5 questions about teaching radiology residents about professionalism

Radiology residents are expected to be professional, but teaching a concept as abstract as professionalism can prove difficult for educators. The so-called “non-interpretative skill” can allow for different interpretations, discrepancies in curriculum and difficulties in assessing progress.

A special review, published online Feb. 22 in Academic Radiology, discusses how to teach and asses professionalism to radiology residents, while offering best practices to do so. The article was written by Aine Marie Kelly, MD, MS, MA, with the department of radiology at University of Michigan in Ann Arbor, and Patricia B. Mullan, PhD, with UM Medical School’s department of learning health sciences.

1. Why teach professionalism at all?

The authors point out a perceived decline in professionalism among physicians, which has led to greater emphasis in graduate and post-graduate programs.

“If we do not emphasize professionalism and ethics in medical school and residency, trainees may be more likely to perceive that it is not important,” Kelly and Mullan wrote. “In previous years, professionalism was less explicitly taught, and learning was more entrenched in the “hidden” or informal curriculum, or through role modeling, parables, and mentors. Even if there were formal courses on professionalism in the preclinical years, they seldom involved summative evaluation of students.”

2. What, exactly, should be taught? 

The two offer a sample formal curriculum for radiology residents with 16 categories, emphasizing desired personal qualities like mindfulness and reliability alongside more practical behaviors like staying informed of new scientific developments.

Training learn about aspects of professionalism through a combination of structured curriculum and the “hidden curriculum” they see and experience.

3. How should it be taught?

Professionalism, Kelly and Mullan point out, is not something that can stand alone as a one-off lesson. It’s tied to a radiologist’s overall goal of delivering high-quality care to a care.

“Teaching professionalism subtopics to groups of residents lends itself to the case method of learning, with clinical (or non-interpretative) scenarios or vignettes presented by the facilitator or the trainees,” the authors wrote. “Scenarios can be presented to small groups by the lecturer or as a handout and a short time is allotted to discussion of the decisions faced and the potential outcomes. Cases can be real, from past events, or constructed to strategically and intentionally cover aspects of radiology practice.”

Kelly and Mullan, for example, suggest diagnostic imaging residents imagine what a patient experiences when going through the radiology department, from initial consultations and scheduling to the examination and discussion of findings.

They also suggest unstructured methods of education like keeping a journal, discussing interactions with patients and playing out case studies in groups.

4. How should instruction be evaluated?

Assessing progress in this area of resident education can be difficult. It’s unlike medical knowledge, which can be measured through tests. The Accreditation Council for Graduate Medical Education (ACGME) calls for six core competencies related to professionalism:

This competency states that residents should demonstrate compassion; integrity and respect for others; responsiveness to patient needs that supersedes self-interest; respect for patient privacy and autonomy; accountability to patients, society and the profession; and sensitivity and responsiveness to diverse patient populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities and sexual orientation.

But these qualities can be difficult to judge with right/wrong or white/black assessments. The authors suggest other methods to measure aptitude in residents, including:

• Using global rating scales with multiple levels of performance.
• A 360-degree assessment that collects evaluations from individuals, nurses, technologists, chief residents, etc.
• Peer assessment.
• A mini-evaluation exercise covering 24 behaviors on a four-point scale.

5. How should lapses be addressed?

According to a 2008 survey of program directors, 95 percent of them managed lapses by expressing expectations of improvement, 68 percent used psychological counseling, 59 percent used probation and 30 percent used dismissal.

“Lapses manifesting as cognitive or academic issues may be addressed with an educational program and more intense instruction and supervision by faculty and mentors,” the authors wrote. “Recognizing that behavioral and interpersonal issues might be more difficult to address at the departmental level, some institutions have dedicated programs to help remediate residents (and faculty) with perceived lapses in professionalism.”