Supporting victim-survivors during investigations of health practitioner misconduct: early learnings from a trauma-informed service.

OBJECTIVE: In 2021, the Australian Health Practitioner Regulation Agency established a support service to provide additional assistance to victim-survivors involved in complaints related to sexual boundary violations. This study evaluates the first stages of service delivery to understand participants' experiences with the service, gauge the service's reception, and improve support provided in future. DESIGN: Programme data was analysed descriptively to understand uptake and participant engagement since inception. Semistructured interviews with a purposive convenience sample of participants who had recently completed service engagement were conducted over 6 months and analysed using reflexive thematic analysis. Findings were triangulated to judge the effectiveness of the support provided by the service and highlight learning and development opportunities. RESULTS: During the study period, 275 participants were referred to the programme and 175 (64%) of those referred had engaged with the service. At the time of analysis, less than a quarter (21%) had refused support or disengaged following referral. Participants reported appreciation of and satisfaction with the support they received from the service and strongly reiterated the need for support in this context. Flexibility and quality communication as part of the service model was associated with participants feeling supported through three main themes: safety and connection, guidance and process navigation and representation and advocacy. CONCLUSION: Good uptake of the service and positive feedback from participants suggests that the programme has been a valuable and well-received initiative. Exploration of engagement trends as well as a more nuanced analysis of the benefits of support provided would augment these findings.

The specifics of the interpretation of non-performance or improper performance by medical or pharmaceutical employees of their professional duties, taking into account the practice of the ECHR.

OBJECTIVE: Aim: To find out the specifics of the interpretation of non-performance or improper performance by medical or pharmaceutical employees of their professional duties, taking into account the practice of the ECHR. PATIENTS AND METHODS: Materials and Methods: This article is based on the analysis of the international legal acts, the practice of the ECHR, national judicial practice, court statistics, criminal and medical law legal doctrine, official statistics of the Office of the Prosecutor General of Ukraine, analytical data based on the results of cooperation with the "Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine". Dialectical, comparative, analytical, synthetic and system analysis research, hermeneutic methods were used. RESULTS: Results: In each specific case it is necessary to establish whether there is non-performance or improper performance of professional duties by medical or pharmaceutical employees, the result of which is the failure to fulfil his direct professional duties, provided for by regulatory and legal acts, job instructions, qualification requirements and standards of treatment. The patient's right to health care is not ensured by the guarantees provided for by national legislation, so patients file complaints with the ECHR. CONCLUSION: Conclusions: A single approach to the interpretation of such terms as "non-performance or improper performance by a medical or pharmaceutical employee his professional duties" is a guarantee of the uniformity of their enforcement and the formation of stable judicial practice in this category of criminal cases.

How can interventions more directly address drivers of unprofessional behaviour between healthcare staff?

Unprofessional behaviours (UBs) between healthcare staff are widespread and have negative impacts on patient safety, staff well-being and organisational efficiency. However, knowledge of how to address UBs is lacking. Our recent realist review analysed 148 sources including 42 reports of interventions drawing on different behaviour change strategies and found that interventions insufficiently explain their rationale for using particular strategies. We also explored the drivers of UBs and how these may interact. In our analysis, we elucidated both common mechanisms underlying both how drivers increase UB and how strategies address UB, enabling the mapping of strategies against drivers they address. For example, social norm-setting strategies work by fostering a more professional social norm, which can help tackle the driver 'reduced social cohesion'. Our novel programme theory, presented here, provides an increased understanding of what strategies might be effective to adddress specific drivers of UB. This can inform logic model design for those seeking to develop interventions addressing UB in healthcare settings.

Physician Specialty Differences in Unprofessional Behaviors Observed and Reported by Coworkers.

