Faculty Bibliography

PURPOSE: Current methods of measuring medical professionalism are subjective. They often do not account for high-pressure environments where professionalism can be strained, such as the intensive care unit (ICU). High-fidelity simulation (HFS) is a technology in which standardized, high-pressure patient scenarios are practiced. The standardization of HFS allows for objective measurement of professionalism-specific behaviors found in the ICU. METHODS: Forty-four second-year internal medicine residents underwent HFS of a critically-ill patient. Professionalism-specific behaviors pertaining to obtaining informed consent for central venous line (CVL) placement and disclosure of an iatrogenic complication secondary to the CVL were evaluated. A comprehensive checklist itemized pre-determined professionalism-specific behaviors as having been 'well done, ' 'partially done, ' or 'not done. ' The checklist was formulated from expert consultation, and items included objectively defined behaviors and excluded medical knowledge prerequisites. Video-recordings of simulations were reviewed by three independent raters, each of which underwent training prior to project initiation. RESULTS: Composite scores from three raters revealed that 74.2% (98/132) and 67.4% (89/132) of residents received 'well done ' scores for discussion of CVL benefits and risks, respectively. Sixteen percent (21/132) of residents received 'well done ' scores regarding discussion of alternatives to CVL placement. Concerning disclosure of the iatrogenic complication, 22% (29/132) of residents performed this task well. Cronbach's alpha analyses of internal consistency were .813 for obtaining informed consent and .709 for disclosure of the iatrogenic complication. CONCLUSIONS: During our ICU simulation, a majority of residents outlined benefits and risks to CVL placement well, though most neglected to discuss alternatives. Furthermore, a minority of residents disclosed the etiology of the iatrogenic complication. It is possible that the high-stress simulated ICU environment contributed to the low prevalence of these behaviors. CLINICAL IMPLICATIONS: Objective tools to evaluate medical professionalism are scarce. However, our assessment tool checklist demonstrates good internal consistency, and therefore HFS of a critically-ill patient can be used to reliably and objectively measure pre-determined professionalism-specific behaviors