SACME session

Note: SACME members can download PowerPoint presentations from the fall meeting in Boston from the SACME Web site. For those who couldn't attend and/or aren't members, I'll be writing up my notes from the sessions and posting them on Capsules. There was a lot of really great stuff!

At the Society for Academic CME fall meeting in Boston last week, Maxine Papadakis, MD, associate dean for student affairs and professor of clinical medicine at the University of California, San Francisco, outlined some interesting results from a study she did in conjunction with the Medical Board of California on the consequences of unprofessional behavior in medical school.

Basically, she said they wanted to see if bad behavior in med school correlates to Medical Board disciplinary actions 20 or 30 years down the road. And in fact, it turns out that unprofessional behavior in med school does correlate with disciplinary actions later on, and is a better predictor than MCAT scores, grades, or other factors. Looks like some zebras don t change their stripes as they mature--or don't mature, as the case may be.

In another study, she found that behaviors most closely associated with disciplinary actions are related to negligence and quality-of-care concerns unlike with malpractice, where doctor-patient communications is a bigger factor. (See this post for more on this.)

She said that it s important to identify problems early so they can nip it in the bud with interventions and remediation, though she admitted that there s a dearth of outcome data so far on what strategies might be most effective in remediating problem behaviors.

The Q&A was pretty interesting. Among the questions were:

What if the behaviors are the result of an affective disorder? Papadakis said that while of course the school would offer help, ultimately decisions have to rest on performance-based measures (at UCSF, students can not be allowed to graduate, even if they passed all their courses, if they flunk professionalism too many times). As she said, "It is a privilege to be a doctor, not a right. If the problem isn t remediable, we will not graduate the student. End of story."

What does all this have to do with CME? She said CME providers should develop CME to help faculty understand what professionalism and ethical behavior is, then help them to see where they themselves fit on the professionalism and ethical scales. "Then CME providers can help them to develop methods to deal with this core competency."

Another good question, I thought, was "What about students who are so traumatized by residents and faculty that the school itself causes the damage by the time they graduate? Papadakis said that her institution applies the same set of standards it uses to gauge the professionalism/ethics of students to residents and faculty.

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