#KeyLIMEPodcast 269: Oh, behave!

Lara introduces a paper that looks at behaviors that make an excellent attending physician. Researchers set out to identify the teaching behaviors of ICU physicians that are commonly observed by residents in the faculty educators they respect and admire.

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KeyLIME Session 269

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Santhosh et. al., Intensive Care Unit Educators: A Multicenter Evaluation of Behaviors Residents Value in Attending Physicians  Ann Am Thorac Soc. 2017 Apr;14(4):513-516.


Lara Varpio (@LaraVarpio)


  • The paper sets out a simple argument in the introduction. Here, the authors make the case that knowing the behaviors that make an excellent attending physician are of great interest to the field of medical education. They contend that the work that has been done to date typically explores how fellow attendings describe the behaviors valued in a clinical educator, but that we’ve not examined what residents consider to be of value. They also suggest that we have not studied how ICU attending physicians, working in a unique context, have different behaviors that will be valued.


  • So, the researchers set out to identify the teaching behaviors of ICU physicians that are commonly observed by residents in the faculty educators they respect and admire.

Key Points on the Methods

  • The authors conducted a cross-sectional, multi-institutional survey at 4 internal medicine residency programs. Internal medicine residents at each site completed an on-line survey that used a Likert scale to rate the importance of specific observed behaviors of esteemed ICU attending physician role models.
  • The survey included 37 questions that clustered under 6 broad domains: interpersonal skills, research skills, clinical skills, teaching skills, educational training and patient interactions.
  • The behaviors included in the survey items were based on three papers. One was paper reporting on Stanford’s clinician teaching program and on—and I quote—“the two major prior studies in this field.” End quote.
  • Trainees were also asked about their institution, their year of training and the survey items. An incentive was included – there was a $500 cash prize towards a residency party to the program with the highest response rate

Key Outcomes

  • 260 residents from the 4 institutions participated with an overall response rate of 43%. The survey respondents were almost perfectly evenly split across first, second and third year of residency.
  • The top 5 behaviors most commonly rated as very important by trainees, in order, were:
    1. Enjoys teaching house staff
    2. Demonstrates empathy and compassion to patients and families
    3. Explains clinical reasoning and differential diagnoses in the critically ill patients
    4. Treats non-MD staff members respectfully
    5. Shows enthusiasm for the topics discussed on rounds

Key Conclusions

  • In the discussion, the authors compare these findings to the 1998 publication that informed the survey development. And the authors show that only ONE of the behaviors that was highly rated in 1998 is still highly rated today.
  • They note that these differences may reflect a new generation of learners, differences between the ICU and ward teaching, or institutional variations.
  • They suggest their findings could inform faculty development for ICU clinician educators
  • They note that their study is limited by their survey response rate, by being carried out in 4 academic teaching hospitals, and that they have no confirmatory data – such as course evaluations

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