Observation, reflection, and reinforcement: surgery faculty members' and residents' perceptions of how they learned professionalism.
OBJECTIVE
To explore perceptions of how professionalism is learned in the current academic environment. Professionalism is a core competency in surgery (as in all of medical practice), and its presence or absence affects all aspects of clinical education and practice, but the ways in which professional values and attitudes are best transmitted to developing generations of surgeons have not been well defined.


METHODS
The authors conducted 34 semistructured interviews of individual surgery residents and faculty members at two academic institutions from 2004 to 2006. Interviews consisted of open-ended questions on how the participants learned professionalism and what they perceived as challenges to learning professionalism. Two researchers analyzed the interview transcripts for emergent themes by using a grounded-theory approach.


RESULTS
Faculty members' and residents' perceptions of how they learned professionalism reflected four major themes: (1) personal values and upbringing, including premedical education experiences, (2) learning by example from professional role models, (3) the structure of the surgery residency, and (4) formal instruction on professionalism. Of these, role modeling was the dominant theme: Participants identified observation, reflection, and reinforcement as playing key roles in their learning from role models and in distinguishing the sometimes blurred boundary between positive and negative role models.


CONCLUSIONS
The theoretical framework generated out of this study proposes a focus on specific activities to improve professional education, including an active approach to role modeling through the intentional and explicit demonstration of professional behavior during the course of everyday work; structured, reflective self-examination; and timely and meaningful evaluation and feedback for reinforcement.
Park
Jason
J
Department of Surgery and the Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada. jpark@sbgh.mb.ca
Woodrow
Sarah I
SI
Reznick
Richard K
RK
Beales
Jennifer
J
MacRae
Helen M
HM
D000328:Adult; D003142:Communication; D004503:Education, Medical, Graduate; D005180:Faculty, Medical; D005260:Female; D013502:General Surgery / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D008297:Male; D017145:Models, Educational; D010819:Physician's Role; D036301:Qualitative Research; D012056:Reinforcement, Social; D012938:Social Perception; D012944:Social Support; D011795:Surveys and Questionnaires; D013663:Teaching