Professionalism Expectations Seen Through the Eyes
of Resident Physicians and Patient Families
WHAT’S KNOWN ON THIS SUBJECT: The professionalism of physicians can have an impact on patient care and satisfaction and physician career success and is increasingly emphasized in residency training programs.
WHAT THIS STUDY ADDS: This study was an examination of the perspectives of families of pediatric patients and of pediatrics residents on the attributes of professionalism in physicians. Important overlaps were found between the attributes of professionalism prioritized by patient families and resident physicians.
abstract
BACKGROUND:Resident physicians and patient families have not tra-ditionally been involved in setting expectations for professional behav-ior by physicians.
OBJECTIVE:To elicit and compare prioritized lists of attributes and behaviors of physician professionalism formulated by residents and patient families.
METHODS/DESIGN:We used qualitative and quantitative methods to identify and compare prioritized perceptions of important attributes and behaviors of physician professionalism among residents and fam-ilies of patients. We conducted 3 resident focus groups, 1 for residents in each resident-training year (postgraduate years 1, 2, and 3), and elicited attributes and behaviors the residents associated with physi-cian professionalism by using free-listing and nominal-group tech-niques. Family perspectives of the attributes/behaviors of physician professionalism were elicited by using semistructured interviews of consecutive families with a child who was admitted to the hospital. All results were transcribed, and common themes were identified.
RESULTS:Fifty-eight residents (78% of the total in the program) and 40 families participated. Similar themes arose from all 3 resident focus groups, which prioritized tactfulness, support of team members, re-spectfulness, good communication, and humanism. Residents also provided specific behavioral strategies to put these attributes into practice, such as avoiding jokes about patients and using patient names when addressing and discussing them. Patient families most frequently cited good communication, caring, knowledge, skill, hon-esty, and attitude. Communication and humanism were aspects con-sistently endorsed by both residents and patient families.
CONCLUSIONS:There was important overlap in the attributes of pro-fessionalism generated and prioritized by resident physicians and pa-tient families, although only residents identified ways that health care providers should interact with each other. This novel approach to iden-tifying professionalism attributes provides opportunities for curricu-lum improvement.Pediatrics2011;127:317–324
AUTHORS:Taylor Regis, MD,aMichael J. Steiner, MD,a,b
Carol A. Ford, MD,a,band Julie S. Byerley, MD, MPHa,b bDivision of General Pediatrics and Adolescent Medicine,
Department of Pediatrics,aUniversity of North Carolina School
of Medicine, Chapel Hill, North Carolina
KEY WORDS
professional-patient relations, patient-centered care, internship, residency
ABBREVIATION
ABP—American Board of Pediatrics
www.pediatrics.org/cgi/doi/10.1542/peds.2010-2472 doi:10.1542/peds.2010-2472
Accepted for publication Nov 1, 2010
Address correspondence to Michael J. Steiner, MD, University of North Carolina, Children’s Outpatient Center, CB 7600, Chapel Hill, NC 27514. E-mail: msteiner@med.unc.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2011 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE:The authors have indicated they have no financial relationships relevant to this article to disclose.
cations for their career success.1The Accreditation Council for Graduate Medical Education has included pro-fessionalism as 1 of the 6 core compe-tencies and charged residency pro-grams with the responsibility to ensure that resident-physicians (resi-dents) demonstrate the behaviors that embody professionalism.2However, it has been a challenge for residency programs to delineate the profession-alism standards by which residents should be assessed.
Recently, the American Board of Pedi-atrics (ABP), along with the Associa-tion of Pediatric Program Directors, identified professionalism as an area of focus for curriculum development. In the summary document, they pri-oritized 8 components of profession-alism: honesty/integrity; reliability/ responsibility; respect for others; compassion/empathy; self-improvement; self-awareness/knowledge of limits; communication and collaboration; and altruism and advocacy.3 These at-tributes were similar to those previ-ously identified by the ABP as essential to the practice of pediatrics.4
Results of previous studies suggest that residents generally agree with professionalism principles outlined by the Accreditation Council for Graduate Medical Education and other medical specialty board committees, including the ABP.2– 6Overall, patient and family perspectives on professionalism have not been included,2although some in-vestigators have recognized that nar-rative comments by parents can be ex-tremely useful in the evaluation of resident professionalism.7Opinions of patients’ family members regarding patient care are increasingly sought8 and have been associated with bio-medical outcomes.9,10 Therefore, a better understanding of patient expec-tations about professionalism is
im-At our resident-training program, we implemented a novel approach to de-fine professionalism expectations through determination by residents and patients’ families of the traits that should be emphasized for resident training and evaluation. Our sequential approach was to elicit from all resi-dents the characteristics that they associate with high levels of profes-sionalism, have third-year residents prioritize characteristics, have second-year residents describe behaviors re-flecting these prioritized characteris-tics, and have first-year residents describe facilitators and barriers to encouraging these behaviors. Each resident class was encouraged to par-ticipate in specific aspects of develop-ment and evaluation of a program to teach professionalism during resi-dency. We also interviewed patients’ families to elicit their perspectives on professionalism.