Importance: Because unprofessional behaviors are associated with patient complications, malpractice claims, and well-being concerns, monitoring concerns requiring investigation and individuals identified in multiple reports may provide important opportunities for health care leaders to support all team members. Objective: To examine the distribution of physicians by specialty who demonstrate unprofessional behaviors measured through safety reports submitted by coworkers. Design, Setting, and Participants: This retrospective cohort study was conducted among physicians who practiced at the 193 hospitals in the Coworker Concern Observation Reporting System (CORS), administered by the Vanderbilt Center for Patient and Professional Advocacy. Data were collected from January 2018 to December 2022. Exposure: Submitted reports concerning communication, professional responsibility, medical care, and professional integrity. Main Outcomes and Measures: Physicians' total number and categories of CORS reports. The proportion of physicians in each specialty (nonsurgeon nonproceduralists, emergency medicine physicians, nonsurgeon proceduralists, and surgeons) who received at least 1 report and who qualified for intervention were calculated; logistic regression was used to calculate the odds of any CORS report. Results: The cohort included 35 120 physicians: 18 288 (52.1%) nonsurgeon nonproceduralists, 1876 (5.3%) emergency medicine physicians, 6743 (19.2%) nonsurgeon proceduralists, and 8213 (23.4%) surgeons. There were 3179 physicians (9.1%) with at least 1 CORS report. Nonsurgeon nonproceduralists had the lowest percentage of physicians with at least 1 report (1032 [5.6%]), followed by emergency medicine (204 [10.9%]), nonsurgeon proceduralists (809 [12.0%]), and surgeons (1134 [13.8%]). Nonsurgeon nonproceduralists were less likely to be named in a CORS report than other specialties (5.6% vs 12.8% for other specialties combined; difference in percentages, -7.1 percentage points; 95% CI, -7.7 to -6.5 percentage points; P < .001). Pediatric-focused nonsurgeon nonproceduralists (2897 physicians) were significantly less likely to be associated with a CORS report than nonpediatric nonsurgeon nonproceduralists (15 391 physicians) (105 [3.6%] vs 927 [6.0%]; difference in percentages, -2.4 percentage points, 95% CI, -3.2 to -1.6 percentage points; P < .001). Pediatric-focused emergency medicine physicians, nonsurgeon proceduralists, and surgeons had no significant differences in reporting compared with nonpediatric-focused physicians. Conclusions and Relevance: In this cohort study, less than 10% of physicians ever received a coworker report with a concern about unprofessional behavior. Monitoring reports of unprofessional behaviors provides important opportunities for health care organizations to identify and intervene as needed to support team members.

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals.

BACKGROUND: Unprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program "Ethos" implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for 'reflection' or 'recognition'. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos. METHODS: A survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5-3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as 'extreme' (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics. RESULTS: In total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32-41% in prevalence post-Ethos. Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message. CONCLUSION: The Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

Unprofessionalism in anesthesiology: A qualitative study on classifying unprofessional behavior in anesthesiology residency education.

STUDY OBJECTIVE: This study aims to identify the domains that constitute behaviors perceived to be unprofessional in anesthesiology residency training programs. DESIGN: Qualitative study. SETTING: Anesthesiology residency training programs. PATIENTS: Not applicable. The participants involved residents, fellows, and faculty members purposefully sampled in four US-based anesthesiology residency programs. INTERVENTIONS: Participants were asked to submit examples of unprofessional behavior they witnessed in anesthesiology residents, fellows, or faculty members via a Qualtrics link. MEASUREMENTS: Not applicable. The behavior examples were independently reviewed and categorized into themes using content analysis. MAIN RESULTS: A total of 116 vignettes were collected, resulting in a final list of 111 vignettes after excluding those that did not describe behavior exhibited by anesthesiology faculty or trainees. Fifty-eight vignettes pertained to unprofessional behaviors observed in faculty members and 53 were observed in trainees (residents and fellows). Nine unprofessionalism themes emerged in the analysis. The most common themes were VERBAL, SUPERVISION, QUALITY, ENGAGEMENT, and TIME. As to the distribution of role group (faculty versus trainee) by theme, unprofessional behaviors falling into the categories of BIAS, GOSSIP, LEWD, and VERBAL were observed more in faculty; whereas themes with unprofessional behavior primarily attributed to trainees included ENGAGEMENT, QUALITY, TIME, and SUPERVISION. CONCLUSION: By reviewing reported professionalism-related vignettes within residency training programs, we identified classification descriptors for defining unprofessional behavior specific to anesthesiology residency education. Findings from this study enrich the definition of professionalism as a multi-dimensional competency pertaining to anesthesiology graduate medical education. This framework may facilitate preventative intervention and timely remediation plans for unprofessional behavior in residents and faculty.

The effects of academic unprofessional behaviour on disciplinary action by medical boards: Systematic review and meta-analysis.

