Hospitalists’ professionalism depends on job characteristics

By Sarah Guy

Hospitalists' participation in unprofessional behavior is uncommon, report researchers in the USA who found that job characteristics are associated with patterns of such behavior in this field.

For example, hospitalists with less clinical and more administrative time are more likely to make fun of others, and hospitalists who work nights are more likely to engage in behaviors relating to time pressure, like signing off early.

Furthermore, young hospitalists are most likely to participate in behaviors relating to workload management, say Vineet Arora (The University of Chicago, Illinois) and co-investigators, including celebrating a blocked admission.

"The discrepancy between what is taught about professionalism in formal medical education and what is witnessed in hospitals has received increasing attention," said Arora in an associated press release.

Writing in the Journal of Hospital Medicine, the research team suggests that interventions to promote professionalism should take institutional culture into account, should focus on behaviors with the highest participation rates, and could include educational or systems-based approaches.

Very few of the 77 hospitalists surveyed anonymously by Arora et al reported engaging in seriously unprofessional behavior such as falsifying patient records or performing procedures beyond their self-perceived skill level (6.4% and 2.6%).

Indeed, the two most common "unprofessional" behaviors reported were having nonmedical or personal conversations in patient corridors (67%) and ordering routine tests as "urgent" in order to expedite care (62%).

Arora and colleagues found that four specific factors accounted for over three-quarters (76%) of variance in hospitalists' responses to their survey: behaviors relating to making fun of others, workload management, the learning environment, and time pressure.

Hospitalists who engaged in any night work were significantly more likely than those who did not to participate in the latter, while those born after 1970 and those with any administrative time were significantly more likely to participate in behaviors relating to workload management.

The authors suggest that hospitalists with more clinical time (at least 5% full time equivalent) may make a greater effort than their more administrative-based counterparts to develop and maintain positive relationships. Equally, those with more administrative time may have competing priorities, motivating them to manage their workload more actively.

The time-pressure-associated behaviors identified by hospitalists who work nights could reflect high workloads and the pressure to "wrap-up" work, resulting in a hasty handover, note Arora and co-workers.

"These results have implications for future work to assess and improve professionalism in the hospital learning environment," they conclude.

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