In this article, we report results from our formative work. We summarize residents’ perspectives on profession-alism and behaviors that residents as-sociate with professionalism and ex-plore differences in perspectives on professionalism between residents and patients’ families. We hypothe-sized that there would be differences between the aspects of professional-ism prioritized by residents and pa-tients’ families. We sought to compare these perspectives with this study.
METHODS
We undertook a mixed qualitative and quantitative study to explore resident-physician and family per-spectives on resident-physician pro-fessionalism at the North Carolina Children’s Hospital. The study proto-col was reviewed by the biomedical institutional review board at the Univer-sity of North Carolina, and the board
de-defined by federal regulations and did not require review by the institutional re-view board (protocol #09-183).
Resident Focus Groups
In May and June 2008, 3 separate focus groups were conducted: 1 with the ris-ing third-year, second-year, and new, first-year resident classes. At the time of the study,⬃75% of pediatrics resi-dents were women, 10% were black, 7% were Asian American, and 2% were American Indian. Each of the 3 focus groups began with a free-listing task to elicit residents’ spontaneous ideas associated with professionalism in physicians. Free-listing is a qualitative method for generating descriptions of the construct of interest (in this case “professionalism”) directly from the respondents of interest.11Specifically, we used a facilitator to encourage res-ident responses while a second per-son recorded all responses on a flip-chart. This process was completed at the very beginning of the focus group meeting, before any other discussion of professionalism occurred.
increase resident engagement in the process of discussing the importance of professionalism within their daily roles.
After the case discussions, each class conducted a different task. The third-year residents used the words from their initial free-listing to name
spe-cific physician behaviors that they ex-pected of themselves and their col-leagues. Then, using nominal-group technique, third-year residents priori-tized those identified behaviors. Nominal-group technique is a group
decision-making method in which ideas are generated, similar ideas are combined, and then group members publically vote for the items they en-dorse.12Ranking of items was then per-formed on the basis of the number of votes received. In the focus group of
second-year residents, after the free-listing and case discussions, the resi-dents were shown the behavior list that had been generated by the third-year residents. Then the second-third-year residents were asked to specify ways that those behaviors could be mea-sured within the residency program.
After the free-listing activity, the first-year residents conducted an activity not related to this study.
Family Structured Interviews
Potential patient families were identi-fied from the inpatient pediatric medi-cine services of the North Carolina Children’s Hospital, a 140-bed tertiary
care facility, during February 2009. The ethnic composition of children admit-ted to the North Carolina Children’s Hospital is 50% white, 25% black, 10% Hispanic, and 15% from other self-identified ethnic groups. An investiga-tor (Dr Regis), who was not involved in
the medical care of the patients or in the resident focus groups, approached consecutive patient families during a 6-day period and asked for their
par-ticipation in an interview about profes-sionalism among resident physicians.
Anonymous, semistructured inter-views were conducted with the paren-tal caregiver(s) present at the time of the visit. Interviews lasted 5 to 20 min-utes and while they were conducted the interviewer used a written inter-view guide and manually recorded family responses. The intent was to record respondents’ major salient ideas and thoughts described in single words and short phrases so that audio recording would not be necessary. Parents first free-listed words they as-sociated with a high degree of profes-sionalism among physicians, and then were asked to individually rank the items by importance. Parents were prompted to complete this exercise by providing responses based on general personal expectations and not neces-sarily related to the current medical care of their child. The parents were then provided with the comprehensive list of resident-generated words de-scribing professionalism, in the same sequence that was spontaneously gen-erated by the resident groups (ie, un-ranked). Then the parent participants were asked to select the 5 listed words they felt were most strongly associ-ated with professionalism so that we could identify differences in how res-idents and families would prioritize the same list of professionalism attributes.
