These findings demonstrate a relationship between measures based on Miller's framework and behavioral measures based on the ABMS/ACGME core competencies. Equally important is the finding that while they are related they are not identical. These findings have implications for continuous professional development programing design.

ObjectiveTo determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available.MethodsA comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians.ResultsTwo-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians.ConclusionsReliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.

It is now well accepted that unprofessional behavior by practicing physicians can have a negative impact on patient safety and quality of care. [1][2][3] Further, unprofessional behavior during training is associated with unprofessional behavior in later practice and regulatory involvement. 4-6 Such behaviors can be classified into the following broad categories: failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness. Specific behavioral examples include poor collaboration, failure to incorporate feedback, argumentative communication, poor teamwork, externalizing blame, and failing to establish and maintain appropriate boundaries. 7In our clinical experience, these behaviors are somewhat consistent with behaviors that are often demonstrated by those with a history of adverse childhood experiences (ACEs). ACEs can include actual and/ or vicarious exposure to physical or sexual abuse, neglect, or loss of a parent. Exposure to such experiences has a strong positive correlation with medical and mental health issues in adult life, [8][9][10][11][12] and there appears to be a dose-response (or exposure-response) relationship between the number of ACEs a person experiences and subsequent medical and mental health difficulties. 10,11 Additionally, developmental exposure to trauma appears to predispose individuals to problems in responding appropriately to subsequent trauma, as they may become self-protective, exert excessive energy scanning their environment for threats, and experience ongoing low levels of fear and heightened vigilance, which can contribute to decreased curiosity, exploration, and learning. 12 Other difficulties associated with exposure to ACEs include affect dysregulation, difficulties labeling and expressing feelings and internal states, difficulties with self-concept, lack of continuous and predictable sense of self, low self-esteem, and experiencing feelings of shame and guilt. 13 Exposure to ACEs may also contribute to a person's decision to choose a helping profession. [14][15][16][17][18] However, there is a small but developing literature suggesting a relationship between boundary issues or sexual misconduct and attachment issues in physicians. 19,20 Sequelae of ACEs in medical trainees and physicians may manifest as professionalism lapses and difficulties with practice-based learning and improvement, such as defensiveness, shame, mistrust, difficulty with collaboration, and heightened reactivity, which may restrict receptivity to feedback, impair learning, and play a potential role in the manifestation