Background:
Unprofessional behaviors can undermine the hospital learning environment and patient care. To date, no study has examined unprofessional behaviors in hospitalists.
Methods:
A 35‐item survey of unprofessional behaviors adapted from prior studies was administered to hospitalists from 3 academic programs at 7 Chicago hospitals. The survey included behaviors related to interactions with others (i.e., making fun of residents), patient care scenarios (i.e., blocking an admission), and interactions with trainees (i.e., asking a student to perform a procedure beyond his or her skill). Participants reported whether they participated and rated their perception of this behavior on a Likert‐type scale ranging from 1 (unprofessional) to 5 (professional). Routine demographics including job type (clinical, teaching, research, administrative, night work, etc.) were also assessed. Data were merged with a deidentified code for site. Factor analysis was performed to extract the principal components of unprofessional behavior. A scree plot determined the number of factors to retain. Item loadings were used to name factors. Site‐adjusted multivariate regression models were used to examine the association between demographic and job characteristics and factors of unprofessional behavior.
Results:
Seventy‐eight percent of hospitalists (79 of 101) responded. Participation in egregious behaviors (i.e., falsifying medical records, mistreatment of students) was very low (<5%), and most behaviors were recognized as unprofessional (rated < 3 on the Likert). The most common unprofessional behaviors reported were having personal conversations in patient corridors (66%), ordering a routine test as “urgent” to expedite care (62%), texting or using smartphones during educational conferences (40%), and disparaging the emergency room (ER) or primary care physician for findings later discovered on the floor (40%). Factor analysis revealed 3 major factors that accounted for half of survey variance: (1) disrespect (e.g., making fun of residents, disparaging the ER), (2) patient safety (e.g., failing to report an error), and (3) workload reduction (e.g., blocking admissions). In site‐adjusted multivariate regression models, hospitalists with less clinical time were more likely to participate in disrespectful behaviors (β = 0.75, P = 0.014), but less likely to disregard safety (β = −20.69, P = 0.034). In addition, hospitalists with any night work were more likely to disregard safety (β = 0.57, P = 0.044). Younger hospitalists (β = 0.94, P = 0.029) and those with administrative time (β = 0.56, P = 0.38) were more likely to participate in behaviors to actively reduce workload. Site differences were only noted for workload reduction.
Conclusions:
Although participation in egregious unprofessional behaviors was low, job type (clinical, administrative, and night work), age, and institutional culture seem to be associated with certain behaviors. Future work to address professionalism among hospitalists should take these findings into account.
Disclosures:
V. Arora ‐ ABIM Foundation, NIA, AHRQ, ACGME, research funding; J. Iwaz ‐NIA, research funding; K. O’Leary ‐ ABIM Foundation, research funding; A. Didwania ‐ ABIM Foundation, research funding; A. Anderson ‐ ABIM Foundation, research funding; H. Humphrey ‐ ABIM Foundation, research funding; J. Farnan ‐ ABIM Foundation, research funding; D. Wayne ‐ ABIM Foundation, research funding; S. Reddy ‐ ABIM Foundation, research funding