Recommended Citation
Simpson D, Ouweneel K, Bidwell J, et al. Would You Trust this Person Professionally? Seeking Agreement on Unprofessional Behaviors. Poster presented at: 2026 ACGME Annual Educational conference; February 19-21, 2026; San Diego, CA
Presentation Notes
Poster presented at: 2026 ACGME Annual Educational conference; February 19-21, 2026; San Diego, CA
Abstract
Background
“That’s just your perception” is a frequent response when told “That’s unprofessional.” Yet unprofessional behavior adversely affects individual learning and team functioning, while increasing avoidable patient complications and malpractice claims. But what if professionalism is reframed as trust? Is there agreement on which behaviors would adversely affect trust; thus, providing a different way to approach this quagmire? Is the person competent with humility? Is reliable? Do they care about others (beneficence)? Using an established four component model of trust as a framework, we wondered if key GME stakeholders would agree on what were untrustworthy behaviors.
Objectives
1. To identify an established evidence-based trust framework that intuitively resonated with those in GME.
2. To develop and conduct a needs assessment framed within the trust framework of key GME stakeholders (eg, residents, faculty, GME leaders, staff) to rate the degree to which selected professionalism-related behaviors are considered untrustworthy.
3. To examine if there are differences by role and/or by selected geographic locations (eg, Illinois, N Carolina, Wisconsin) to inform future interventions.
Methods
Residents, faculty, GME leaders/staff were asked to submit brief, de-identified unprofessional behaviors that they had experienced/witnessed. The behavior could be exhibited by anyone in GME (eg, resident, faculty member, coordinator). Behaviors were then categorized into 1 of 4 trust categories: reliability, competence (with humility), sincerity, or caring. 5 items were selected for each category (to represent an array of behaviors, settings, actors) yielding a 20-item assessment tool with two demographic items (role, state). Respondents rated items on the degree to which they would trust this person as a professional (4-point Likert scale). Protected time was provided in existing forums (eg, GMEC, faculty/resident meetings), to present a brief introduction to the tool and then complete it using SurveyMonkey to minimize anonymity concerns.
Results/Outcomes/Improvements
206 responses were received between July and September 2025 from Residents/Fellows (47%), Faculty (19%); DIOs, PDs, APDs (16%); and coordinators (18%), with average completion time < 4.5 minutes. Greater than 70% of respondents expressed a lack of trust (rating “No, Probably Not" or "No, Definitely Not" trust) on 75% of the items. For example, respondents expressed lack of trust on items about unapproved days off (85%), being unresponsive to feedback (96%), and heavy cell phone use in front of patients (84%) . Items with less consensus focused on timeliness of certification completions (47%), personal hygiene (46%), and asking for feedback (46%). When items were examined by the 4 elements of trust “sincerity” related items had the highest not trustworthy agreement ranging from 78%-86% while “competence with humility” related items had the lowest range of agreement 46%-75% of respondents expressing lack of trust. There were no observed differences by role or location.
Significance/Implications/Relevance
Unprofessional behavior poses a significant challenge in GME, as one’s perception is often reality—adversely impacting patients, teams, and learning environments. However, differing perceptions on what constitutes unprofessional conduct can complicate efforts to address these behaviors effectively. To navigate this complexity, we conducted a needs assessment using the 4 elements of trust framework to establish common ground as we seek to foster candid conversations about professionalism and appropriate conduct. Using trust as a framework is consistent with EPA decisions and reframes what can be thorny discussions about professionalism into one about trust among team members performing stressful jobs that require individuals to act with integrity, reliability, competence with humility, and caring. Our next steps are to hold scenario-based professionalism / trust discussions in our existing GME forums facilitated by trained residents and f
Type
Poster
Affiliations
Aurora Health Care
Advocate Health Care
Atrium Health / Levine Children’s – Charlotte, NC