Authors: Chen F et al.
Anesthesiology, February 5, 2026
Summary
Professionalism is a core ACGME competency, yet how anesthesiology trainees and attendings interpret “unprofessional behavior” may not be aligned. This multi-site cross-sectional study examined differences in professionalism perceptions across five anesthesiology residency programs.
A total of 369 respondents (153 trainees and 216 attendings; 35.9% response rate) rated 19 workplace vignettes depicting potentially unprofessional behaviors using a 7-point Likert scale. The scenarios were grouped into five thematic categories:
• Verbal conduct
• Supervision
• Quality of care
• Time management
• Engagement
Proportional odds modeling evaluated differences by role (trainee vs attending), adjusting for gender, race, underrepresented status, age, and institution.
Key findings:
• Six vignettes were broadly viewed as clearly unprofessional (>80% agreement).
• Four vignettes demonstrated substantial variability (<50% agreement).
• Significant institutional differences were identified in five scenarios (ORs <0.14 or >3.7).
• Age influenced ratings in five scenarios.
• Gender, race, and underrepresented status did not significantly affect ratings.
• After adjustment, trainees and attendings differed significantly in 10 of 19 scenarios.
In nine scenarios, attendings were more likely to rate behaviors as unprofessional (OR 0.26–0.50), whereas trainees rated only one scenario as more unprofessional than attendings (OR 2.01).
Overall, attendings appear to apply stricter standards in multiple domains, while trainees show greater tolerance or interpret context differently in certain professional gray zones.
Key Points
• Perceptions of professionalism vary significantly by clinical role.
• Attendings generally rated more behaviors as unprofessional compared to trainees.
• Institutional culture influences perceptions in several scenarios.
• Age affects some professionalism judgments; gender and race did not in this cohort.
• Not all professionalism scenarios are perceived uniformly — gray zones remain.
What You Should Know
For anesthesiology department leaders, residency program directors, and anesthesia group CEOs, this study highlights an important operational reality: professionalism standards are not universally interpreted the same way within departments.
In anesthesia — where teamwork, OR dynamics, supervision models, and time pressure are constant — misalignment in professionalism expectations may contribute to:
• Faculty-trainee conflict
• Disciplinary inconsistency
• Cultural fragmentation
• Variable feedback messaging
From a systems leadership standpoint, simply stating professionalism policies is insufficient. Programs may benefit from:
• Case-based professionalism discussions
• Institution-specific expectation calibration
• Transparent discussion of gray-zone behaviors
• Faculty development to ensure consistency in evaluation
For groups building culture across multiple hospitals — particularly if expanding across states or sites — this study reinforces the importance of clearly articulated behavioral standards coupled with structured dialogue.
Professionalism is both role-dependent and culture-sensitive. Effective education must account for both.
Thank you to Anesthesiology for allowing us to summarize and share this important article.