BACKGROUND: When faculty evaluate medical students' professionalism, they make judgments based on the observation of behaviors. However, we lack an understanding of why they feel certain behaviors are appropriate (or not).

OBJECTIVE: To explore faculty's reasoning around potential student behaviors in professionally challenging situations.

DESIGN: Guided interviews with faculty who were asked to respond to 5 videotaped scenarios depicting students in professionally challenging situations.

SUBJECTS: Purposive sample of 30 attending Internists and surgeons.

APPROACH: Transcripts were analyzed using modified grounded theory to search for emerging themes and to attempt to validate a previous framework based on student responses.

RESULTS: Faculty's reasoning around behaviors were similar to students' and were categorized by three general themes: Imperatives (e.g., take care of patients, behave honestly, know your place), Affect (factors relating to a student's "gut instincts" or personality), or Implications (for the student, patients, and others). Several new themes emerged, including "know when to fudge the truth", "do what you're told", and "know when to step up to the plate". These new codes, along with a near ubiquitous reference to Affect, suggests that faculty feel students are responsible for knowing when (and how) to bend the rules. Potential reasons for this are discussed.

CONCLUSIONS: Although faculty are aware of the conflicts students face when encountering professional challenges, their reliance on students to "just know" what to do reflects the underlying complexity and ambiguity that surrounds decision making in these situations. To fully understand professional decision-making, we must acknowledge and address these issues from both students' and faculty's points of view.