Data Analysis
Resident responses to free-listing ac-tivities were transcribed verbatim. Three researchers (Drs Regis, Steiner, and Byerley) independently reviewed free-listing results from resident focus groups, and by consensus identified major themes. We present a list of all professional characteristics gener-ated by free-listing across all resident focus groups, and sample behaviors and ways to measure behaviors
asso-ciated with high levels of professional-ism provided by third-year and second-year residents. Examples of coding decisions for residents include: sup-port of team members is the theme coded for phrases such as “be sup-portive and positive to peers especially during hard times”; tactfulness the theme coded for “commit to ‘joking’ only within the family and confront each other if it goes too far”; respect for team members the theme coded for “treat nursing, medical students, and other staff with respect”; human-ism is the theme coded for “treating patients as humans”; and communica-tion for “commit to communicate well with patients.”
The responses generated and priori-tized by individual families to free-listing interview questions were com-bined and compared. The frequency with which each item listed by parents was ranked as the highest profession-alism priority was recorded, and re-sults were combined. The 3 authors who were not involved in parent inter-views then met to review the identified themes (Drs Byerley, Steiner, and Ford). The authors agreed on the over-arching themes by consensus. Exam-ples of these combinations for families include: compassionate, caring, kind, and loving were all counted as caring/ concerned; full disclosure, keeping in-formed, and free-spoken were counted as communication; smart, education, and knows what they are talking about were counted as knowledge; speedy help was combined with the idea of promptness; competence, good at what they do, and know how to do their job were counted as skilled; cheerful was combined with the attitude response.
the 5 professionalism behaviors prior-itized by the resident focus groups to look for similarities and differences.
RESULTS
Resident Respondents
Our residency program includes pedi-atrics and combined medicine/pediat-rics residents. The third-year–resident focus group, which included third-year and fourth-year medicine/pediatrics residents, was attended by 12 of 28 residents, the second-year resident fo-cus group included all of the rising second-year residents (n⫽23 of 23), and the first-year resident group in-cluded all of the incoming first-year residents (n⫽23 of 23).
Residents’ Perspectives on Professionalism
All 3 focus groups spontaneously pro-vided both traits and behaviors to de-scribe professionalism (Table 1). The included themes and tone of the resi-dent descriptors shifted as resiresi-dent groups became more senior. First-year residents listed words that in-cluded altruism, greater good, toler-ance, courteous, and integrity. They also included personal traits in their list of principles of professionalism, such as self-regulation, hygiene, and leadership. Second-year residents identified altruism, greater good, tol-erance, and humility as principles of professionalism. However, unlike the first-year residents, second-year resi-dents also named ethics and empathy. Although this group of residents also listed personal traits on their list, they did not include communication, self-regulation, demeanor, leadership, or hygiene. Instead, they listed continued learning and accuracy. The third-year residents’ list differed from that of the first-year residents with the exception of respect and integrity. In addition,
the third-year resident group placed an emphasis on recommendations against negative behaviors such as not gossiping, yelling, whining, or being rude. When asked to prioritize within their list, the third-year residents high-lighted support of team members, tact, respect, humanism, and respect-ful treatment and communication among everyone on the health care team as ideals to be prioritized.
Tables 2 and 3 demonstrate the work that third-year and second-year resi-dents did in the focus groups when they attempted to make the potentially abstract professionalism concepts more clear and measurable. Table 2 summarizes third-year residents’ re-sponses when asked to list behaviors that demonstrated the professional-ism concepts they generated in their free-listing exercise. They reported, for example, that “communication” would be demonstrated through the behavior of “calling the PMD [primary medical doctor] on admit or consult.” One-half of the behaviors listed by the third-year residents were described as be-haviors to avoid, rather than bebe-haviors that affirmed positive ideals. For exam-ple, residents described behaviors that reflected high levels of profes-sionalism as: “no public gossiping that
makes peers feel stupid”; “do not dis-respect with inappropriate question-ing or tone”; or simply “don’t yell.” Ta-ble 3 lists the work by the second-year resident focus group when asked to take the 5 behaviors that third-year residents felt should be prioritized
Residents Residents
Honesty Responsibility Integrity
Courteous Ethics Respect
Communication Honesty Bedside manner Integrity Continued Learning Patience
Punctuality Empathy Continuous education Self-regulation Reliability Selflessness
Teamwork Teamwork Dedication
Respect Respect Communication
Responsibility Punctuality Equanimity
Humility Courtesy Self-governing
Demeanor Accuracy Decisive
Tolerance Critical but not judgmental
Leadership Role model
Hygiene Collegial
Greater good Not condescending
Altruism Interprofessional empathy
Words are presented in the sequence in which they were generated.
