warning or probation had total professionalism scores in the bottom 20% of residents. CONCLUSION: Observation-based assessments of professionalism were associated with residents' knowledge, clinical skills, and conscientious behaviors.
Authors: Michael W Cullen; Darcy A Reed; Andrew J Halvorsen; Christopher M Wittich; Lisa M Baumann Kreuziger; Mira T Keddis; Furman S McDonald; Thomas J Beckman Journal: Mayo Clin Proc Date: 2011-03 Impact factor: 7.616
Authors: Amy T Wang; Nicole P Sandhu; Christopher M Wittich; Jayawant N Mandrekar; Thomas J Beckman Journal: Mayo Clin Proc Date: 2012-11-07 Impact factor: 7.616
Authors: Ryan F Coughlin; Alina Tsyrulnik; Michael Gottlieb; Jessica Bod; Ryan Barnicle; James Dziura; David Della-Giustina; Katja Goldflam Journal: AEM Educ Train Date: 2022-09-17
Authors: Michael W Cullen; Thomas J Beckman; Kristine M Baldwin; Gregory J Engstler; Jay Mandrekar; Christopher G Scott; Kyle W Klarich Journal: Tex Heart Inst J Date: 2020-08-01
Authors: Petra M Casey; Brian A Palmer; Geoffrey B Thompson; Torrey A Laack; Matthew R Thomas; Martha F Hartz; Jani R Jensen; Benjamin J Sandefur; Julie E Hammack; Jerry W Swanson; Robert D Sheeler; Joseph P Grande Journal: BMC Med Educ Date: 2016-04-27 Impact factor: 2.463