Introduction: Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees’ perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism.

Methods: We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions.

Results: Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the “respect for others” and “honor and integrity” valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the “duty and service” domain (p<0.05). Among different residencies, significant differences were found with attributes within the “altruism” and “duty and service” domains (p<0.05).

Conclusion: Residents perceive differences in the relative importance of traditionally defined professional attributes and this may be useful to educators. Explanations for these differences are hypothesized, as are the potential implications for professionalism education. Because teaching professional behavior is taught most effectively via behavior modeling, faculty awareness of resident values and faculty development to address potential gaps may improve professionalism education.

Introduction: Many patients meeting criteria for severe sepsis are not given a sepsis-relateddiagnosis by emergency physicians (EP). This study 1) compares emergency department (ED)interventions and in-hospital outcomes among patients with severe sepsis, based on the presenceor absence of sepsis-related diagnosis, and 2) assesses how adverse outcomes relate to three-hoursepsis bundle completion among patients fulfilling severe sepsis criteria but not given a sepsisrelateddiagnosis.

Methods: We performed a retrospective cohort study using patients meeting criteria for severesepsis at two urban, academic tertiary care centers from March 2015 through May 2015. Weincluded all ED patients with the following: 1) the 1992 Consensus definition of severe sepsis,including two or more systemic inflammatory response syndrome criteria and evidence of organdysfunction; or 2) physician diagnosis of severe sepsis or septic shock. We excluded patientstransferred to or from another hospital and those <18 years old. Patients with an EP-assignedsepsis diagnosis created the “Physician Diagnosis” group; the remaining patients composed the“Consensus Criteria” group. The primary outcome was in-hospital mortality. Secondary outcomesincluded completed elements of the current three-hour sepsis bundle; non-elective intubation;vasopressor administration; intensive care unit (ICU) admission from the ED; and transfer to theICU in < 24 hours. We compared proportions of each outcome between groups using the chi-squaretest, and we also performed a stratified analysis using chi square to assess the association betweenfailure to complete the three-hour bundle and adverse outcomes in each group.

Results: Of 418 patients identified with severe sepsis we excluded 54, leaving 364 patients foranalysis: 121 “Physician Diagnosis” and 243 “Consensus Criteria.” The “Physician Diagnosis” grouphad a higher in-hospital mortality (12.4% vs 3.3%, P < 0.01) and compliance with the three-hour sepsisbundle (52.1% vs 20.2%, P < 0.01) compared with the “Consensus Criteria” group. An incompletethree-hour sepsis bundle was not associated with a higher incidence of death, intubation, vasopressoruse, ICU admission or transfer to the ICU in <24 hours in patients without a sepsis diagnosis.

Conclusion: “Physician Diagnosis” patients more frequently received sepsis-specific interventionsand had a higher incidence of mortality. “Consensus Criteria” patients had infrequent adverseoutcomes regardless of three-hour bundle compliance. EPs’ sepsis diagnoses reflect riskstratificationbeyond the severe sepsis criteria.