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Background: Professionalism is often taught to residents and medical students in case-based sessions using faculty-developed curriculum and faculty-led discussion. Resident-generated curriculum has been rarely published. After professional misconduct by a faculty member and reports of unprofessional conduct by residents from internal surveys of medical students, we surveyed our internal medicine residents to ask about gaps in professionalism training and optimal venues for professionalism education. Purpose: To develop case-based discussions within the morning report structure for resident-led discussion on professionalism topics that were not addressed by our standard faculty-generated curriculum. Description: A paper-based 9 item survey was distributed to residents at an attendance-required educational conference. 39 residents returned the survey. The survey revealed that a significant number of residents had engaged in less than ideal standards of professionalism at some time and that many residents had observed unprofessional behavior among attendings. Based on the results of this survey, one of the authors (RM) wrote 7 clinical cases involving ethical or professional dilemmas faced by residents that were infrequently addressed in our program. Topics addressed in these scenarios included respect for patients (specifically use of disparaging comments or labels), placing patient care needs above individual physicians needs, working through conflicts with other admitting services, providing medical care to a family member or significant other, inter-professional relationships with consulting residents, appropriate means of dealing with non-compliant patients who frequently 'bounce,' patient ownership when one resident admits a patient to another team's service, appropriate use of social media, and appropriate use of cut-and-paste function in the electronic health record. All of the scenarios also discussed responding to colleagues (including faculty) who were observed to engage in the unprofessional conduct highlighted in the case. Once per month instead of our usual morning report, one resident chose one or two cases of their choice and led discussion with residents and students. Faculty were invited to attend, but the chief resident requested that their input be restricted to posing questions instead of leading discusions. Over the course of twelve months, all cases were discussed at least once. Cases discussing respect for patients and appropriate use of social media were especially popular and chosen for over 50% of the sessions. Compared to our regular ethics conferences, these sessions were better attended and had more discussion by medical students. Conclusions: Resident-led discussion of resident-generated scenarios addressed perceived gaps in professionalism education in our internal medicine training program. Respect for patients and appropriate use of social media were the most frequently discussed topics.'


Oral presentation at Society of Hospital Medicine, 04/03/2012, San Diego, CA