OBJECTIVE: The objective of this study is to evaluate the association of disciplinary actions by regulatory councils and unprofessional behaviour during medical graduation. METHODS: A search strategy was developed using the terms: 'physicians', 'disciplinary action', 'education', 'medical', 'undergraduate' and their synonyms, subsequently applied to the electronic databases MEDLINE, Embase, Cochrane Library, LILACs and grey literature, with searches up to November 2023. The risk of bias was assessed using the Newcastle-Ottawa scale and statistical analysis was performed using the RevMan software. RESULTS: A total of 400 studies were found in the databases, and 15 studies were selected for full-texting reading. Four studies met the inclusion criteria and were included, bringing together a total of 3341 evaluated physicians. Three studies were included in the meta-analysis, showing a greater chance of disciplinary actions among physicians who exhibited unprofessional behaviour during medical graduation (OR: 2.54; 95%CI: 1.87-3.44; I2: 0%; P < 0.0001; 3077 participants; physicians with disciplinary action: 107/323; control physicians: 222/2754). CONCLUSIONS: There is a statistically significant association between unprofessional behaviour during medical undergraduate study and subsequent disciplinary actions by Medical Councils. The tools for periodic assessments of student behaviour during undergraduate studies can be a perspective for future studies aimed at reducing disciplinary actions among physicians.

Self-Reported Academic Misconduct among Medical Students: Perception and Prevalence.

Academic integrity is the basis of an education system and must be taught as an ethical behavior during academic training. Students who reflect honesty and truthfulness during the academic years are more likely to follow this path, develop professional integrity, and thus become responsible and dependable professionals. Here, we determine the prevalence of academic lapses among medical students by a cross-sectional descriptive survey based on a self-assessment questionnaire. Students' perception of 37 behaviors comprising five domains, plagiarism, indolence, cheating, disruptive behavior, and falsifying data, were explored. A high percentage of students (83%) indicated that all 37 behaviors constitute misconduct. Approximately 65% of students thought that their fellow students were involved in dishonest behaviors, and 34% answered that they were indulged in some form of misconduct. Content analysis identified some prevalent behaviors such as doing work for another student (82.5%), getting information from the students who already took the exam (82.5%), copying the answer from neighbors (79%), and marking attendance for absent friends (74.5%). Multiple regression analysis points out that future indulgence in a behavior is significantly (p ≤ 0.5) correlated with understanding a behavior as wrong, perceiving that others do it and whether one has already indulged in it. This study can serve as a diagnostic tool to analyze the prevalence of misconduct and a foothold to develop the medical school system's ethical guidelines.

Multiple United States Medical Licensing Examination Attempts and the Estimated Risk of Disciplinary Actions Among Graduates of U.S. and Canadian Medical Schools.

PURPOSE: The United States Medical Licensing Examination (USMLE) recently announced 2 policy changes: shifting from numeric score reporting on the Step 1 examination to pass/fail reporting and limiting examinees to 4 attempts for each Step component. In light of these policies, exam measures other than scores, such as the number of examination attempts, are of interest. Attempt limit policies are intended to ensure minimum standards of physician competency, yet little research has explored how Step attempts relate to physician practice outcomes. This study examined the relationship between USMLE attempts and the likelihood of receiving disciplinary actions from state medical boards. METHOD: The sample population was 219,018 graduates from U.S. and Canadian MD-granting medical schools who passed all USMLE Step examinations by 2011 and obtained a medical license in the United States, using data from the NBME and the Federation of State Medical Boards. Logistic regressions estimated how attempts on Steps 1, 2 Clinical Knowledge (CK), and 3 examinations influenced the likelihood of receiving disciplinary actions by 2018, while accounting for physician characteristics. RESULTS: A total of 3,399 physicians (2%) received at least 1 disciplinary action. Additional attempts needed to pass Steps 1, 2 CK, and 3 were associated with an increased likelihood of receiving disciplinary actions (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01, 1.13; OR: 1.09, 95% CI: 1.03, 1.16; OR: 1.11, 95% CI: 1.04, 1.17, respectively), after accounting for other factors. CONCLUSIONS: Physicians who took multiple attempts to pass Steps 1, 2 CK, and 3 were associated with higher estimated likelihood of receiving disciplinary actions. This study offers support for licensure and practice standards to account for physicians' USMLE attempts. The relatively small effect sizes, however, caution policy makers from placing sole emphasis on this relationship.

Why Otolaryngologists Get Excluded From Medicare and Medicaid.

The List of Excluded Individuals and Entities (LEIE) is a federally updated and available list of providers who have been excluded from participating from federal healthcare programs. With over 40 year's worth of exclusion history, we were able to isolate and identify otolaryngologists who were excluded and the most common cause, albeit exceptionally rare, was revocation of their medical license due to negligence.

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals.

