title: Residents' perceptions of professionalism in training and practice: barriers, promoters, and duty hour requirements.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education duty hour requirements may affect residents' understanding and practice of professionalism.
  
  
  OBJECTIVE
  We explored residents' perceptions about the current teaching and practice of professionalism in residency and the impact of duty hour requirements.
  
  
  METHODS
  Anonymous cross-sectional survey.
  
  
  METHODS
  Internal medicine, neurology, and family practice residents at 3 teaching hospitals (n=312).
  
  
  METHODS
  Using Likert scales and open-ended questions, the questionnaire explored the following: residents' attitudes about the principles of professionalism, the current and their preferred methods for teaching professionalism, barriers or promoters of professionalism, and how implementation of duty hours has affected professionalism.
  
  
  RESULTS
  One hundred and sixty-nine residents (54%) responded. Residents rated most principles of professionalism as highly important to daily practice (91.4%, 95% confidence interval [CI] 90.0 to 92.7) and training (84.7%, 95% CI 83.0 to 86.4), but fewer rated them as highly easy to incorporate into daily practice (62.1%, 95% CI 59.9 to 64.3), particularly conflicts of interest (35.3%, 95% CI 28.0 to 42.7) and self-awareness (32.0%, 95% CI 24.9 to 39.1). Role-modeling was the teaching method most residents preferred. Barriers to practicing professionalism included time constraints, workload, and difficulties interacting with challenging patients. Promoters included role-modeling by faculty and colleagues and a culture of professionalism. Regarding duty hour limits, residents perceived less time to communicate with patients, continuity of care, and accountability toward their colleagues, but felt that limits improved professionalism by promoting resident well-being and teamwork.
  
  
  CONCLUSIONS
  Residents perceive challenges to incorporating professionalism into their daily practice. The duty hour implementation offers new challenges and opportunities for negotiating the principles of professionalism.
authors.affiliation: Johns Hopkins Bayview Medical Center, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. neda@jhmi.edu
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Shari
authors.initials: S
authors.lastname: Bolen
authors.forename: Eric E
authors.initials: EE
authors.lastname: Howell
authors.forename: David E
authors.initials: DE
authors.lastname: Kern
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Sisson
authors.forename: Dan
authors.initials: D
authors.lastname: Larriviere
mesh_terms: D001291:Attitude of Health Personnel; D004501:Education, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000523:psychology*; D010561:Personnel Staffing and Scheduling; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods