The One Tiny Book That Changed How I Remediate Professionalism

Professionalism issues are the cases that make faculty quietly groan into their coffee mugs. Not because they don’t care, and not because the resident is a lost cause, but because professionalism is messy. It’s inconsistent. It’s personal. It can look completely different depending on the day, the rotation, the workload, or the attending. And unlike medical knowledge or procedural skills, you can’t pull out a multiple-choice quiz to diagnose it.

After more than 13 years as an education specialist in a residency program, I’ve learned that professionalism issues are difficult, not impossible. They just require a different kind of precision and a different kind of patience. And, honestly, a different kind of conversation.

Very early in my career, I came across a small Harvard Business Review book titled Giving Effective Feedback. It didn’t look like anything that would become essential to my work, but it did. It quickly became one of the most valuable tools in my remediation toolkit and one I relied on often in faculty development sessions. Inside was a simple diagram showing a continuum with personality traits on one side and influenceable behaviors on the other, and that visual changed the way I approached professionalism issues from that day forward.

Faculty began to recognize something important: traits aren’t coachable. Traits are who someone is when they roll out of bed. Quiet, intense, sarcastic, anxious, enthusiastic, blunt, overthinking, underthinking, introverted, extroverted. None of these are things we remediate. Behaviors, however, are coachable. Behaviors are the things you can see, measure, track, and thankfully, influence.

Once faculty understood this, everything became easier. Instead of telling a resident, “You’re too quiet,” they learned to say, “I need you to verbalize your thought process when we staff cases.” Instead of, “You seem disengaged,” it became, “I need you to proactively communicate delays to nursing.” Instead of, “You’re disorganized,” it became, “I need your documentation completed within 24 hours.” Suddenly residents weren’t confused, faculty weren’t frustrated, and the whole process felt a lot less like we were speaking different dialects of the same language.

Over the years, I’ve also had weekly standing meetings with residents who struggle with professionalism. These conversations aren’t fluffy check ins. We walk through comments submitted by staff, co residents, and faculty, and when there are specific examples, we unpack them together. I show them alternate scripting they could have used, talk through different choices they might make next time, and walk step by step through how the situation could have played out differently. I don’t sugar coat anything, because sugar coating has never helped anyone get better. I say what I mean and mean what I say. But I deliver it in a way that feels supportive and free of judgment, because that’s exactly how I would want someone to talk to me. Residents respond to honesty delivered with respect, and those meetings have become some of the most meaningful parts of my work.

Now let’s talk about how to turn that clarity into an actual remediation plan.

Start with a multi source assessment. Professionalism issues rarely exist in one neat location. They show up in patterns. Review faculty evaluations, nursing feedback, patient interactions, timeliness, communication habits, inbox responsiveness, and missed tasks. A resident who struggles only under high workload pressure is very different from a resident whose professionalism concerns appear no matter the setting or supervisor. Look for clusters, not isolated moments.

Translate the vague stuff into behaviors someone could observe with a clipboard. No more “poor communicator” or “unprofessional attitude.” Identify the concrete actions instead: responding to staff messages within a reasonable timeframe, arriving prepared, completing documentation within expected windows, communicating delays promptly. When expectations are measurable, residents know exactly what to fix and faculty know exactly what to look for. The plan stops being guesswork.

Next, you need strategies that actually change behavior. Shadowing high performers is one of my favorites. Professionalism is often caught, not taught. Weekly check ins matter too, and not the awkward ones where everyone politely pretends things are fine. Real conversations about what went well, what didn’t, and what the resident will try next week. Communication scripts can help residents who freeze when conversations feel uncomfortable. Accountability systems such as daily documentation checkpoints or inbox logs build consistency. Reflection prompts help residents pause long enough to notice their own patterns. It’s not glamorous, but it works.

Monitoring is where programs either shine or fall apart. You need predictable, consistent data. Use faculty ratings over time, staff feedback at set intervals, timestamp audits, logs of incomplete tasks, direct observation when relevant, and resident self tracking. You’re not building a surveillance system; you’re building clarity. The question is simple: Is improvement happening consistently across settings over time? If yes, great. If not, that’s important information too.

Document everything. Dates, examples, resident responses, follow through, and patterns. Skip vague words like “improving” or “struggling.” They’re meaningless without context. Use specifics such as “Completed 13 of 15 notes within 24 hours” or “Two late arrivals documented this week” or “No nursing concerns reported for the past two weeks.” These details protect both the program and the resident. No one has to rely on memory, emotions, or interpretations.

Finally, define success before the plan begins. What does improvement look like day to day? How long must it be sustained? Who will verify it? How do you know the improvement reflects true change and not a short term surge of effort, especially for residents who try to hide, stay quiet, or fly under the radar? Avoidance might buy time, but it never fixes the underlying issue, which is why keeping them actively engaged throughout the process is so important.

Professionalism remediation isn’t magic, but it also isn’t guesswork. With the right structure, it becomes far more predictable than most people think. When you approach professionalism concerns with clarity, specificity, and a realistic understanding of what can and cannot be influenced, the entire process becomes more manageable and more fair. Residents grow. Faculty feel supported. And your program strengthens its culture and expectations instead of bending around inconsistent behaviors.

If you’re looking for a place to start evaluating your own program’s remediation systems, I created a free Remediation Risk Quiz that helps faculty and program leaders identify exactly where their processes are strong, where the gaps are, and what practical next steps they can take. It only takes a couple of minutes and offers immediate, actionable insights. You can take the quiz here:
https://www.docmaclearning.com/Assessment 

For a comprehensive overview of remediation best practices, visit the Resident Remediation Guide:
Resident Remediation Guide

Reference
Harvard Business Review. (2014). Giving Effective Feedback. Harvard Business Review Press.