When it is known that professional attributes are part of the hiring decisions, it becomes clear that they are valued. Attributes outlined earlier should be embedded by listing the expected behaviors and skills as hiring criteria. Then, these skills and behaviors should be assessed as part of the hiring process. Currently, it is more typical that general observations occur in an attempt to identify deficiencies and potential problems. It is more useful to undertake affirmative questioning, asking candidates how they have displayed expected professional skills. For example, an applicant can be asked how they have displayed compassion or integrity in patient care. Some candidates will come up with concrete personal examples. Other candidates will make general statements or brush off the question. Interviewers should probe to discern the behaviors and attitudes that the person displays during the course of their work. Furthermore, candidates can be asked about situations that challenged their ability to show respect. Prospective residents and faculty can be asked to describe times when it was difficult to be responsive to a patient’s expressed needs and how they handled the situation. With skilled probing, a picture of the person’s professional values and behaviors will emerge. When interview questions are attempted at assessing how the person manages professional and communication challenges, the values of the organization as well as the candidate are highlighted.

To effectively teach professionalism and communication skills, it is helpful to outline their benefits for students, as the importance of this topic is often underappreciated by physicians in training. Explicit discussion is worthwhile in order to remind the trainee of the following.

These skills will be essential for an effective and enjoyable career [11]. Being appreciated by patients and staff, feeling respected, and feeling rewarded by medical practice requires effective human interactions, marked by professionalism and communication skill.

With standards and expectations set, professionalism and communication can be taught. During apprenticeship in the ED, when learning is observational and participatory, near-peer and senior physicians serve as role models and are the dominant influence on the student’s learning. When the role model offers a good example, an insight, and feedback, the trainee can improve more rapidly. The trainee’s experiences alone, in the absence of feedback, are less effective and can lead to overconfidence and perpetuate incorrect actions. Expertise is best developed when direct feedback is provided. Teachers must be willing and able to model excellent behavior, observe behaviors of the trainees, and provide feedback.

Feedback is neither judgment nor criticism. Feedback is a helpful observation that enables the learner to be more effective in the future. Everyone has deeply held attitudes, outlooks, personality traits, and developed habits that could be beneficial or limiting. Human beings do not want to be critically evaluated, and negative judgments are unhelpful, as they create defensive reactions. Instead, the teacher can be wise, understanding that natural behaviors and instincts of the junior physician will not always be ideal. The teacher can simply offer better ideas about how to interact with difficult patients. The great teacher can help the student recognize patients’ anxieties, needs, fears, and frustration and relieve them. The superior faculty member will display mastery of the medical encounter when conflict occurs, deescalating and controlling the situation. Established personalities are unlikely to change, but communication skills can be learned and improved, so honest conversations about what behaviors work are most helpful. A great gift that academic faculty can provide is the encouragement to be open to such discussion. The truly great physicians are on a lifelong quest for personal and professional growth.

Student learners will be exposed to both positive and negative role models [2]. In fact, 98% of medical students in six medical schools reported witnessing unprofessional behavior by their faculty teachers [12]. Negative role models can be educational as well, provided the behaviors are recognized as counterproductive and discussed. Because of the frequency of observed negative behaviors, it is suggested that a discussion forum be provided for in-depth exploration of witnessed behaviors. The students can benefit from the wisdom of the teacher who provides a safe environment and facilitates discussion. The department potentially benefits from the feedback provided by the students.

Deliberate positive discussions are also needed for the learner to reach a high level of performance. Given the extreme demands placed on emergency physicians during a typical clinical shift, it should not be assumed that student learners are picking up on the positive keys to communication and professionalism [13]. If possible, emergency physicians should be aware that explicitly discussing challenging events and interactions can greatly aid those in training [2]. Having shifts where educators are present strictly to tend to the needs of the students, without patient care duties, helps in deciphering positive and negative role model actions and can also serve to evaluate student progress [14]. Other innovative methods of teaching include standardized patient encounters, high-fidelity simulations, and panel discussions, in addition to traditional didactic lectures [11, 15]. In reality, a combination of many of these modalities is required to most effectively teach the complexities of professionalism and communication.