Purpose: Postgraduate trainees (‘residents”) are required to convey professional behaviours as they navigate complex clinical environments. However, little is known about experiential learning for professionalism. Thus, we asked residents about professionalism challenges within the clinical learning environment: 1) how challenges were identified, 2) what supported successfully addressing challenges and 3) the impact of addressing challenges to further inform resident education. Method: From 2015-2016, twenty-five residents across specialties and multiple university affiliated teaching hospitals participated in appreciative inquiry informed audio-taped semi-structured interviews. Transcripts were categorized deductively for the 2015 CanMEDS Professional Role element addressed (commitment to patients, society, the profession, and physician health).  A pragmatic research paradigm focussed descriptive data analysis on actions and outcomes.  Results: Residents actively identify opportunities for experiential learning of professionalism within the clinical workplace– addressing conflicting priorities with interprofessional clinicians to ensure excellent patient care, providing informal feedback regarding peers’ and other healthcare clinicians’ professionalism lapses and by gaining self-awareness and maintaining wellness. There were no descriptions of commitment to society. Values, relationships, and reflection supported professional behaviours. Many described transformative personal and professional growth as an outcome of addressing professionalism challenges. Conclusions: Residents self-regulated experiential learning for professionalism often results in transformational changes personally and professionally. Elucidation of how residents successfully navigate power dynamics and conflict to provide excellent patient care and feedback for professional regulatory behaviour will support professionalism education. An interprofessional research lens will be valuable to explore how best to incorporate commitment to society within clinical environments.

BackgroundThe multifaceted nature of leadership as a construct has implications for measuring leadership as a competency in junior residents in healthcare settings. In Canada, the Royal College of Physicians and Surgeons of Canada’s CanMEDS physician competency framework includes the Leader role calling for resident physicians to demonstrate collaborative leadership and management within the healthcare system. The purpose of this study was to explore the construct of leadership in junior resident physicians using a new multisource feedback tool.MethodsTo develop and test the Learning by Evaluation from All-Inclusive 360 Degree Engagement of Residents (LEADER) Questionnaire, we used both qualitative and quantitative research methods in a multiphase study. Multiple assessors including peer residents, attending physicians, nurses, patients/family members and allied healthcare providers as well as residents’ own self-assessments were gathered in healthcare settings across three residency programmes: internal medicine, general surgery and paediatrics. Data from the LEADER were analysed then triangulated using a convergent-parallel mixed-methods study design.ResultsThere were 230 assessments completed for 27 residents. Based on key concepts of the Leader role, two subscales emerged: (1) Personal leadership skills subscale (Cronbach’s alpha=0.81) and (2) Physicians as active participant-architects within the healthcare system (abbreviated to active participant-architects subscale, Cronbach’s alpha=0.78). There were seven main themes elicited from the qualitative data which were analogous to the five remaining intrinsic CanMEDS roles. The remaining two themes were related to (1) personal attributes unique to the junior resident and (2) skills related to management and administration.ConclusionsFor healthcare organisations that aspire to be proactive rather than reactive, we make three recommendations to develop leadership competence in junior physicians: (1) teach and assess leadership early in training, (2) empower patients to lead and transform training and care by evaluating doctors, (3) activate frontline care providers to be leaders by embracing patient and team feedback.