Table 2 Change in the specific categories and behavioral descriptors of unprofessional behavior after implementing Casper. The numbers associated with behavioral descriptors are more than the number of residents exhibiting unprofessional behavior as more than one behavior was exhibited by some residents. The 4I framework and the original tabular format of unprofessional behaviors is used with permission from Dr. M van der Vossen. As described in the Methods section, two behavioral descriptors were added to the Introspection category (nervous exhaustion and none-to-five mentality) and no residents exhibited these behaviors in either cohort

INVOLVEMENT (Failure to engage)

INTEGRITY (Dishonest behaviors)

Pre-

Post-

Pre-

Post-

Absent or late for assigned activities

6/12

3/6

Cheating in exams

0/12

0/6

Not meeting deadlines

9/12

5/6

Lying

2/12

0/6

Poor initiative

4/12

3/6

Plagiarism

0/12

0/6

General disorganization

5/12

5/6

Data fabrication

2/12

0/6

Cutting corners

4/12

3/6

Data falsification

3/12

0/6

Poor teamwork

3/12

2/6

Misrepresentation

2/12

0/6

Language difficulties

0/12

0/6

Acting without required consent

3/12

0/6

Not obeying rules and regulations

9/12

3/6

Number of residents

Number of residents

Pre-Casper (12/12; 100%) à post-Casper (5/6; 83%); 17% reduction

Pre-Casper (9/12; 75%) à post-Casper (3/6; 50%); 25% reduction

INTERACTION (Disrespectful behavior)

INTROSPECTION (Poor self-awareness)

Pre-

Post-

Pre-

Post-

Poor verbal/non-verbal communication

8/12

3/6

Avoiding feedback

5/12

2/6

Inappropriate use of social media

0/12

0/6

Lacking insight in own behavior

10/12

4/6

Inappropriate clothing

0/12

0/6

Not sensitive to other person’s needs

3/12

1/6

Disruptive behavior in teaching sessions

2/12

0/6

Blaming external factors rather than own inadequacies

5/12

3/6

Privacy and confidentiality violations

1/12

1/6

Not accepting feedback

10/12

3/6

Bullying

1/12

0/6

Resisting change

7/12

1/6

Discrimination

0/12

0/6

Not aware of limitations

7/12

4/6

Sexual harassment

0/12

0/6

Number of residents

Number of residents

Pre-Casper (8/12; 67%) à post-Casper (3/6; 50%): 17% reduction

Pre-Casper (12/12; 100%) à post-Casper (5/6; 83%): 17% reduction