TABLE 2 List of Behaviors Generated by Third-Year Residents That Reflect High Professionalism
Be supportive and positive to peers especially during hard timesa
Commit to recognize patients as humana
Treat nursing with respect as professionalsa
No public gossiping that makes peers feel stupida
Commit to “joking” only within the family and confront each other if too fara
Commit to communicate well with patientsa
Do not disrespect with inappropriate questioning or tone
Treat medical students with respect of other professionals, eg, praise public/criticize private
Commit to call PMD on an admit or consult Not appropriate to get attention from patients
due to dress
All residents should attend conferences whenever reasonably possible No public “bad-mouthing” other residents Take consults eagerly/provide good
communication with other services No profanity/rudeness/acting like others are
stupid, especially to ED
Discuss admissions from other services with enthusiasm, refrain from criticism Don’t yell
PMD indicates primary medical doctor.
as an area of focused resident edu-cation in professionalism for that year, and develop practical and mea-surable ways to encourage and eval-uate those behaviors through the residency program.
Family Respondents
A total of 43 families with a caregiver present during the 6-day period were
approached, and 40 families agreed to participate in the study.
Perspectives of Families on Professionalism
Table 4 demonstrates the free-listing of family-generated professionalism characteristics. In order of frequency, the most commonly identified charac-teristics during free-listing with fami-lies were showing caring/concern, good communication, knowledge, and skill, and honesty and attitude tied for the fifth most frequently listed items in their individual lists. Table 5 shows the frequency with which families en-dorsed characteristics from the list originally generated by residents dur-ing their free-listdur-ing. From the resident
list, families most frequently priori-tized responsibility, honesty, respect, humanism, and communication as the 5 most important descriptors of physi-cian professionalism. No families en-dorsed physician self-regulation as 1 of the 5 most important characteris-tics, and very few families endorsed al-truism or tolerance as being priority items (Table 5).
DISCUSSION
Physician professionalism can have an impact on patient satisfaction and is a recently emphasized area of resident education. This study highlights areas of agreement in professionalism traits generated by unprompted patient fam-ilies and residents and also demon-TABLE 4 Professional Characteristics Generated by Families During Free-Listing
Ability to answer questions Know how to do the job Ability to find solutions Know what they are doing
Assertiveness Knowledge
Attention Knows what they are talking about Attention to detail Listening
Attitudes Logical
Bedside manor Love
Being upfront Loving towards patient
Caring Makes patients and their family comfortable
Charisma Patience
Cheerful Patient care
Clarity Precision
Communication Privacy
Compassionate Professional dress
Competence Promptness
Concerned for patient Put in time and effort
Confident Sanitation
Courteous Show they care
Do a great job Sincerity
Education Skilled
Ethics/values Smart
Explains diagnosis and plan to family Speaking on family’s level Explain the concepts clearly to families Speedy help
Family education for discharge Taking control of situation immediately Friendly Taking time to explain
Giving the complete picture/full disclosure Thorough Good at what they do Thoughtfulness
Good care Timeliness
Good education Timing (working around the family) Good follow-up Understanding
Honesty Urgentness
How they present themselves Verbal (free-spoken) Information Wants what’s best for patient Keeping informed Willingness to listen
Kind Ability to explain to patients/parents
Kindness To the point/direct
Understanding
TABLE 3 Third-Year Resident–Prioritized Behaviors, With Second-Year Resident–Generated Ways to Encourage and Evaluate These Behaviors
“Be supportive and positive to peers especially during hard times”
Residents get the opportunity to evaluate each other anonymously
When called in for back up, do it without complaint or making a big joke of it Change the culture to notice the needs and
support the needs of peers
Upper levels help with the work of the team “Commit to recognize patients as humans”
Use the patients’ names and expect others to do the same
Use support services appropriately Ask every patient how this illness has affected
them and what support services they need Have ancillary services evaluate residents Have patients evaluate residents “Treat nursing, med students, and other staff
with respect”
When students evaluate residents, follow up on negative comments
Turn in at least 50% of student evaluations within one week of experience Give each student feedback at least once on
each rotation
If student evaluations include a negative comment, speak to the student about the issue first
“Commit to &lquote;joking’ only within the family and confront each other if it goes too far” Have residents evaluate each other Put this on the rotation evaluation form “Commit to communicate well with patients”
