American researchers spoke to 77 Illinois hospitalists – doctors who provide care tailored to the needs of hospitalized patients as a general internist, rather than focusing on an organ, disease or a specific patient age-group.
The three-center study found four key factors or patterns underlying unprofessional behavior: making fun of others, conduct in the learning environment (i.e. texting during educational conferences), workload management (i.e. celebrating transferring a patient) and time pressures (i.e. signing out early).
“The discrepancy between what is taught about professionalism in formal medical education and what is witnessed in hospitals has received increasing attention” says co-author Dr Vineet M Arora from the Department of Medicine at the University of Chicago, USA.
“As a result, regulatory agencies require training programs and medical schools to evaluate the learning environment and its impact on professionalism. Our research suggests that educational interventions could be tailored towards hospitalists with certain job types or personal characteristics.”
Most of the hospitalists who took part in the study (79%) completed their residency after the year 2000. More than half (57%) were male and had worked with their current hospital group for one to four years (61%). They were asked to grade more than 30 unprofessional behaviours on a simple, five-point scale commonly used in research to measure attitudes or opinions. Hospitalists reported witnessing unprofessional behaviour more frequently than taking part in it.
The most common unprofessional behaviors that hospitalists reported participating in were: having non-medical or personal conversations in patient corridors (67%), ordering a routine test as urgent to expedite care (62%), signing out a patient over the phone when it could have been done in person (41%) and making fun of other physicians to colleagues (40%). But when the researchers looked at how many observed those same behaviours in colleagues, the figures were much higher, at 80%, 80.5%, 66% and 67.5% respectively.
The four key factors or patterns underlying unprofessional behavior accounted for 76% of the variations in the survey responses and had the greatest impact on the overall findings.
Job characteristics – such as clinical time, administrative time and night work – together with age and hospital site were all associated with different patterns of unprofessional behavior.
For example, hospitalists with less clinical time were more likely to report behaviors relating to making fun of others. Young hospitalists and those who had any administrative duties were more likely to participate in behaviors related to workload management. And hospitalists who worked nights were more likely to report behaviors related to time pressures.
“Interventions to promote professionalism should take institutional culture into account and should focus on behaviors with the highest participation rates” concludes Dr Arora.
Dr. Kevin O’Leary, a co-investigator from Northwestern University summarized “Although this study found that unprofessional behavior was thankfully rare, such behavior is unacceptable in a professional hospital setting and needs to be addressed.”