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.
DISCLOSURE: The following authors have nothing to disclose: Versha Taparia, Kevin Felner, Brian Kaufman
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