Date of Award

10-12-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Julie Rosenbaum

Abstract

BECOMING THE DOCTOR I WANT TO BE: EVALUATING THE PROFESSIONAL DEVELOPMENT OF INTERNS. Merritt Evans, Eric Holmboe, Jeffrey Wong, Julie Rosenbaum. Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT. BACKGROUND: Several studies have suggested that the current medical training environment may include experiences that compromise trainees professional development. Little work has been done to explore this evolution during internship. METHODS: Interns in the Yale University Internal Medicine Residency Programs were asked to evaluate their professional development during internship through a qualitative study involving two open-ended written surveys and a focus group interview. Participants were identified in June 2003 during the annual Professionalism Workshop that occurs during internship orientation. Participanting interns completed an initial survey asking them to describe the physician each aspired to be. In February 2004, interns attended a follow-up Professionalism Workshop. Prior to the Workshop, participating interns completed a second survey, which asked them to evaluate their progress toward achieving their previously stated aspirations. Following this Workshop, interns were divided into three groups for a focus group interview. Each facilitator followed the same script, probing the personal and professional changes interns noticed in themselves during internship. Interviews were taped and transcribed. Data were analyzed using the constant comparison method by at least two investigators, who achieved consensus regarding the extracted themes. Twenty-four interns from the primary care, traditional, and medicine-pediatrics residencies participated, and nineteen completed all parts of the study. RESULTS: On the initial surveys, interns demonstrated great concordance in describing physician characteristics to which they aspire, such as being compassionate (N=19), competent (N=19), and an effective communicator (N=10). On the follow-up survey and in the focus groups, none of the interns said they were failing to become the doctor they would like to be. In the focus group discussion, interns believed they were on track to attain their professional ideals, although the constraints of internship forced them to delay focusing on certain aspirations, with more emphasis on developing certain competencies (e.g, technical proficiency and medical knowledge) instead of others (such as interpersonal skills). Themes that emerged from the interns descriptions of how they struggled to sustain their professional development included: acceptance of the role of intern (as distinct from an ideal of physician), the necessity of constricting their responsibilities to their patients given the limitations of internship, increased emphasis on self-care and self-awareness, and pride in the skills they mastered. CONCLUSIONS: Our interns entered residency with professional ideals consistent with most professionalism statements. Although interns were frustrated by parts of their educational experience, they still believed they were on track to become the doctors they wanted to be. However, they felt that they postponed development of interpersonal skills while emphasizing technical and knowledge aspects of care. Further research should evaluate more senior physicians to see if they still delay attainment of certain ideals, achieved their ideals, or altered them in favor of more attainable ones. If professional development remains compromised, the factors preventing physicians from achieving their ideals should be clarified and modified.

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