Touch base with the family when the patient’s condition or plan changes
Get feedback from families on the resident’s performance
Give each patient a handout or 5 minute orientation to the process of hospitalization and the work of academic teams
Have the senior resident meet every patient and see them at least twice per week Talk with the patients and families every
afternoon
Provide consistency of message among team members
Do direct observations on inpatients
strates ways in which these 2 groups differ in prioritization of these traits. Awareness of these multiple perspec-tives on physician professionalism may be important in shaping profes-sionalism training programs for resi-dents13–18and may lead to improved patient care.9,10
Resident physicians generated lists of professionalism traits that closely mirrored those of the ABP and other professional societies.2,3The resident-generated lists included honesty, re-sponsibility, respect, integrity, self-governing, communication, empathy, and self-improvement. These traits and behaviors closely overlap with some of the principles cited by the ABP, including honesty/integrity, reliability/ responsibility, respect for others, self-awareness/knowledge of limits, communication, collaboration, and altruism.4
We noted a difference in the quality and focus of professional traits that
that emerged was that first-year res-idents focused their free-listing on the presence of positive or high-professionalism personal traits. Exam-ples included humility, courteousness, tolerance, and altruism. Meanwhile, the free-listing terms of third-year res-idents focused much more on the im-portance of avoiding negative or poor professionalism traits such as not yell-ing, not being judgmental or conde-scending, and “no whining.” Wagner et al (2007) demonstrated a different type of shift in important principles of professionalism based on the level of training, a shift of emphasis from rela-tionship qualities to knowledge and skills the further along the research participants were in their training.5 One explanation for the difference be-tween the findings of Wagner et al and our results may be that participants in the study by Wagner et al were prompted with questions on profes-sionalism that were formulated by use of Epstein and Hundert’s principles of professionalism as a template.5,6 Ar-nold actually examined changes in pro-fessional behavior that were associ-ated with the stage of the medical career, but this work did not include residents.16 As a group, physicians who evaluated professionalism were found to have varying views that man-ifested as a lack of agreement.19 More-over, physicians have been found to have a variety of beliefs regarding the components of professionalism and frequently revealed gaps between their beliefs on standards of profes-sionalism and their actual behavior.20 It may be that more senior residents have had more exposure to these gaps between beliefs and behaviors, or lapses in professionalism. Replication in studies at other residency pro-grams is needed to clarify whether the trends observed between the charac-terization of professionalism and the
of residency training or was merely
the result of differing personalities within classes.
The characteristics most frequently prioritized by families whose children were patients in pediatrics services were caring/concern, communication,
knowledge, skilled, honesty, and atti-tude. These families were in agree-ment with the ABP principles of hon-esty, compassion, and communication, although the degree to which patient
and family perspectives have been in-corporated into the professionalism recommendations from professional societies is unclear. Our study incorpo-rated residents and patient families
to generate professionalism ideals and specify criteria for evaluation of professionalism. Both residents and families endorsed humanism and
communication to be important for professionalism. However, as a group, families considered responsibility and honesty to be additional qualities most strongly associated with
professional-ism, whereas residents indicated that tactfulness and supportive of team members were 2 of the most impor-tant professionalism qualities. These findings coincide with previous data
that suggest that patients prioritize patient-centered components of pro-fessionalism, such as communication in honest “layperson” terms and the
ability to listen.21,22It should be noted that lack of literacy may have limited family understanding of some of the words listed by the residents. The in-terviewer did answer questions and
define words when asked, but families may not have asked for additional def-initions every time they did not under-stand a word. Differing literacy levels
may have had an impact on how fami-lies ranked words, and such an impact would not necessarily represent a true
Associated Words No. of Families
Endorsing
Characteristics
22 Honesty 20 Communication
19 Treating patients as humans 19 Responsibility
14 Respect 10 Ethics 10 Reliability 10 Courtesy 10 Hygiene
8 Accuracy
8 Supportive of team members 6 Integrity
difference from residents in how the families would prioritize the concepts.
