Authors: Chen F et al.
Anesthesiology, February 05, 2026, 10.1097/ALN.0000000000005974
This multi-institutional study examined how anesthesiology trainees and attending physicians perceive professionalism and unprofessional conduct in clinical training environments. Professionalism is considered a core competency in graduate medical education, yet there is limited specialty-specific research examining whether trainees and faculty interpret professional behaviors differently.
The investigators conducted a cross-sectional survey across five anesthesiology residency programs in the United States. Participants were presented with 19 hypothetical workplace scenarios describing potentially unprofessional behaviors. Each vignette was rated on a 7-point Likert scale according to the degree of perceived unprofessionalism. The scenarios were organized into five thematic categories: verbal conduct, supervision practices, quality of care, time management, and engagement with professional responsibilities.
A total of 369 individuals responded to the survey, including 153 trainees and 216 attending anesthesiologists, producing a response rate of approximately 36%. The researchers then used proportional odds models to analyze how perceptions varied based on professional role while adjusting for demographic variables such as age, gender, race, underrepresented minority status, and institutional affiliation.
The results showed considerable variation in how different behaviors were perceived. Six of the nineteen scenarios were widely agreed upon as clearly unprofessional, with more than 80% of respondents rating them as such. In contrast, four scenarios produced substantial disagreement, with fewer than half of respondents labeling them unprofessional. These findings suggest that while some behaviors are universally recognized as unacceptable, other situations fall into a gray zone where interpretation varies.
Institutional culture appeared to play a significant role in shaping perceptions. Five of the scenarios demonstrated strong differences between institutions, indicating that local norms and training environments may influence how professionalism is interpreted and enforced.
Age also influenced responses in several cases. Older physicians tended to rate certain behaviors as more unprofessional compared with younger respondents. In contrast, demographic factors such as gender, race, and underrepresented minority status did not significantly influence professionalism ratings.
The most consistent finding involved differences between trainees and attending physicians. After adjustment for demographic variables, trainees and attendings differed significantly in their assessment of ten scenarios. In nine of these scenarios, attending physicians judged the behavior as more unprofessional than trainees did. Only one scenario was rated as more unprofessional by trainees than by attendings.
These findings suggest that trainees may have a higher tolerance for certain behaviors or interpret professional expectations differently than faculty members. Alternatively, attendings may develop stricter views of professionalism as they gain experience and responsibility for patient care and teaching.
The authors emphasize that these differences do not necessarily indicate that trainees lack professionalism. Instead, they highlight the influence of clinical experience, generational expectations, and institutional culture on professional norms. Recognizing these differences may help educators design more effective professionalism curricula that address ambiguous situations and encourage open discussion between trainees and faculty.
Overall, the study suggests that professionalism is not always interpreted uniformly within anesthesiology training programs. While core standards remain consistent, perceptions of borderline behaviors vary depending on role, age, and institutional environment. These findings support the development of more context-sensitive educational strategies to align expectations between trainees and attending physicians.
What You Should Know
Professionalism is a central competency in anesthesiology training, yet perceptions of what constitutes unprofessional behavior vary among clinicians.
Attending physicians generally judged questionable behaviors as more unprofessional than trainees did.
Institutional culture had a measurable effect on how professionalism scenarios were interpreted.
Age influenced perceptions of professionalism in several scenarios, while gender and race did not show significant effects.
The study suggests that professionalism education may benefit from addressing ambiguous situations and explicitly discussing expectations between faculty and trainees.
Key Points
A multi-institutional survey evaluated perceptions of professionalism among anesthesiology trainees and attending physicians.
Participants rated 19 workplace scenarios involving potentially unprofessional behavior.
Six scenarios were widely recognized as clearly unprofessional, while several others showed substantial disagreement.
Attendings rated nine scenarios as more unprofessional than trainees.
Institutional culture significantly influenced responses in several cases.
The findings highlight the importance of structured professionalism education that accounts for generational and institutional differences.
Thank you to Anesthesiology for allowing us to summarize this article.