Table 1.

Responses to Survey 1.

Please describe the most common and/or most challenging unprofessional resident behaviors you have encountered.
Theme	Example Comments
Inappropriate comments about fellow employees (21%)	“Accusing other residents of improper behavior” “Badmouthing of faculty to other residents” “Inappropriate comments about resident peers, faculty or fellow employees in general”
Poor attendance/tardiness (21%)	“Lecture attendance issues” “The most common unprofessional resident behavior is tardiness. Nevertheless, it is also the most common attending behavior.”
Being disrespectful to support staff (21%)	“Disrespectful or unprofessional attitude (ex. Poor attitude towards/interactions with support staff)” “Contentiousness and interpersonal conflict among residents or between residents and support staff over work roles.”
Dishonesty (21%)	“Lying; falsifying documents” “Dishonesty”
Not attending conferences (17%)	“Not attending conferences” “Most common - missing conferences”
What actions do you take to address unprofessional resident behavior?
Theme	Example Comments
Talk to the residents involved (58%)	“Call the trainee to have a face to face conversation” “Face to face discussions with the trainee, providing direct feedback and asking each trainee for his or her action plan to address these behaviors.”
Document unprofessional behaviors (28%)	“Documenting unprofessional behavior in evaluations” “Documentation is clearly most important.”
Probation/Disciplinary action (28%)	“Use professional integrity office, use of “impaired provider program”, documentation!!!!.” “Leave of absence” “Monitoring of resident behavior”
Counseling (24%)	“Counseling Behavioral therapy Self reflection with journaling” “Start with counseling; progress to “professionalism probation” in extreme cases”
How do you determine if remediation is successful?
Theme	Example Comments
The behavior does not repeat (52%)	“End to inappropriate behavior” “See outcomes” “No repeat transgressions”
Observation/feedback from faculty (28%)	“Observation of repetitive behavior” “Very difficult. input from all faculty and chief residents” “Would be dependent upon the individual situation and may include – personal observation, monitoring feedback from faculty, achievement of specific behavioral goals (attendance, timeliness, etc)”
Have you ever dismissed a resident for professionalism issues?
5 respondents (17.2%) had dismissed a resident for professionalism issues:
4 of these respondents indicated that, Efforts were made to remediate the resident’s unprofessional behavior before termination. 1 respondent indicated that, The resident was terminated immediately due to egregiously unprofessional behavior.
Four of the respondents who dismissed a resident also provided the following comments:
“This was very difficult to do and requires extensive documentation” “Greater than 10 years ago. Was a mixture of professionalism and academic issues that led to non-renewal of the contract.” “A resident who clocked in another resident who did not come in for the day.(Human Resources dept got involved and it was an immediate dismissal.) I believe that the consequences were too severe but the human resource dept took over and it was a breach of hospital policy.” “The drug addiction case was largely out of my hands—had to follow institutional policy and state regulations. Resident was put in state mandated rehab—which was successfully completed and resident returned … ”