ABSTRACT
INTRODUCTION: Clinicians treating human immunodeficiency virus (HIV) patients are expected to stay up-to-date with rapidly changing knowledge and practice. Continuing medical education (CME) programs are one source of new knowledge about HIV clinical management. Little is known about instructor-participant discourse in HIV CME programs and whether or how instructors model their decision-making strategies. METHODS: Discussions about clinical cases between instructors and participants in attendance at a HIV CME program were videotaped, transcribed, segmented, and coded, focusing on the participants' questions and the instructor's responses. RESULTS: Twenty-four case studies involving four instructors and 45 participants (54% infectious disease clinicians and 46% general practitioners) were analyzed. Five case studies are presented herein to illustrate how the instructors use the participants' questions and case studies to model cognitive processing and decision making in HIV treatment practice. DISCUSSION: This article provides a model of interactive and practice-based teaching discourse in the context of an HIV CME activity. Throughout this discourse the instructors model the fluent use of representations for the CME learners and provide a safe environment where participants can share their misunderstandings.
Subject(s)
Clinical Competence , Education, Medical, Continuing , HIV Infections , Practice Patterns, Physicians' , California , Decision Making , Drug Resistance , HIV Infections/drug therapy , Humans , Models, Organizational , Videotape RecordingABSTRACT
BACKGROUND: Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. METHODS: The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). RESULTS: Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. CONCLUSIONS: In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career.
Subject(s)
Employee Discipline , Licensure, Medical , Physicians , Professional Misconduct , Students, Medical , College Admission Test , Female , Fraud , Governing Board , Humans , Male , Organizational Case Studies , Physician Impairment , Schools, Medical , United StatesABSTRACT
BACKGROUND: In a previous study, we showed that unprofessional behavior in medical school was associated with subsequent disciplinary action. This study expands on that work by identifying the domains of unprofessional behavior that are most problematic. METHOD: In this retrospective case-control study, negative comments were extracted from student files for 68 case (disciplined) and 196 matched control (nondisciplined) physicians. Comments were analyzed qualitatively and subsequently quantified. The relationship between domains of behavior and disciplinary action was established through chi-square tests and multivariate analysis of variance. RESULTS: Three domains of unprofessional behavior emerged that were related significantly to later disciplinary outcome: (1) poor reliability and responsibility, (2) lack of self-improvement and adaptability, and (3) poor initiative and motivation. CONCLUSIONS: Three critical domains of professionalism associated with future disciplinary action have been defined. These findings could lead to focused remediation strategies and policy decisions.
