Professionalism - Challenges and Opportunities

While all CLEs have mechanisms to address disruptive and disrespectful behaviors, the findings suggest that existing mechanisms are not always effective. Even if a CLE has an aggressive system to deal with unprofessional behavior, that system is undermined if standards are applied inconsistently. Similarly, no CLE wants its personnel to compromise their integrity but the finding that some residents and fellows feel that way suggests the need for further exploration. Absent robust attention to these issues, resident, fellow, and faculty physicians and other staff may conclude that the system lacks integrity or makes exceptions capriciously.

The findings suggest that CLEs are committed to providing a clinical and educational environment where professionalism is manifest. However, the findings also suggest that didactic and computer-based education, while necessary, are not sufficient to guide residents and fellows in important aspects of professionalism. CLEs are encouraged to improve resident and fellow learning through planned experiential activities. Such training could include role modeling and procedures to address a diverse set of topics, such as safety culture, team-work, patient interaction, cultural sensitivity, and diversity.

With regard to issues of mistreatment, there may be situations in which residents or fellows are uncomfortable pursuing resolution within the GME administrative structure. In these situations the resident or fellow and the CLE are at high risk for an unfavorable outcome. While all CLEs have established confidential, non-punitive reporting mechanisms for handling unprofessional behavior, this does not ensure residents and fellows are familiar and comfortable with the reporting mechanisms outside of GME.

CLER National Report of Findings - Challenges and Opportunities