1. Maxine A. Papadakis, M.D. Professor of Medicine UCSF
1/15/2019
Classifying lapses of professionalism around behaviors; an organizational tool to determine best practices for remediation
Maxine A. Papadakis, M.D.
Professor of Medicine
UCSF
S. Breanndan (Brendan) Moore death notice by his neighbors

3. It is a privilege and a joy to be involved in the education of medical students and residents

4. Behaviors are derived from the foundational system of professionalism
Why focus on behaviors?
Functional for teaching
Standardized assessment
Competencies and milestones
Performance-based for educational advancement

5. Assessment of Professional Behavior Methods Used in U. S
Assessment of Professional Behavior Methods Used in U.S. Medical Schools

6. What do we know about remediation?
1/15/2019
What do we know about remediation?
National Board of Medical Examiners study
“There is an urgent need for multi-institutional, outcomes based research on strategies for remediation of less than fully competent trainees and physicians with the use of long-term follow-up to determine the impact on future performance.”
K. Hauer et al Acad Med 2009
There is an urgent need for
multiinstitutional, outcomes-based
research on strategies for remediation of
less than fully competent trainees and
physicians with the use of long-term
follow-up to determine the impact on
future performance.

7. Behavioral Domains 1. Responsibility 2. Capacity for self-improvement
2. Capacity for self-improvement  
3. Relationship with patients
4. Relationship with the health care
environment
Behavioral Domains

8. 1. Responsibility Unreliable attendance at clinic
1/15/2019
1. Responsibility
Unreliable attendance at clinic
Problematic notification about missed activities
Not following up on activities related to patient care
Late or absent for assigned activities
Unreliable
In Brandeis's view, a profession has three characteristics. First, it is an occupation for which the necessary training is intellectual, involving knowledge and learning as distinguished from skill. Second, it is an occupation pursued largely for others. Third, it is an occupation in which the amount of financial return is not the accepted measure of success. In my view, compliance satisfies all three per John Walsh

9. 2. Diminished capacity for self improvement
1/15/2019
2. Diminished capacity for self improvement
Failure to accept constructive criticism
Brusque, hostile or argumentative
Negative or poor attitude
Arrogant
Overconfident
Overly sensitive
In Brandeis's view, a profession has three characteristics. First, it is an occupation for which the necessary training is intellectual, involving knowledge and learning as distinguished from skill. Second, it is an occupation pursued largely for others. Third, it is an occupation in which the amount of financial return is not the accepted measure of success. In my view, compliance satisfies all three per John Walsh

10. 3. Relationship with patients
1/15/2019
3. Relationship with patients
Impaired relationships with patients
Failure to establish rapport
Insensitive to patient needs
In Brandeis's view, a profession has three characteristics. First, it is an occupation for which the necessary training is intellectual, involving knowledge and learning as distinguished from skill. Second, it is an occupation pursued largely for others. Third, it is an occupation in which the amount of financial return is not the accepted measure of success. In my view, compliance satisfies all three per John Walsh

11. 4. Relationship with the health care environment
1/15/2019
4. Relationship with the health care environment
Not respectful to members of the health care team
Creating a hostile educational environment
Testing irregularities
Falsification of patient data
In Brandeis's view, a profession has three characteristics. First, it is an occupation for which the necessary training is intellectual, involving knowledge and learning as distinguished from skill. Second, it is an occupation pursued largely for others. Third, it is an occupation in which the amount of financial return is not the accepted measure of success. In my view, compliance satisfies all three per John Walsh

12. Patterns of behaviors Timing in training when behaviors are displayed
Foundational sciences? Clinical interactions?
Severity of lapses
Repetition of behaviors and whether there is a trajectory for improvement
How does faculty know when remediation has been achieved?

13. Vignettes

14. Late student
Repeatedly shows up late for didactics, small group sessions, and start of call.
Tardiness ranges from minutes.
Either does not acknowledge tardiness or has an imprecise excuse for being late.
His peers are aware of the tardiness.

15. Demanding student Is insensitive and demanding to others.
Often interrupts fellow students during their presentations.
Nurses feel that student is self-centered, impatient, & arrogant.
Staff notes that student complains about not getting the “perfect” clinic schedule & requests changes to assignments.
Student rejects claims that evaluations are valid; believes faculty discriminates against her because of her disability

16. Medicine clerkship student
Enthusiastic about science of diseases
High MCATs (40) & high score on medicine shelf exam
Disrespectful and arrogant towards staff but not to evaluators
Defensive in accepting constructive criticism
Criticizes the subjective nature of evaluations ; claims his intent is laudable