Resident perspectives on professionalism lack common consensus.
OBJECTIVE
We sought to characterize and understand the residents' perspective on how professionalism develops through pediatric emergency medicine experiences.


METHODS
Qualitative methods (freelisting--listing words associated with professionalism--and semistructured interviews) were conducted with senior emergency medicine and pediatric residents about their experiences rotating in the emergency department of a large, urban, tertiary care, freestanding children's hospital. All senior residents were eligible, with purposive sampling to maximize demographic variability. Saliency (importance) of words was analyzed with Smith S scores and consensus analysis. Interviews were conducted until content saturation was achieved; transcripts were coded by independent investigators to reach thematic consensus.


RESULTS
Twenty-five interviews (36% emergency, 64% pediatrics) were conducted. Common words associated with professionalism were "respect," "compassion," "empathy," and "integrity"; however, residents did not share a common consensus. The framework for how residents described the development of their professionalism includes observations, interactions, and environment. Examples include resident observation of role models; interactions with patients, families, and coworkers; self-reflection; and the unique environment of the ED. Residents believed that role modeling was the most influential factor. Few reported receiving sufficient observation by attending physicians during their interactions with patients and most reported receiving little direct feedback on their professionalism. Residents' descriptions of professionalism crossed multiple Accreditation Council for Graduate Medical Education (ACGME) competencies.


CONCLUSIONS
Residents displayed high variability in their understanding of professionalism, which was frequently at variance with the corresponding ACGME competency definition. The resident perspective and understanding of professionalism may usefully inform refinements in ACGME milestones and entrustable professional activities.
Departments of Pediatrics and Emergency Medicine, UCSF Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA. Electronic address: christine.cho@ucsf.edu.
Christine S
CS
Cho
Division of Emergency Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Eva M
EM
Delgado
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Frances K
FK
Barg
Division of Emergency Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Jill C
JC
Posner
D002983:Clinical Competence / Q000592:standards*; D004635:Emergency Medicine / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D010372:Pediatrics / Q000193:education* / Q000592:standards; D010817:Physician-Patient Relations; D036301:Qualitative Research