Aimed to gain insight into patients’ expectations regarding the professionalism of GPs, we first studied unsolicited patient complaints. It appeared that a substantial proportion of unsolicited... Show moreAimed to gain insight into patients’ expectations regarding the professionalism of GPs, we first studied unsolicited patient complaints. It appeared that a substantial proportion of unsolicited complaints concern professionalism issues. This dissertation provides insight into how patients experience unprofessional behaviour of physicians.Further, it provides educators with appropriate language to describe the unprofessional behaviour of residents, which matches that of the 4 I’s model. This language can contribute to the early identification of professionalism issues and the remediation of lapses in professionalism.This dissertation also provides insights into the PIF of GP residents from the perspectives of both supervisors and residents. According to residents, identity formation occurs primarily in the workplace as they move from doing the work of to becoming a GP and negotiate perceived norms. Residents feel that a tapestry of interrelated influencing factors – most prominently clinical experiences, clinical supervisors, and self-assessments – which changes over time, is felt to exert its influence predominantly in the workplace. Their supervisors have an image of the professional identity they are supporting and work toward that goal through role-modeling and mentoring. Supervisors believe that a bond of trust between supervisor and resident is a prerequisite to properly support residents’ PIF. Show less
Background Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later... Show moreBackground Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. Methods We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. Results Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. Conclusions The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation. Show less
