Perceptions, attitudes and behaviors regarding professionalism and their relationships reported by newly enrolled...

The professionalism perceptions of newly enrolled residents determine how to implement targeted professionalism training during residency, but few studies have paid attention to this point. Moreover, it is unclear whether residents' perceptions reflect their attitudes and behaviors regarding professionalism when examined quantitatively. This study aimed to investigate residents' professionalism perceptions (their understanding of professionalism and approach to teaching professionalism), and to examine the relationships between perceptions, attitudes, and behaviors regarding professionalism.

Using cluster sampling, we conducted a cross-sectional survey of newly enrolled residents from 23 training bases of China Medical University in Liaoning Province, China. A self-designed qualitative questionnaire was used to understand the residents' professionalism perceptions, and the revised Penn State College of Medicine Professionalism Questionnaire and the China Medical Professionalism Inventory were used to assess their professionalism attitudes and behaviors respectively. Directed and conventional content analysis was used to analyze qualitative data. Descriptive statistics, Spearman rank correlation, and univariate/multivariable linear regressions were used to analyze the quantitative data.

A total of 838 (84.3%) residents effectively completed the survey. Through analysis of residents' professionalism perceptions, we identified 23 professionalism attributes across five domains (Compassion, respect, communication, and collaboration; Integrity and duty; Pursuit of excellence; Equity in health care, humanitarianism, adherence to ethical guidelines; and Other), 25 undergraduate courses involving professionalism in four disciplines, and 12 approaches to improving professionalism at five levels. We also found positive associations between professionalism perceptions and attitudes (β = 0.54, SE = 0.26), and between attitudes and behaviors (β = 1.18, SE = 0.04), but no association between perceptions and behaviors.

Residents collectively demonstrated a comprehensive understanding of professionalism, but there are inadequacies at the individual level, suggesting the need to strengthen the professionalism education during residency. No association was found between perceptions and behaviors, indicating the gap between them, and efforts are still needed to realize the translation from knowing into doing.