Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty

Background 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.

Do Programme Coordinators Contribute to the Professional Development of Residents? An Exploratory Study

Background: With the development of training programmes for health professions, the role of programme coordinators has become increasingly important. However, their role in providing educational support for the professional development of resident trainees has not been well investigated. This study aimed to qualitatively analyse the involvement of programme coordinators in educational support for residents.Methods: Semi-structured reflective writing on “support for residents” was collected from programme coordinators in teaching hospitals in Japan in 2017-18 using a web-based questionnaire. Descriptions were qualitatively analysed thematically, using the professional identity formation (PIF) framework. Results: A total of 39 cases of “support for residents” by 31 coordinators were analysed. We found that prior personal problems, including mental health issues and insufficient social skills/unprofessional behaviour, were the most common issues that residents faced. Thematic analysis revealed that coordinators played a variety of educational roles: 1) requesting supervisors to re-consider their teaching; 2) protecting residents from the negative influence of clinical experiences; 3) facilitating residents’ self-assessment and confidence; 4) creating a safer learning environment; 5) providing support for prior personal problems, 5-1) fostering a better atmosphere for the mental health of residents, 5-2) intervening for residents with insufficient social skills/unprofessional behaviour; 6) providing support for isolated residents; and 7) preventing problems with peers. Conclusions: This study identified seven educational roles of programme coordinators for residents from a standpoint of PIF of residents. It also discussed four valuable attributes for coordinators: non-hierarchical relationships with residents, parenting attitudes, sensitivity to residents’ change, and the perspective of a member of the public. These attributes would underpin coordinators’ educational roles and facilitate the professional development of residents. This study provides a basis for defining and revising the role profiles of programme coordinators.

The Presence of Ghost Publications Among Canadian Plastic Surgery Residency Applicants: How Honest Are Canadians?

Background: Physicians with history of unprofessional behaviour during their medical training are shown to be 3 times more likely to have board disciplinary action later in their career. One realm in which unprofessional behaviour takes place is the phenomenon of unverifiable publications or “ghost publications.” To that end, this study aims to assess the rate of ghost publications among a recent cohort of Canadian Plastic Surgery residency applicants to determine if this phenomenon is geographic in nature. Methods: The current study was a retrospective, cross-sectional observational study; a review of all residency applications submitted to a single Canadian Plastic Surgery residency program from 2015 to 2018 was performed and all their listed publications were verified for accuracy. The review was conducted by a third party librarian and a research coordinator blinded to the authors identifying information. “Ghost publication” was defined as any publication listed as “published,” “accepted,” or “in-press” that did not exist in the literature. Results: A total of 196 applications of 186 applicants were submitted over the span of 4 years. A total of 362 publications listed as peer-reviewed articles, belonging to 114 applications were extracted and reviewed. Among the 362 publications listed as peer-reviewed articles, 2 could not be found in the literature (0.55%). Additionally, 42 citations were found with 48 minor differences than what was cited. Conclusions: The rate of ghost publications among recent applicants to a Plastic Surgery residency program is low (less than 1%). Future studies should investigate methods to further improve and instill the value of professionalism in our future plastic surgery trainees.

Factors Contributing to Unprofessional Behaviour among Nursing Students at the University of Namibia

Globally, there is a universal expectation that nurses should have a duty to serve others with commitment and dedication. Therefore, it is expected from all professional nurses including nursing students that they behave professionally and ethically in accordance with the ethical codes of practice and conduct. Unprofessional behaviour among student nurses has the potential to negatively affect staff and workplace relationships, and most importantly, compromise patient safety and care. The factors contributing to unprofessional behaviour among nursing students in Namibia have not been extensively researched. This requires institutions of higher learning to establish which factors are likely to promote unprofessional behaviour among student nurses, which could then be used to deal with unprofessional behaviour among these students. The objectives of this study were to explore and understand the factors contributing to unprofessional behaviour among nursing students at the University of Namibia. A qualitative, explorative, descriptive and contextual study was conducted. The accessible population in this study consisted of 17 undergraduate nursing students. Purposive sampling was used and the requisite data collected from the 17 participants using individual semi-structured interviews. The data were analysed by means of qualitative content analysis. Three themes were subsequently identified, namely, unprofessional behaviour in nursing, factors contributing to unprofessional behaviour, and moulding unprofessional behaviour. These findings call for well-articulated plans on the part of the faculty management team to deal with unprofessional behaviour among nursing students. It is recommended that further research be conducted to identify specific curriculum components that may be incorporated to strengthen the teaching of nursing ethics to students.

How to distance yourself from social media problems

This year certainly highlighted the benefits of social media for staying in touch with friends and family. But what are the risks? Here, Andrew Collier provides guidance for the dental nurse when posting photos online Aim To consider the personal and professional implications and potential pitfalls in the use of social media Objectives Enhance the understanding of professional behaviour and obligations both inside and outside of the dental surgery, including the use of social media Consider possible patient perception of unprofessional behaviour Review GDC guidance regarding social media use GDC development outcome D