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Study sheds light on patterns of unprofessional behavior

With increased focus on patient safety and quality of care, awareness of the need to ensure professional behavior among physicians has grown in importance. A recent study in the Journal of Hospital Medicine, which sought to quantify the extent of unprofessional behavior in the field of hospital medicine, found that job characteristics can play a role in the type and amount of such behavior.

The authors categorized their data on unprofessional behavior into four categories: making fun of others, conduct in learning environment (i.e., texting), workload management (i.e., celebrating transferring a patient), and time pressures (i.e., signing out early).

Some specific examples of such behavior, as described in a HealthLeaders Media article, include "ridiculing coworkers, clumsy and callous patient transfers, texting during meetings, and leaving work early."

The study found that, while incidence of unprofessional behavior by hospitalists is low, different shifts of hospitalists were more likely to participate in different types of unprofessionalism. Night shift hospitalists were more likely to engage in unprofessional behavior related to time management, whereas administrators and young physicians were more likely to engage in unprofessional behavior related to workload management. Also, clinicians were less likely than administrators to exhibit unprofessional behavior.

These results suggest that "educational interventions could be tailored towards hospitalists with certain job types or personal characteristics," said co-author Vineet Arora, MD, of the University of Chicago. Similarly, notes a study in the Archives of Surgery, graduate medical education program directors should be proactive in identifying and correcting behavioral issues in "problem residents."

This begs the question: Can professionalism be taught? A commentary in the Canadian Medical Association Journal explores this question and the impact of the formal versus "hidden" curriculum. The author notes, "Some doctors . . . wonder if professionalism can really be learned effectively in the classroom. Many of the qualities required to uphold the professional ideals of medical practice go far behind biological know-how. Selflessness, empathy, benevolence — these aren't exactly things one gleans from a text book."

The AMA has convened a study of the medical education learning environment that is looking at ways of measuring and assessing professionalism across the variety of clinical experiences that occur during the third and fourth years of medical school.