#ACGME2026 Session Summary: Professionalism Lapses in Graduate Medical Education – Myths, Realities, and Practical Remedies
Professionalism lapses are among the most challenging issues faced by graduate medical education (GME) programs – not because they are rare, but because they are deeply human, emotionally charged, and often misunderstood. In the #ACGME2026 Featured Plenary, Professionalism Lapses in Graduate Medical Learners: Myths, Realities, and Remedies, a panel of national and institutional leaders reframed these concerns, offering clarity, nuance, and practical guidance for addressing professionalism early, fairly, and effectively.
The interactive session brought together experts who approach professionalism from clinical, regulatory, coaching, and institutional perspectives, and worked through several scenarios that elicited interesting responses from the audience to help frame the discussion, across which, two messages were clear:
- Avoiding professionalism concerns does not protect learners or patients.
- The work is really hard and challenging.
ACGME Senior Vice President, Competencies, Milestones, and Faculty Development Laura Edgar, EdD, CAE challenged the common assumption that professionalism lapses are “soft” issues disconnected from patient care. Rather, she warned, disengagement has real consequences. When learners disengage, it affects communication, teamwork, and situational awareness, directly impacting patient safety and care delivery. Engagement, she emphasized, is not optional, but foundational.
Dr. Edgar also addressed the fear of retaliation that can silence learners and educators alike. When fear of retaliation arises, it should be named and addressed through appropriate channels, not allowed to quietly shape decision-making.
Behavior Is the Signal; Context Is the Lens
Karen Warburton, MD, associate designated institutional official (DIO) and director of Clinician Wellness at the University of Virginia, grounded the conversation in a critical distinction: Learners come to attention because of observable behaviors. Professionalism concerns are not about personality or intent; they are about what happens in the workplace.
Importantly, Dr. Warburton emphasized the importance of context. Each learner’s situation is unique, shaped by individual, systemic, and situational factors. Understanding context is not about excusing behavior, but about informing coaching, regulatory decisions, and prognosis. Every case, she noted, “continues to break the mold,” reminding educators that professionalism is a contextual phenomenon, not a rigid formula.
She also urged educators to explore the internal “shoulds” that often surface in these moments – what we think learners should be doing or feeling. Strong emotions may arise, but professionalism conversations require reflection and response, not judgment, and feedback should remain behavior-based and descriptive.
Importantly, Dr. Warburton reframed disengagement as a coping strategy, often an attempt by learners to protect themselves. However, she said, disengagement does not protect what learners believe it does; instead, over time, it increases risk rather than reducing it.
Professionalism Cannot Be Averaged Out
University of Virginia Associate Professor of Neurology and Pediatrics and Program Director Kathryn Xixis, MD addressed another common pitfall: the tendency to “average out” professionalism across competencies. Strong clinical performance does not offset lapses in integrity, accountability, or respect. Programs may develop blind spots when they like a learner, or when external, non-role-related factors influence judgment.
Dr. Xixis emphasized that professionalism concerns rarely resolve on their own, and when avoided, often recur and escalate into regulatory issues. Research consistently links professionalism lapses with poorer patient outcomes, strained relationships, and increased costs of care, she said. Intermittent reinforcement, or addressing concerns inconsistently, can be particularly harmful.
She encouraged educators to view professionalism as a developmental spectrum. Once a lapse is identified, programs face a critical inflection point: address it early, and support growth; avoid it, and inadvertently reinforce negative behavior.
Language, Documentation, and Patterns Matter
Indiana University Clinical Professor of Family Medicine and Associate DIO Kathleen Zoppi, PhD, MPH focused on practical assessment and documentation. Key questions include: Is this an isolated incident or a pattern? Is there harm? Are there issues such as falsification of data? Consequences matter, she stressed, and remediation should not mean “no consequence.”
Dr. Zoppi highlighted the importance of using descriptive, rather than evaluative or judgmental language. Documentation should focus on what was observed, not inferred motives or emotions. While human circumstances may warrant remediation and support, persistent patterns require clear boundaries and decisions. At its core, professionalism work represents an opportunity to help the learner, but also an obligation to the system.
Betsy White Williams, PhD, MPH, clinical director of the Professional Renewal Center at the University of Kansas, reinforced the importance of separating behavior from identity. Professionalism lapses can be passive as well as aggressive, and educators should resist the urge to ascribe negative intent, a principle she summarized as, “DAMN: Don’t Assume Maliciousness Negatively.”
Educators may feel frustrated or annoyed, she acknowledged, and those reactions are human. However, they should not drive the response. Powerful underlying factors, including early life experiences, may contribute to behavior, but they do not define an individual. Bad behavior does not make a bad person, but it does require action, Dr. Williams concluded.
Moving from Avoidance to Accountability
Across perspectives, the discussion in this Featured Plenary at the 2026 ACGME Annual Educational Conference last month reinforced a central tenet: Addressing professionalism doesn’t harm learners, but not addressing it does. Early, objective, and compassionate intervention protects learners, patients, and programs alike. With trained coaches, clear language, and a commitment to both support and standards, professionalism remediation can be a powerful investment in the future of medical education.