OBJECTIVE: To identify individual and organisational factors associated with the prevalence, type and impact of unprofessional behaviours among hospital employees. DESIGN, SETTING, PARTICIPANTS: Staff in seven metropolitan tertiary hospitals operated by one health care provider in three states were surveyed (Dec 2017 - Nov 2018) about their experience of unprofessional behaviours - 21 classified as incivility or bullying and five as extreme unprofessional behaviour (eg, sexual or physical assault) - and their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills. MAIN OUTCOME MEASURES: Frequency of experiencing 26 unprofessional behaviours during the preceding 12 months; factors associated with experiencing unprofessional behaviour and its impact, including self-reported speaking-up skills. RESULTS: Valid surveys (more than 60% of questions answered) were submitted by 5178 of an estimated 15 213 staff members (response rate, 34.0%). 4846 respondents (93.6%; 95% CI, 92.9-94.2%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2009 (38.8%; 95% CI, 37.5-40.1%) who reported weekly or more frequent incivility or bullying; 753 (14.5%; 95% CI, 13.6-15.5%) reported extreme unprofessional behaviour. Nurses and non-clinical staff members aged 25-34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively. Staff with self-reported speaking-up skills experienced less incivility/bullying (odds ratio [OR], 0.53; 95% CI, 0.46-0.61) and extreme behaviour (OR, 0.80; 95% CI, 0.67-0.97), and also less frequently an impact on their personal wellbeing (OR, 0.44; 95% CI, 0.38-0.51). CONCLUSIONS: Unprofessional behaviour is common among hospital workers. Tolerance for low level poor behaviour may be an enabler for more serious misbehaviour that endangers staff wellbeing and patient safety. Training staff about speaking up is required, together with organisational processes for effectively eliminating unprofessional behaviour.

Abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe health facilities.

BACKGROUND: Antenatal care utilization is fundamental in preventing adverse pregnancy and birth outcomes. This paper assessed abuse and disrespectful care on women during access to antenatal care services and its implications in Ndola and Kitwe districts of Zambia. METHODS: The assessment used a cross-sectional study design with a sample size of 505 women of child bearing age (15-49). Eighteen (18) high volume health facilities were identified as benchmarks for catchment areas (study sites) and using cluster sampling, households within catchment areas of health facilities were sampled. Chi-square and poison regression analysis was performed to ascertain associations between abuse and disrespect and antenatal care utilization. RESULTS: One third (33%) of the participants attended less than half of the recommended antenatal visits. Results reveal a statistical significant association between; physical abuse (p value = 0.039); not being allowed to assume position of choice during examination (p value = 0.021); not having privacy during examination (p value = 0.006) and antenatal care service utilization. The difference in the logs of expected count on the number of antenatal care visits is expected to be; 0.066 (CI: -0.115,-0.018) unit lower for women who experienced lack of privacy during examinations; 0.067 (CI: -0.131,-0.004) unit lower for women who were discriminated based on specific attributes and 0.067 (CI: -0.120,-0.014) unit lower for women who were left unattended. CONCLUSION: Abuse and disrespect during antenatal care service impedes demand for health care and service utilization thereby barricading the element of the package of services aimed at improving maternal and newborn health.

Academic dishonesty among university students: The roles of the psychopathy, motivation, and self-efficacy.

Academic dishonesty is a common problem at universities around the world, leading to undesirable consequences for both students and the education system. To effectively address this problem, it is necessary to identify specific predispositions that promote cheating. In Polish undergraduate students (N = 390), we examined the role of psychopathy, achievement goals, and self-efficacy as predictors of academic dishonesty. We found that the disinhibition aspect of psychopathy and mastery-goal orientation predicted the frequency of students' academic dishonesty and mastery-goal orientation mediated the relationship between the disinhibition and meanness aspects of psychopathy and dishonesty. Furthermore, general self-efficacy moderated the indirect effect of disinhibition on academic dishonesty through mastery-goal orientation. The practical implications of the study include the identification of risk factors and potential mechanisms leading to students' dishonest behavior that can be used to plan personalized interventions to prevent or deal with academic dishonesty.

Isn't high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms.

