Background:

Unprofessional behaviors undermine the hospital learning environment and patient care quality.A prior needs assessment of residents and hospitalists regarding lapses in professionalism was utilized to identify clinical scenarios which increased during internship at our 3 institutions (blocking admissions, disparaging the ED or PCP for missed findings, and misrepresenting a test as urgent).

Purpose:

To develop videos that illustrate common unprofessional behaviors by residents in the inpatient setting and the role that hospitalists may play in promoting such behavior. To use the videos to facilitate reflection among hospitalists on why unprofessional behaviors occur and how to prevent them. To ascertain whether the exercise resulted in changes in perception and intention to change behaviors.

Description:

With ABIM Foundation funding, a 60–minute video–based educational workshop was developed by faculty at three institutions to address unprofessional behaviors related to inpatient care. Scripts that highlighted three scenarios were developed and sent to internal and external reviewers for institutional relevance and external generalizability. Videos were filmed with a professional videographer and actors were coached by a member of the Screen Actor’s Guild. A moderator guide and debriefing tool was also developed and moderators practiced the workshop format prior to delivery. Workshops were scheduled at each individual institution and moderated by two core faculty. Video–based scenarios were viewed and participants, utilizing a structured debriefing tool, divided into groups and discussed behaviors highlighted in each video. Large group debrief followed each video, and addressed identifying potential barriers and strategies to professional behavior. Participants were asked to complete a post–workshop evaluation form regarding their beliefs on behaviors displayed in the video scenarios, satisfaction with workshop and its potential impact on future practice.

Conclusions:

Forty–four (53%) teaching hospitalists from three sites attended the workshop. 89% of participants reported the workshop to be “useful and effective” with two–thirds intending to change their behavior. Most (86%) thought video scenarios were realistic with praise for the “amazing scripts and acting.” When comparing pre and post responses among the 24 hospitalists who were able to complete the initial needs assessment 9 months prior, unprofessional behaviors were perceived as MORE unprofessional after participating in the workshop compared to baseline (disparaging ED/PCP 2.13 pre vs 1.35 post, P = 0.0001; misrepresenting test as urgent 2.92 pre vs. 1.79 post, P < 0.0001; celebrating a blocked admission 1.83 pre vs. 1.46 post, P = 0.04). Video–based education and debriefing is a feasible and effective way to promote interactive reflection and cultivate the desire to address unprofessional behaviors among academic hospitalists.