Evaluating Professionalism in Residency Training: The Learning Environment for Professionalism Survey

Abstract Background Professionalism is a key competency in multiple medical education frameworks. The teaching and evaluation of professionalism is an accreditation standard for undergraduate and postgraduate medical training in Canada. As a result, there is a need for valid tools to assess professionalism in the learning environment (LE). One method that has demonstrated promise is the Learning Environment for Professionalism (LEP) survey. It is a brief and balanced tool consisting of 11 questions that assesses medical trainees' and attending physicians' positive and negative professionalism behaviours. Previous studies have shown it is an easily administered, reliable tool that produces valid results for assessing professionalism in both undergraduate and postgraduate LEs. This study aimed to expand the application of the LEP survey to more varied programs, across several institutions and to examine LEs longitudinally over a longer period of time. Methods All postgraduate medical programs at the University of Ottawa were approached to participate in this study. Seven training programs (anesthesiology, cardiac surgery, plastic surgery, urology, family medicine, internal medicine, and pediatrics) agreed to facilitate the administration of the LEP survey at four hospitals in Ottawa (The Ottawa Hospital Civic and General campuses, the Ottawa Heart Institute, and Children’s Hospital of Eastern Ontario). The LEP survey was carried out iteratively between 2013 and 2020. The LE ratings in each training program and hospital were assessed longitudinally using univariate linear regression. A Bonferroni corrected p-value of ≤ .0045 was used to account for multiple comparisons. Results 3783 survey responses over seven years were included in the analysis. Overall, positive professional behaviours were observed across time and programs. However, one negative item relating to attending physicians treating patients unfairly because of their financial status, ethnic background, sexual or religious preferences worsened. Conclusions This study demonstrated that applying the LEP survey longitudinally across diverse training programs is feasible. Furthermore, it can help program leaders identify areas that require attention and acknowledge areas of exemplary professionalism. Implementation of the LEP survey is an effective strategy to demonstrate continuous monitoring of the LE to accrediting bodies and can be considered an important quality improvement metric.