Germinal studies have described the prevalence of sex-based harassment in high schools and its associations with adverse outcomes in adolescents. Studies have focused on students, with little attention given to the actions of high schools themselves. Though journalists responded to the #MeToo movement by reporting on schools' betrayal of students who report misconduct, this topic remains understudied by researchers. Gender harassment is characterized by sexist remarks, sexually crude or offensive behavior, gender policing, work-family policing, and infantilization. Institutional betrayal is characterized by the failure of an institution, such as a school, to protect individuals dependent on the institution. We investigated high school gender harassment and institutional betrayal reported retrospectively by 535 current undergraduates. Our primary aim was to investigate whether institutional betrayal moderates the relationship between high school gender harassment and current trauma symptoms. In our pre-registered hypotheses (https://osf.io/3ds8k), we predicted that (1) high school gender harassment would be associated with more current trauma symptoms and (2) institutional betrayal would moderate this relationship such that high levels of institutional betrayal would be associated with a stronger association between high school gender harassment and current trauma symptoms. Consistent with our first hypothesis, high school gender harassment significantly predicted college trauma-related symptoms. An equation that included participant gender, race, age, high school gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal also significantly predicted trauma-related symptoms. Contrary to our second hypothesis, the interaction term was non-significant. However, institutional betrayal predicted unique variance in current trauma symptoms above and beyond the other variables. These findings indicate that both high school gender harassment and high school institutional betrayal are independently associated with trauma symptoms, suggesting that intervention should target both phenomena.

Association Between Web-Based Physician Ratings and Physician Disciplinary Convictions: Retrospective Observational Study.

BACKGROUND: Physician rating websites are commonly used by the public, yet the relationship between web-based physician ratings and health care quality is not well understood. OBJECTIVE: The objective of our study was to use physician disciplinary convictions as an extreme marker for poor physician quality and to investigate whether disciplined physicians have lower ratings than nondisciplined matched controls. METHODS: This was a retrospective national observational study of all disciplined physicians in Canada (751 physicians, 2000 to 2013). We searched ratings (2005-2015) from the country's leading online physician rating website for this group, and for 751 matched controls according to gender, specialty, practice years, and location. We compared overall ratings (out of a score of 5) as well as mean ratings by the type of misconduct. We also compared ratings for each type of misconduct and punishment. RESULTS: There were 62.7% (471/751) of convicted and disciplined physicians (cases) with web-based ratings and 64.6% (485/751) of nondisciplined physicians (controls) with ratings. Of 312 matched case-control pairs, disciplined physicians were rated lower than controls overall (3.62 vs 4.00; P<.001). Disciplined physicians had lower ratings for all types of misconduct and punishment-except for physicians disciplined for sexual offenses (n=90 pairs; 3.83 vs 3.86; P=.81). Sexual misconduct was the only category in which mean ratings for physicians were higher than those for other disciplined physicians (3.63 vs 3.35; P=.003). CONCLUSIONS: Physicians convicted for disciplinary misconduct generally had lower web-based ratings. Physicians convicted of sexual misconduct did not have lower ratings and were rated higher than other disciplined physicians. These findings may have future implications for the identification of physicians providing poor-quality care.

Speak-Up Culture in Academic Nursing: Empowering Junior Faculty.

BACKGROUND: Faculty-to-faculty incivility in academic nursing is well documented, yet speaking up about the unprofessional behaviors of academic colleagues is still a challenge, particularly for junior faculty. METHOD: A unique faculty development session presented an opportunity to explore junior faculty experiences and perceptions of incivility, with the objectives of addressing concerns in a safe environment, identifying appropriate responses and resources for managing incivility, and supporting decisional influences on speaking up. RESULTS: Junior faculty were valued for their unique perspectives of the institutional culture and empowered as members of speak-up culture in the academic setting. CONCLUSION: Administrators benefit from intentionally seeking junior faculty perspectives regarding unprofessional faculty behaviors in the academic setting. Overall school culture benefits from ongoing efforts toward discussion, resource development, and upholding policies related to incivility. [J Nurs Educ. 2020;59(4):210-213.].

An Innovative Civility Intervention Created by a Faculty and Student Action Research Team.

BACKGROUND: Incivility is a significant issue in nursing education and practice, contributing to ineffective learning, unprofessional nursing practice, and negative patient outcomes. METHOD: A team of nursing faculty and students used Action Research to develop a quality improvement project targeting civility. A two-part, evidence-based training was offered to prelicensure nursing students, faculty, and staff. Part one was designed to increase incivility awareness, and part two was intended to enhance communication skills. RESULTS: Program evaluation data were collected through an anonymous survey and analyzed descriptively for themes. Results indicated students, faculty, and staff perceived the educational innovation as valuable and useful. CONCLUSION: By using free resources, a college of nursing was able to implement a cost-effective program to begin a conversation and offer a communication strategy to address incivility for students, faculty, and staff. This program design can be adopted by others for use in their organization. [J Nurs Educ. 2020;59(4):214-217.].