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The study explored the learning experiences of first-year resident physicians during the first year of graduate medical education. The experiences of four intern physicians in the first year of residency training at an urban academic health system provided the site for the research. An exploratory case study research design was employed to examine the learning experiences of these new physicians. A qualitative approach was used to analyze data from interviews and ethnographic observations. The findings of this research study provide evidence surrounding how and what these physician trainees learned regarding professionalism during the first year of residency training. The findings indicate these first-year resident physicians experienced significant learning related to professionalism through incidental learning in the clinical environment, particularly from role models and the hidden curriculum. The interns learned both positive and negative professional behaviors from attending physicians. The findings illustrate the increases and decreases of confidence due to the development of clinical skills, increase in responsibilities, and increase in autonomy experienced by all four participants across the first year of residency training. Additionally, the findings highlight the important role of critical incidents, particularly memorable patient encounters, as potentially transformative learning experiences for these interns. Finally, the findings enumerate the pervasive influence of the hidden curriculum of graduate medical education on what these new physicians learned about professionalism, particularly the unprofessional social norms transmitted through attending physicians and others within the context of clinical learning. The findings of the research study support the conclusions that a) incidental learning experiences during the first year of residency education directly influenced how and what these new physicians learned regarding professionalism; b) these intern physicians experienced non-transformative learning during the first year of residency, but critical reflection and critical self-reflection after critical incidents did hold the potential to result in learning that was transformative; and c) the ubiquitous nature of the hidden curriculum significantly impacted what these first-year residents learned about professionalism. These conclusions contribute to the literature related to the development of professionalism in the new physician and the power of the hidden curriculum in medical education to influence professional identity development. Implications for medical educators and recommendations for future research are also identified.

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Since academic literature indicates that emotional intelligence (EI) is tied to work performance, there is increasing interest in understanding physician EI. We studied the EI of resident physicians in surgery, pediatric, and pathology residency programs at three academic centers to describe the EI profiles of residents in different specialties and determine whether gender differences in resident physician EI profiles mirror those in the general population. 325 residents were electronically invited to complete the validated Trait Emotional Intelligence Questionnaire (TEIQue), a tool comprised of 153 items that cluster to 15 independent facets, 4 composite factors, and 1 global EI score. The overall response rate was 42.8% (n=139, 84 women). Global EI of all residents (mean=101.0, SD=8.0) was comparable to the general population sample and was not statistically different between specialties or genders. EI profiling demonstrated distinct strengths and opportunities for development between specialty groups with an effect of specialty on sociability factor (p=0.005) and five TEIQue facets including optimism, stress management, emotion management, assertiveness, and social awareness (p=0.008-0.043). Women scored higher than men in emotionality factor (p=0.044) and the TEIQue facets impulse control, empathy, relationships, and self-motivation (p=0.004-0.049). Men scored higher than women in sociability factor (p=0.034) and 2 facets including stress management and emotion management (p=0.008-0.023). Linear regression demonstrated that age had a statistically significant predictive relationship with Global EI, though the effect was small (B=0.033, p=0.014). These findings suggest that similar to the general population, male and female residents may benefit from specific training of different EI domains to enhance well-rounded development. EI profiling may also inform future educational programming decisions for each specialty. Future research should focus on the functional relationship between educational interventions that promote targeted EI development and enhanced clinical performance.

Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The “hidden curriculum” within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies.

Graduate medical education (GME) is a critical link in the educational chain for physicians. Graduating from a strict apprenticeship model, GME has become a highly structured educational system whose peer-review organization provides an intentional and direct approach to ensuring that GME not only addresses the public's expectations of the profession but also positions itself to be a foundational structure in the outcomes-focused healthcare environment of the nation. GME is currently in a state of accelerated change—grounded in both educational and patient outcomes. This article provides an update on the significant changes that have occurred in GME over the past 10 years, a review of current initiatives and the perspectives related to educating physicians-in-training. Additionally, an analysis is provided on the future of GME, including areas of continued focus and uncertainty.

Indiana University-Purdue University Indianapolis (IUPUI) / In relationship-centered care, the relationship formed between physician and patient is critical to the creation of positive patient outcomes and patient satisfaction (Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess medical students’ abilities to utilize a relationship-centered approach in clinical interviewing. OSCEs, however, have recently come under scrutiny as critics contend that the overly scripted and standardized nature of the OSCE may not accurately reflect how medical students build and maintain relationships with patients. Although some studies have looked at how standardized patients help teach medical students interviewing skills, few studies have looked specifically at how the structured nature of the OSCE may influence relationship-building between standardized patients and medical students. Therefore, this study asks the question “How is relationship-centered care negotiated between standardized patients and medical students during a summative diagnostic OSCE?” Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an ethnographic field journal, transcripts of semi-structured interviews with SPs and medical students, and transcripts of headache and chronic cough videotaped scenarios. Using grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was conducted in discovering the saturation of conceptual categories, linking relationships, and in critically comparing interpretive categorical concepts with relevant literature (Josselson & Leeblich, 1999). Findings suggest that standardized patients and medical students hold differing expectations for 1) diagnostic information gathering and 2) making personal connections upon entering a diagnostic summative OSCE. SPs “open up” both verbally and nonverbally when medical students “go beyond the checklist” by asking discrete diagnostic questions and when overtly trying to connect emotionally. Fourth year medical students, however, expect SPs to “open-up” during what they experience as a rushed, time-constrained, and overly structured “gaming” exercise which contradicts their own clinical experiences in being more improvisational during empathetic rapport building. Differences between SPs and medical students’ expectations and communication practices influence how they perform during summative diagnostic OSCEs. Findings may suggest the re-introduction of more relationship-focused OSCEs which positions SPs as proactive patients who reflexively co-teach students about the importance of making personal connections.

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This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. In the first study, we report a number of barriers that might prevent supervisors from providing constructive feedback to medical trainees, including a fear of being labeled as intimidating or harassing. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees including insufficient documentation, a perceived lack of support from program leadership, insufficient opportunities to observe performance, competing demands on time, fear of appeals or legal action, and fear of reciprocated poor staff evaluations. The second study examines the effectiveness of two new tools for assessing trainees’ performance and determines that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Participants reported that the new tools were helpful for improving learning in six ways: by sparking a dialogue regarding performance; by promoting a structured, procedure-specific framework which could be used as a mechanism for providing high quality feedback; by providing a framework for directing future learning; by facilitating a systematic tracking of progress over time; by promoting an increased motivation to learn; and by introducing a learning focus to the intraoperative environment. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessments and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care. / Thesis / Master of Science (MSc) / This thesis investigates problems with current assessment and feedback practices in surgical training, and proposes ways to mediate some of these issues. We present two studies. In the first, we explore barriers that might prevent supervisors from providing constructive feedback to medical trainees. We also identify some barriers which make it challenging for supervisors to accurately report the progress of underperforming trainees. The second study examines the effectiveness of two new tools for assessing trainees’ performance and demonstrates that these tools might be helpful in overcoming some of the barriers identified in the first study to help supervisors provide more meaningful feedback to trainees. Together, the data from this thesis provide us with a better understanding of how we might improve the use of assessment and feedback in surgical training. The hope is that our findings will improve the education of new physicians and ultimately improve patient care.