The program in which you teach admits only 4 residents per year. Your admission process is an arduous one. Out of hundreds of applicants, only those with strong academic records, committed community involvement, and applicants who appear to be fully devoted to the specialty during the interview are considered. However, the admissions process is not without its flaws. Every now and then, a less deserving applicant is admitted who complicates life for everyone else.
Seth is one such resident whose acceptance might be questioned. Your seasoned admissions committee sometimes becomes mesmerized by a spotless grade point average in college and dental school, even to the point where qualities of a professional can be overlooked. Recently you received calls from 3 patients who complained that Seth does not return their text messages or phone calls. His chart entries are often incomplete, despite your admonition of the potential liability this incurs. And every time you lecture, Seth is late and has never approached you with any justification for his tardiness.
The “root” of professionalism is the profession itself. We select those that will succeed us by accepting individuals we believe are worthy of doing so. Our dental boards are appointed by us, and we are entrusted by society to determine if our graduates are sufficiently competent to treat the vulnerable public. We abide by our own ethical code. We seek to continually enrich the knowledge that defines our specialty through our choice of continuing education. However, along with these luxuries come obligations. The commitment to those behaviors that distinguish us as professionals such as reliability, dependability, and the desire to follow through with commitments are among them, but do these traits that define professionalism really matter?
The professional careers of medical school graduates whose transcripts were cited at least 3 times for disciplinary actions were evaluated. Three institutions were represented. Two hundred thirty-five of these individuals were compared with a control group of 469 MDs who were not involved in disciplinary actions but who graduated from the same schools. All subjects graduated between 1970 and 1999. The disciplinary actions occurred between 1990 and 2003. The most common offenses listed on the transcripts were “severe irresponsibility” and “diminished capacity for self-improvement.” Those MDs with transcript citations required disciplinary action after graduation at a rate of 8 times that of the control group. Apathetic behavior was also associated with increased frequency of disciplinary action.
Is there anything faculty can do to encourage and preserve professionalism? From the outset, emphasis on admission should not be overwhelmingly based on academic performance or the applicant’s ability to satisfy high tuition fees. Grade inflation and potential dishonesty can and does confound the authenticity of a transcript. And genuinely superb academic performance might not correlate with quality clinicians or academicians. Clear guidelines and emphasis on professionalism should be provided when the program begins. Feedback not only from faculty but also from co-residents, staff, and even patients via anonymous questionnaires should be used to determine if constructive feedback for a resident is indicated.
The selection of volunteer faculty should reflect the same emphasis. Faculty appointments should be based not only on the ability to offer didactic and clinical education but also to serve as ethical role models. The mere availability of a volunteer faculty member should not qualify for attending status if the individual’s history indicates unethical or unprofessional behavior.
Seth’s behavior, rather than his character, should be tactfully criticized. I recall that one of my favorite instructors always told me not to tell a patient that he’s sloppy and doesn’t brush his teeth. “That gets into a ‘Yes I do, no I don’t’ argument,” he said. “Rather, merely tell him he isn’t CLEANING his teeth.” Irrefutable.
As Sergeant Joe Friday, played by Jack Webb in the famous detective series, Dragnet would say, “Just the facts, ma’am.” That’s what Seth needs now.