Pediatric Emergency Medicine Attending Perspectives on Maintaining Professionalism

Abstract

Attending physicians are the primary role models of professionalism, but little is known what their perspective is on the maintenance of their professionalism. This study characterizes the pediatric emergency medicine (PEM) attending perspective on maintaining professionalism during their career. Two qualitative methods were used: field observation and semi-structured interviews. Field observations were conducted in one pediatric emergency department (ED) based on a framework for professionalism education. Semi-structured interviews were conducted with a purposive sample of PEM attendings from across the country. Interviews were transcribed and themes analyzed using an iterative, inductive process. The two differing methods allowed for data triangulation. Forty-five hours of ED observation were completed with thematic coding of observations. Seventeen interviews were conducted with PEM physicians around the country with a wide variety of demographic characteristics. Observations and interviews revealed several themes describing the PEM attending’s perspective on professionalism. Challenges to professionalism include: patient related factors (such as high volume and acuity, difficult medical situations and dissatisfied families), staff interactions (RN, ancillary, etc), trainee education and interaction, ED environment, academic pressures, and personal factors. By understanding the PEM attending perspective on professionalism, resources and education can be better targeted for professional development and interventions to solve the challenges that PEM physicians identify. Understanding the PEM attending perspective may also be useful in developing assessment tools for attendings and may provide deeper insight into the impact of role models on trainee professionalism education.