One complicating factor that may have affected the comparison of resident and family responses was that a differ-ent qualitative technique was used to elicit responses from the 2 groups. In addition, the residents may have ap-proached the sessions differently from patient families because the residents knew that we hoped to establish expec-tations by using the results of the ses-sions. It is also possible that residents performed free-listing with the as-sumption that certain traits were “a given” and were too obvious to be men-tioned. For example, patient families listed “responsibility” and “honesty” as traits, and these were not listed by the resident physicians, despite the fact that they are recognized as core aspects of professionalism. However, if residents were avoiding obvious traits, then it seems that descriptors such as “treating patients as humans” would also have been omitted by the residents. The differences between resident and family lists may have been attributable to problems with the
free-listing method or true differences in perspective on the relationships in-volved in care. The final potential limi-tation was that each resident class performed free-listing, but only the third-year residents prioritized that list, the second-year residents estab-lished measures, and the first-year residents identified facilitators and barriers to implementing the priori-tized behaviors and measures. All of these components occurred after case discussions and may have altered the priorities of the residents. This method of divided tasks was chosen in part to allow a single class to take responsi-bility for a component of a new profes-sionalism evaluation process in the residency. However, it is possible that this strategy altered the outcomes of some secondary findings within the study.
CONCLUSIONS
While residents engage in practical day-to-day performance of their jobs, resident-physician professionalism is informally judged by people who have variety of different perspectives, in-cluding other resident-physicians,
at-tending physicians, staff, and the fam-ilies of patients. For this reason, it is important to include multiple perspec-tives in the formal evaluative pro-cesses and education of residents. The similarities we observed between res-idents and patient families in their pri-oritization of professionalism traits were reassuring because they indicate that common expectations between different stakeholders can be estab-lished. Conversely, the traits that were viewed differently by resident-physicians and patient families need further exploration because they might indicate an opportunity to im-prove the comprehensiveness of resi-dent professionalism training. More-over, our findings should stimulate further exploration into how resident-physician beliefs and prioritization of characteristics of professionalism evolve during training, and how this process might affect future behavior.
ACKNOWLEDGMENT
We thank Kenneth B. Roberts for thoughtful revisions on earlier ver-sions of the manuscript.
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SCOURGE OF HUMANKIND:Several infections could vie for the title of scourge of humankind. Certainly HIV, tuberculosis, and syphilis would have their support-ers. Few diseases, however, have had a larger and more persistent impact on the human population than malaria. As reported in The Wall Street Journal
(November 26, 2010: Life & Culture), even the name malaria, or “bad air” lets us know how serious the disease is. Also known as “swamp fever” for centuries before that, malaria has molded the human genome and to this day causes millions of deaths each year. The areas of the world with the highest prevalence rates of malaria (e.g. sub-Saharan Africa) also tend to be the poorest. Scientists have long debated whether malaria causes poverty through premature death and chronic disability or the unhealthy conditions associated with poverty allow malaria to run rampant. The discussion is more than just academic. If malaria causes poverty, eradication of malaria should promote prosperity. However, malaria remained endemic in the U.S. until general affluence rose. Widespread spraying of DDT in the 1950s and 1960s did not tend to improve general eco-nomic outcomes. Foreign aid to raise the socioecoeco-nomic level of malarious regions has not proven particularly successful in eradicating malaria. Unfortu-nately, both the parasite and the mosquito evolve quickly. Resistance to new anti-malaria drugs such as artemisinin has been reported. The mosquito seems less affected by pyrethrin, the insecticide applied to bed nets. Malaria research in the U.S. and the world, however, has taken a turn with the support of The Bill and Melinda Gates Foundation. The Foundation has not only supported vaccine development and drug distribution, but also system-based approaches. Whether the Foundation will be more successful than other malaria eradication campaigns remains to be seen, but let us hope so. For a more in depth discus-sion, two recently published books detail the radically different approaches to the duel problems of malaria and poverty:The Fever by Sonia ShahandThe Imaginations of Unreasonable Menby Bill Shore.
DOI: 10.1542/peds.2010-2472 originally published online January 17, 2011;
2011;127;317
Pediatrics
Taylor Regis, Michael J. Steiner, Carol A. Ford and Julie S. Byerley
Patient Families
Professionalism Expectations Seen Through the Eyes of Resident Physicians and
Services
Updated Information &
http://pediatrics.aappublications.org/content/127/2/317
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References
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DOI: 10.1542/peds.2010-2472 originally published online January 17, 2011;
2011;127;317
Pediatrics
Taylor Regis, Michael J. Steiner, Carol A. Ford and Julie S. Byerley
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