Based on the limited existing literature and on personal experience, I believe it is rare for a resident to simply refuse to be professional. Residents who have admitted to personal professionalism lapses cite factors such as lack of training, system issues, and the behavior of others as contributors. These residents did sometimes rationalize away their lapses by viewing them as minor issues, but they did not report an overall lack of desire to be professional.~(15) Ainsworth and Szauter~(16) found that less than 10% of medical students with noted professionalism lapses did not acknowledge them and accept responsibility.Remediation may fail despite explicit education, a resident's willingness to meet expectations, and honest attempts to remove barriers and provide a nurturing educational environment.~(33) If a resident continues to be unprofessional despite a thorough exploration of underlying issues, followed by sincere attempts to address those issues, preparation for dismissal is appropriate.
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