Participation in unprofessional behaviors among hospitalists: a multicenter study.

BACKGROUND: Unprofessional behaviors undermine the hospital learning environment and quality of patient care. OBJECTIVE: To quantify perceptions of, and participation in, unprofessional behaviors among hospitalists. DESIGN: Observational survey study. SETTING: Three academic health centers. SUBJECTS: Hospitalists. MEASUREMENTS: Observation, participation in, and perceptions of unprofessional behaviors. RESULTS: Response rate was 76% (77/101). Nearly all behaviors were perceived as unprofessional ("unprofessional" or "somewhat unprofessional" on the Likert scale). Participation in egregious behaviors (ie, falsifying records) was low (<5%). The most frequent behaviors reported were having personal conversations in patient corridors (67.1%), ordering a test as "urgent" to expedite care (62.3%), and making fun of other physicians (40.3%). Four factors accounted for 76% of survey variance: (1) making fun of others; (2) learning environment (eg, texting during conferences); (3) workload management (eg, celebrating a blocked-admission); and (4) time pressure (eg, signing out work early). Hospitalists with less clinical time (<50% full-time equivalents [FTE]) were more likely to report making fun of others (ß = 0.94 [95% CI 0.32-1.56], P = 0.004). Younger hospitalists (ß = 0.87 [95% CI 0.07-1.67], P = 0.034) and those with administrative time (ß = 0.61 [95% CI 0.11-1.10], P = 0.017) were more likely to report participating in workload management behaviors. Hospitalists who work night shifts were more likely to report participating in time-pressure behaviors (ß = 0.67 [95% CI 0.17-1.17], P = 0.010). Workload management and learning environment varied by site. CONCLUSION: While hospitalist participation in unprofessional behaviors is low, job characteristics (clinical, administrative, nights), age, and site were associated with different types of unprofessional behavior that may affect the learning environment and patient care.

Incoming resident interest in global health: occasional travel versus a future career abroad?

BACKGROUND: While there is growing interest among residents in participating in international health experiences, it is unclear whether this interest will translate into intentions to pursue a global health career. We aimed to describe overall interest in and career intentions toward global health among interns. METHODS: We administered an anonymous survey to incoming interns in all specializations during graduate medical education orientation at 3 teaching hospitals affiliated with 2 Midwestern US medical schools in June 2009. Survey domains included demographics, previous global health experiences, interest in and barriers to participating in global health experiences during residency, and plans to pursue a future global health career. RESULTS: Response rate was 87% (299 of 345 residents). The most commonly reported barriers to participating in global health experiences were scheduling (82%) and financial (80%) concerns. Two-thirds of interns (65%) reported they were likely to focus on global health in their future career. Of those envisioning a global health career, 77% of interns reported interest in participating in short, occasional trips in the future; and 23% of interns intended to pursue a part-time or full-time career abroad. Interns committed to a career abroad were more willing to use vacation time (73% vs. 40% of all others, respectively; P < .001) or to personally finance the trip (58% vs. 27% of all others, respectively; P  =  < .001), and were less concerned about personal safety than interns not committed (9% vs. 26% of all others, respectively; P  =  .01). CONCLUSIONS: Although a large proportion of incoming interns report interest in global health careers, few are committed to a global health career. Medical educators could acknowledge career plans in global health when developing global health curricula.

Changes in perception of and participation in unprofessional behaviors during internship.

BACKGROUND: Do perceptions of and participation in unprofessional behaviors change during internship? METHOD: Interns at three Chicago medicine residencies anonymously reported participation in unprofessional behaviors before and after internship. On the basis of a prior survey, interns rated 28 unprofessional behaviors from 1 (unprofessional) to 5 (professional). Site-adjusted regression examined changes in participation rates and perception scores. RESULTS: Response rates were 93% (105) before and 88% (99) after internship. Participation in on-call unprofessional behaviors increased ("blocking" admissions [12% versus 41%, P < .001], disparaging the ER [27% versus 45%, P = .005], misrepresenting tests as urgent to expedite care [40% versus 60%; P = .003], and signing out by phone [20% versus 42%, P < .001]). Participation in egregious behaviors (fraud, disrespect, misrepresentation) and perceptions of most behaviors remained unchanged. CONCLUSIONS: Although participation in egregious unprofessional behavior remained unchanged during internship, participation in on-call unprofessional behaviors increased.

Incoming interns' perspectives on the institute of medicine recommendations for residents' duty hours.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) has announced revisions to the resident duty hour standards in light of a 2008 Institute of Medicine report that recommended further limits. Soliciting resident input regarding the future of duty hours is critical to ensure trainee buy-in. PURPOSE: To assess incoming intern perceptions of duty hour restrictions at 3 teaching hospitals. METHODS: We administered an anonymous survey to incoming interns during orientation at 3 teaching hospitals affiliated with 2 Midwestern medical schools in 2009. Survey questions assessed interns' perceptions of maximum shift length, days off, ACGME oversight, and preferences for a "fatigued post-call intern who admitted patient" versus "well-rested covering intern who just picked up patient" for various clinical scenarios. RESULTS: Eighty-six percent (299/346) of interns responded. Although 59% agreed that residents should not work over 16 hours without a break, 50% of interns favored the current limits. The majority (78%) of interns desired ability to exceed shift limit for rare cases or clinical opportunities. Most interns (90%) favored oversight by the ACGME, and 97% preferred a well-rested intern for performing a procedure. Meanwhile, only 48% of interns preferred a well-rested intern for discharging a patient or having an end of life discussion. Interns who favored 16-hour limits were less concerned with negative consequences of duty hour restrictions (handoffs, reduced clinical experience) and more likely to choose the well-rested intern for certain scenarios (odds ratio 2.33, 95% confidence interval 1.42-3.85, P  =  .001). CONCLUSIONS: Incoming intern perceptions on limiting duty hours vary. Many interns desire flexibility to exceed limits for interesting clinical opportunities and favor ACGME oversight. Clinical context matters when interns consider the tradeoffs between fatigue and discontinuity.