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Nivolumab plus ipilimumab (N+I) in patients (pts) with colorectal cancer (CRC) with BRCA1/2 alterations (alts): Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study
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Would You Trust this Person Professionally? Seeking Agreement on Unprofessional Behaviors
No full textBackground
“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 \u3c 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 faculty
Fetal skull fracture with overlying hematoma after a high-speed motor vehicle collision with limited maternal trauma
No full textInside Aurora Sinai Medical Center, 2002 April
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2240/thumbnail.jp
Inside Aurora Sinai Medical Center, 2002 February
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2238/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 March
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events. This issue introduces the Planetree plan for Aurora hospitals.https://institutionalrepository.aah.org/alldocuments/2259/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 January
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2257/thumbnail.jp
A Bayesian re-analysis of the STRESS trial
No full textBackground: Prophylactic steroids are often used to reduce the systemic inflammatory response to cardiopulmonary bypass in infants undergoing heart surgery. The STRESS trial found that the odds of a worse outcome did not differ between infants randomized to methylprednisolone (n=599) versus placebo (n=601) (adjusted odds ratio [OR], 0.86; P=0.14). However, secondary analyses showed possible benefits with methylprednisolone. To investigate further using a different probabilistic approach, we re-analyzed the STRESS trial using Bayesian analytics.
Methods: We used a covariate-adjusted proportional odds model using the original STRESS trial primary endpoint, a ranked composite of death, transplant, major complication and post-op length of stay. We performed Markov Chain Monte Carlo simulations to assess the probability of benefit (OR1). Primary analysis assumed a neutral probability of benefit versus harm with weak prior belief strength (nearly non-informative prior distribution). To illustrate magnitude of effect, we calculated predicted risk of death, transplant or major complications for methylprednisolone and placebo. Sensitivity analyses evaluated pessimistic (5%-30% prior likelihood of benefit), neutral and optimistic (70%-95%) prior beliefs, and controlled strength of prior belief as weak (30% variance), moderate (15%) and strong (5%). A secondary analysis derived empirical priors using data from four previous steroid trials.
Results: The posterior probability of any benefit from methylprednisolone was 92% and probability of harm was 8%. Composite death or major complication occurred in 18.8% of subjects with an absolute risk difference of -2% (95% CI -3%, +1%) for methylprednisolone. Each of 9 sensitivity analyses demonstrated greater probability of benefit than harm in the methylprednisolone group with 8 of 9 demonstrating \u3e80% probability of benefit and ≥1% absolute difference in risk of death, transplant or major complications. In secondary analysis deriving priors from previous steroid trials, results were consistent with a 95% posterior probability of benefit.
Conclusion: Our Bayesian re-analysis of the STRESS trial, using a range of prior beliefs, demonstrated a high probability that perioperative methylprednisolone reduces the risk of death or major complications in infants undergoing cardiopulmonary bypass compared with placebo. This more in-depth analysis expands the initial clinical evaluation of methylprednisolone provided by the STRESS trial