Residents’ transformational changes through self-regulated, experiential learning for professionalism

Abstract

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.

Ethical Issues in Residency Education Related to the COVID-19 Pandemic: A Narrative Inquiry Study

“…(10) While the rationale for competency-based medical education is "to ensure physicians graduate with the competencies required to meet local health needs," 11 research has also shown a lack of awareness regarding the commitment to the public aspect of the Professional Role even before the onset of the COVID-19 pandemic. 17 Although these gaps in ethics education, a lack of experience with managing ethical issues, and the potential lack of awareness amongst residents regarding broader public health needs all existed prior to the pandemic, the impact of the pandemic on residency training and the adoption of methods to maintain consistency in training quality has added more complexity. 5 For example, in the healthcare system changes to usual operations and the allocation of resources such as resident service significantly altered routine workflow in hospitals.…”

“…1 2 As such, “residents may have little direction on the practical management of ethical issues and principles.” (10) Furthermore, residents “have little experience applying them in complex patient care situations, and they are at a loss when they confront a situation in which at least one important principle of medical ethics must be relinquished.” (10) While the rationale for competency-based medical education is “to ensure physicians graduate with the competencies required to meet local health needs,” 11 research has also shown a lack of awareness regarding the commitment to the public aspect of the Professional Role even before the onset of the COVID-19 pandemic. 17…”

“…There may have been little exposure to commitment to the public (macroethical situations) until the pandemic. 17…”

“…There may have been little exposure to commitment to the public (macroethical situations) until the pandemic. 17 The circumstances of COVID-19 in residency education described above, such as the suspension of in-person learning as well as re-deployment of resident physicians, may have led 1 Populations are constituted by diverse communities of heterogeneous beliefs and practices. They represent communities and the broader social and environmental influences of health on these communities collectively.…”