Department of Medicine. INTERNAL MEDICINE RESIDENCY. Program information on the. About the Pacific Regional Medical Command and Tripler Army Medical Center.
Objective and Methods After significant concerns regarding resident professionalism were raised by Tripler Army Medical Center faculty, a novel transitional residency professionalism curriculum was conceived and implemented. Universal expectations of physician professionalism, as perceived by various stakeholders (patients, parents, faculty, and nurses), were explored using a small group, discussion-based curriculum. This was combined with a small group, discussion-based, lessons-learned project and a military-unique curriculum.
Introduction Transitional year residencies must provide a general enough clinical experience to prepare residents for a wide variety of specialty training programs. In the military, they must also provide an experience intense enough to give a background for independent practice as a general medical officer. The end result should be a clinician professionally mature enough to take on the roles of a specialty trainee, clinic supervisor, and/or command advisor. In our training program, it was made clear in 2008 during the annual internal review that faculty had serious concerns about resident performance regarding professionalism.
These concerns were partially based on recent events resulting in dismissal of 1 resident from the program for repeated lapses in professionalism and program-level remediation for several others. Several faculty members called for a transitional year program professionalism curriculum. Although professionalism curricula have been developed and published for many other specialties, such as pediatrics, surgery, anesthesiology, and internal medicine, –, published guidelines on professionalism training for transitional year residencies is lacking. The program sought to create a novel approach to professionalism training based on how it obtained feedback on resident performance in this core competency.
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Settings and Participants Tripler Army Medical Center has a small military transitional year residency program with 10 to 14 residents per year and 14 designated core clinical faculty. Approximately one-half of the residents select the program after failing to match in their specialty of choice. These residents will either match for an alternate program in their intern year or become general medical officers at the completion of their transitional year residency. The remaining residents are preselected for residencies in ophthalmology, radiology, dermatology, or anesthesiology. Educational Interventions At the time of inception, residents were solicited for ideas to improve professionalism training.
One recurring theme was the notion that expectations of professional behavior were nebulous. More than 1 resident stated that they couldn't explain what professionalism is, only what it is not.
Using published literature, and solicited faculty and resident feedback, a professionalism curriculum was developed, focusing on perceptions and expectations of the resident physician from patients, patients' families, nurses, and faculty. The impetus for this focus was the disparity of opinions regarding professional behavior expressed between these groups on prior resident evaluations and the knowledge that most programs rely on evaluations from a variety of sources to include nurses, patients, peers, and faculty regarding professionalism. The curriculum consisted of small group discussions, which were resident led but mediated by faculty, involving each of these parties.
There were 4 hour-long discussions held throughout the year. Each session focused on a different group: patients, parents of patients, nurses, and consulting faculty physicians. The discussions were scenario based and used an anonymous audience response software system to allow the residents to answer a series of questions about what qualities/behaviors constitute professionalism in a physician. 
The patients, faculty, family members, and nurses were provided the questions ahead of time and the responses were compared and contrasted.
Differences and similarities were discussed. In the course of the hour, 4 to 6 scenarios were presented and served as springboards for discussion. In the context of these discussions, the residents were able to voice areas of concern within the health care environment and were offered clarity regarding their role in the health care team and regarding patient expectations. Similarly, patients, nurses, family members, and faculty were able to voice their expectations of professional behavior from residents.