Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

Abstract

Introduction: Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.

Method: In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a “brief” and “extended” professionalism checklist for monitoring physician misconduct.

Results: This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.

Discussion: Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Policy capturing: A method employed by researchers to assess how decision makers use available information when making evaluative judgments. The purpose of this methodology is to capture individual judges? decision-making policies, that is, how they weight, combine, or integrate information. It involves asking decision makers to judge a series of scenarios describing various levels of one or more explanatory factors, and then using statistical methods to determine the emphasis decision makers give to each factor in their decision-making process. The results indicate the relative importance of the various factors for the decision makers.

Notes on contributors

Dr. Michael J. Cullen, PhD is the Director of Evaluation for Graduate Medical Education at the University of Minnesota Medical School, Minneapolis, United States.

Dr. Mojca R. Konia, MD, PhD, is an Associate Professor and Vice Chair of Education and Residency Program Director in the Department of Anesthesiology at the University of Minnesota Medical School, Minneapolis, United States.

Dr. Emily C. Borman-Shoap, MD, is the Residency Program Director and Assistant Professor in the Department of Pediatrics at the University of Minnesota Medical School, Minneapolis, United States.

Dr. Jonathan P. Braman, MD, is the former Residency Program Director and is an Associate Professor in the Department of Orthopaedic Surgery at the University of Minnesota Medical School, Minneapolis, United States.

Dr. Ezgi Tiryaki, MD, is the former Residency Program Director and an Associate Professor of Neurology at the University of Minnesota Medical School and the Associate Chief of Staff for Education for the Minneapolis VA Health Care System, Minneapolis, United States.

Brittany Marcus-Blank, BA, is a doctoral student in the Industrial-Organizational Psychology Department at the University of Minnesota – Twin Cities, Minneapolis, United States.

Dr. John S. Andrews, MD, is the Associate Dean for Graduate Medical Education and the Designated Institutional Official (DIO) at the University of Minnesota Medical School, Minneapolis, United States.