The Need for Professionalism

There are a number of studies that describe widespread unprofessional behaviors by a variety of healthcare professionals, including faculty, students and staff. These behaviors have contributed to medical errors, unsafe working environments, and high levels of cynicism and burnout.

Unprofessional behaviors in superiors and peers can lead to ethical erosion in trainees. In one study, third-year medical students anonymously reported observation, participation in and perceptions of 27 unprofessional behaviors before and five months after clerkships. Student observation of (21 of 27) and participation in (17 of 27) unprofessional behaviors increased. Students perceived unprofessional behaviors as increasingly appropriate. Participation in unprofessional behaviors was associated with diminished likelihood of perceiving a behavior as unprofessional.

Surveys and other studies of U.S. medical schools and practicing physicians identify a need for improvement in professionalism education. An American Osteopathic Association publication highlighted difficult issues in professionalism assessment and remediation.

Many studies have shown the effects of unprofessional behaviors in medical education. In one study, 98 percent of medical students at six schools reported observing unethical and unprofessional behaviors among faculty. In another study, many students admitted to participating in what they considered unethical behavior.

Learners have reported high levels of cynicism and burnout related to their exposure to unprofessional behaviors. Moreover, because of the pressures of the hidden curriculum, students who observe and participate in unprofessional behaviors find them to be more acceptable than they had previously indicated.

These studies highlight the need for professional formation training among learners.