Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Papadakis, Maxine A.; Arnold, G; Blank, Linda L.; Holmboe, Eric S.; Lipner, Rebecca S.

doi:10.7326/0003-4819-148-11-200806030-00009

Cited by 218 publications

(166 citation statements)

References 32 publications

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“…Papadakis et al then reviewed state licensing board disciplinary actions against 66,171 physicians who entered United States internal medicine residency training programs from 1990 to 2000 to determine whether behaviour during residency also predicted the likelihood of future disciplinary actions against practicing physicians. 7 A low professionalism rating on the resident's annual in-training evaluation summary predicted an increased risk for disciplinary action, and a high performance on the American Board of Internal Medicine certification examination predicted a decreased risk for disciplinary action.…”

Section: Predicting Problem Patterns Of Behaviour In Physiciansmentioning

confidence: 99%

Physician professional behaviour affects outcomes: A framework for teaching professionalism during anesthesia residency

Bahaziq

Crosby

2011

Can J Anesth/J Can Anesth

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Purpose In this review, we examine the association between physician professional behaviour and indicators measuring patient outcomes and satisfaction with care as well the potential for complaints, discipline, and litigation against physicians. We also review issues related to the structured teaching of professionalism to anesthesia residents, including resident evaluation. Source A search of the OVID Medline and PubMed databases was carried out using keywords relevant to the topics under consideration. Program directors of Canadian anesthesiology training programs were also surveyed to assess the current state of professionalism training and evaluation in their programs. Principal findings Unprofessional behaviour is frequently manifested in practice by medical students, residents, and physicians, and it is associated with personality characteristics that are evident early in training. There is a correlation between unprofessional physician behaviours and patient dissatisfaction, complaints, and lawsuits as well as adverse outcomes of care. Physician health and workplace relationships are negatively impacted by such behaviours. Canadian program directors recognize the need to approach the teaching of professionalism in an organized fashion during physician training. Conclusions A framework is provided for defining behavioural expectations, and mechanisms are offered for teaching and evaluating behaviours and responding to individuals with behaviours that persistently breach defined expectations. There is a need to define explicitly not only the expectations for behaviour but also the processes by which the behaviours will be assessed and documented. In addition, emphasis is placed on the nature, order, and magnitude of the responses to behaviours that do not meet expectations.

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Section: Predicting Problem Patterns Of Behaviour In Physiciansmentioning

confidence: 99%

Physician professional behaviour affects outcomes: A framework for teaching professionalism during anesthesia residency

Bahaziq

Crosby

2011

Can J Anesth/J Can Anesth

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“…Ratings on the RAES have been shown to correlate with performance on the certifying examination, peer ratings of postlicensure performance, and professional behavior in practice. [18][19][20] A descriptive analysis compared the professionalism ratings with the 2 ratings procedures. Residents with low scores in professionalism were identified as those rated as unsatisfactory (<4) in professionalism on the RAES form, 20 or those rated below a 2.5 and below a 2 on any of the 4 professionalism subcompetencies of the milestones.…”

Section: Statistical Analysesmentioning

confidence: 99%

Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014

Hauer

Vandergrift

Hess³

et al. 2016

JAMA

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IMPORTANCE US internal medicine residency programs are now required to rate residents using milestones. Evidence of validity of milestone ratings is needed.OBJECTIVE To compare ratings of internal medicine residents using the pre-2015 resident annual evaluation summary (RAES), a nondevelopmental rating scale, with developmental milestone ratings. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of US internal medicine residency programs in the 2013-2014 academic year, including 21 284 internal medicine residents (7048 postgraduate-year 1 [PGY-1], 7233 PGY-2, and 7003 PGY-3).EXPOSURES Program director ratings on the RAES and milestone ratings. MAIN OUTCOMES AND MEASURESCorrelations of RAES and milestone ratings by training year; correlations of medical knowledge ratings with American Board of Internal Medicine (ABIM) certification examination scores; rating of unprofessional behavior using the 2 systems. RESULTSCorresponding RAES ratings and milestone ratings showed progressively higher correlations across training years, ranging among competencies from 0.31 (95% CI, 0.29 to 0.33) to 0.35 (95% CI, 0.33 to 0.37) for PGY-1 residents to 0.43 (95% CI, 0.41 to 0.45) to 0.52 (95% CI, 0.50 to 0.54) for PGY-3 residents (all P values <.05). Linear regression showed ratings differed more between PGY-1 and PGY-3 years using milestone ratings than the RAES (all P values <.001). Of the 6260 residents who attempted the certification examination, the 618 who failed had lower ratings using both systems for medical knowledge than did those who passed (RAES difference, −0.9; 95% CI, −1.0 to −0.8; P < .001; milestone medical knowledge 1 difference, −0.3; 95% CI, −0.3 to −0.3; P < .001; and medical knowledge 2 difference, −0.2; 95% CI, −0.3 to −0.2; P < .001). Of the 26 PGY-3 residents with milestone ratings indicating deficiencies on either of the 2 medical knowledge subcompetencies, 12 failed the certification examination. Correlation of RAES ratings for professionalism with residents' lowest professionalism milestone ratings was 0.44 (95% CI, 0.43 to 0.45; P < .001).CONCLUSIONS AND RELEVANCE Among US internal medicine residents in the 2013-2014 academic year, milestone-based ratings correlated with RAES ratings but with a greater difference across training years. Both rating systems for medical knowledge correlated with ABIM certification examination scores. Milestone ratings may better detect problems with professionalism. These preliminary findings may inform establishment of the validity of milestone-based assessment.

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“…In a review article, van Mook et al (2014) examines the multiple issues related to the identification and remediation of ''dyscompetent'' residents, particularly in the area of professionalism. And an original study by Santen et al (2014) extends the findings of two landmark studies by Papadakis et al (2004Papadakis et al ( , 2008, which showed that unprofessional behavior in practice was apparently predictable from performance in medical school. Both studies used a ''case control'' design in which individuals who had the outcome of interest (discipline by a state licensing body)-''cases'' were compared to a random sample of doctors who were not reported-''controls''.…”

mentioning

confidence: 74%

Identifying the bad apples

Norman

2015

Adv in Health Sci Educ

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Performance during Internal Medicine Residency Training and Subsequent Disciplinary Action by State Licensing Boards

Cited by 218 publications

References 32 publications

Physician professional behaviour affects outcomes: A framework for teaching professionalism during anesthesia residency

Physician professional behaviour affects outcomes: A framework for teaching professionalism during anesthesia residency

Correlations Between Ratings on the Resident Annual Evaluation Summary and the Internal Medicine Milestones and Association With ABIM Certification Examination Scores Among US Internal Medicine Residents, 2013-2014

Identifying the bad apples

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