title: Fellows' in intensive care medicine views on professionalism and how they learn it.
abstract: BACKGROUND
  The emphasis on the importance of professionalism in a recent CoBaTrICE-IT paper was impressive. However, insight into the elements of professionalism as perceived relevant for intensivists from the fellows' view, and how these are taught and learned, is limited.
  
  
  OBJECTIVE
  A nationwide study was performed in 2007-2008. All ICM fellows (n = 90) were sent a questionnaire containing the following questions regarding training in professionalism (7-point Likert scale (1 = very inadequate, 7 = very adequate)): which are the elements perceived to be important in intensivists'' daily practice (38 items, cat. I)? Which methods of learning and teaching are recognised (16 items, cat. II)? Which methods of teaching and learning are considered especially useful (16 items, cat. III)? Finally, the perceived quantity and quality of formal and informal learning methods, as well as the responsible organisational body was studied. Data were analysed using SPSS 15.0.
  
  
  RESULTS
  Response was 75.5 % (n = 68), mean age 34 years. Regarding Elements, scores on virtually all items were high. The factor 'striving for excellence' explained half the variance. Two other aspects, 'Teamwork' and 'Dealing with ethical dilemmas', were identified. Regarding Methods, three dimensions, 'formal curriculum'', 'private and academic experiences' and 'role modelling', proved important. The factor 'formal curriculum' explained most of the variance. Regarding Usefulness the same factors, now mainly explained by the factor Private and academic experiences, emerged with variance. In both categories the items 'observations in daily practice' and 'watching television programmes like ER and House' were the highest- and lowest-scoring items (5.99 and 5.81, and 2.69 and 2.49, respectively). Mean scores regarding the quantity of formal and informal teaching were 4.06 and 4.58 (range 1.841 and 1.519). For the quality of teaching, the figures were 4.22 and 4.52 (range 1.659 and 1.560, respectively). 54 suggestions for improvement of teaching were documented. The need for some form of formal teaching of professionalism aspects as well as for feedback was most frequently mentioned (n = 19 and 16). The local training centres are considered and should remain pivotal for teaching professionalism issues (n = 17 and 28).
  
  
  CONCLUSIONS
  Almost all elements of professionalism were considered relevant to intensivists' daily practice. Although formal teaching methods regarding professionalism aspects are easily recognised in daily practice, learning by personal experiences and informal ways quantitatively plays a more important, and more valued role. Qualitative comments, nevertheless, stress the need for providing and receiving (solicited and unsolicited) feedback, thereby requesting expansion of formal teaching methods. The local training centres (should continue to) play a major role in teaching professionalism, although an additional role for the (inter)national intensive care organisations remains.
authors.affiliation: Department of Intensive Care, Maastricht University Medical Centre, P. Debeyelaan 25, 6202 AZ, Maastricht, The Netherlands. w.van.mook@mumc.nl
authors.forename: Walther N K A
authors.initials: WN
authors.lastname: van Mook
authors.forename: Willem S
authors.initials: WS
authors.lastname: de Grave
authors.forename: Simone L
authors.initials: SL
authors.lastname: Gorter
authors.forename: Arno M M
authors.initials: AM
authors.lastname: Muijtjens
authors.forename: Jan Harm
authors.initials: JH
authors.lastname: Zwaveling
authors.forename: Lambert W
authors.initials: LW
authors.lastname: Schuwirth
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003422:Critical Care; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D011795:Surveys and Questionnaires; D000078329:Workforce