Recommended Citation
Simpson D, Ouweneel K, La Fratta T, et al. Connecting Unprofessional Behaviors to Trust: Medical Education Perspectives. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Perceived unprofessional behavior (PUB) poses a significant challenge in medical education (ME), as research demonstrates its adverse impact on patient care, teamwork, and learning. But what if professionalism is reframed as trust consistent with ME’s entrusted professional activities (EPA)? Agreement on which behaviors adversely affect trust can provide educators with a different approach to illuminate PUB.
Purpose:
To develop and conduct a needs assessment to assess the degree to which selected professionalism-related behaviors are linked to trust.
Methods:
Key ME stakeholders (i.e., learners, faculty, ME leaders/staff) submitted brief, de-identified unprofessional behaviors that they had experienced/witnessed exhibited in practice. Behaviors were categorized into 1 of 4 Feltman trust categories: reliability, competence (with humility), sincerity, or caring. 5 items were selected for each category (to represent an array of behaviors, settings, professional roles) yielding a 20-item assessment tool. ME stakeholders rated items on the degree to which they would trust this person as a professional (4-point Likert scale with unable to judge option). Protected time was provided in existing forums to complete the voluntary needs assessment using Survey Monkey to minimize anonymity concerns.
Results:
265 responses were received (July-October 2025) from residents/fellows (37%), medical students (18%), faculty (15%), ME staff (17%), and ME Leaders (12%) with average completion time < 4.5 minutes. Cronback’s Alpha = .84. Greater than 70% of respondents expressed a lack of trust (rating “No, Probably Not" or "No, Definitely Not" trust) on 75% of the items [e.g., being unresponsive to feedback (94%), senior trainee repeatedly late to service (92%); heavy cell phone in front of patients (86%)]. 15% of items had < 50% consensus [e.g., lack of progressive autonomy (49%); rarely asking for help/feedback (45%)]. When items were examined by trust categories, “sincerity” related items had the highest not trustworthy agreement (range: 78%-86%) while “competence with humility” related items had the lowest agreement (range: 44%-94%).
Conclusion:
Conducting a reliable needs assessment focused on unprofessional behaviors reframed as trust revealed common ground and a few areas of disagreement that will be used to foster candid conversations about professionalism and appropriate conduct.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
Connecting Unprofessional Behaviors to Trust: Medical Education Perspectives
Background/Significance:
Perceived unprofessional behavior (PUB) poses a significant challenge in medical education (ME), as research demonstrates its adverse impact on patient care, teamwork, and learning. But what if professionalism is reframed as trust consistent with ME’s entrusted professional activities (EPA)? Agreement on which behaviors adversely affect trust can provide educators with a different approach to illuminate PUB.
Purpose:
To develop and conduct a needs assessment to assess the degree to which selected professionalism-related behaviors are linked to trust.
Methods:
Key ME stakeholders (i.e., learners, faculty, ME leaders/staff) submitted brief, de-identified unprofessional behaviors that they had experienced/witnessed exhibited in practice. Behaviors were categorized into 1 of 4 Feltman trust categories: reliability, competence (with humility), sincerity, or caring. 5 items were selected for each category (to represent an array of behaviors, settings, professional roles) yielding a 20-item assessment tool. ME stakeholders rated items on the degree to which they would trust this person as a professional (4-point Likert scale with unable to judge option). Protected time was provided in existing forums to complete the voluntary needs assessment using Survey Monkey to minimize anonymity concerns.
Results:
265 responses were received (July-October 2025) from residents/fellows (37%), medical students (18%), faculty (15%), ME staff (17%), and ME Leaders (12%) with average completion time < 4.5 minutes. Cronback’s Alpha = .84. Greater than 70% of respondents expressed a lack of trust (rating “No, Probably Not" or "No, Definitely Not" trust) on 75% of the items [e.g., being unresponsive to feedback (94%), senior trainee repeatedly late to service (92%); heavy cell phone in front of patients (86%)]. 15% of items had < 50% consensus [e.g., lack of progressive autonomy (49%); rarely asking for help/feedback (45%)]. When items were examined by trust categories, “sincerity” related items had the highest not trustworthy agreement (range: 78%-86%) while “competence with humility” related items had the lowest agreement (range: 44%-94%).
Conclusion:
Conducting a reliable needs assessment focused on unprofessional behaviors reframed as trust revealed common ground and a few areas of disagreement that will be used to foster candid conversations about professionalism and appropriate conduct.
Affiliations
Aurora UW Medical Group, Aurora Sinai Medical Center, Aurora St. Luke’s Medical Center, Carolinas Medical Center – Atrium Health, Advocate Illinois Masonic Medical Center