A Professional Development Course Improves Unprofessional Physician Behavior.

BACKGROUND: In 2008 The Joint Commission issued a Sentinel Event Alert that further defined "behaviors that undermine a culture of safety," stating that "intimidating and disruptive behaviors" can result in medical errors that affect patient care and safety. The American College of Physician Executives found that more than 95% of respondents encountered "disturbing . . . and potentially dangerous" behaviors on a regular basis. The purpose of this study is to evaluate the effectiveness of a professional development program on unprofessional physician behaviors using the B29™, a reliable and valid tool to assess workplace behaviors. METHODS: A pre-post study design was used to measure changes in physicians' unprofessional behaviors using the B29, a 35-item, Web-based survey. The survey is completed as a 360° assessment by peers, colleagues, administrators, and staff, and the physician completes a self-assessment. In most cases, the survey is voluntary. Those who completed both a precourse and a postcourse survey made up a convenience sample or subset of the larger number of physicians who completed the course. RESULTS: Twenty-four of 28 physicians in the study experienced an improvement in professional behavior, demonstrated as a decrease in the number of lowest-rated items. The mean decrease for all 28 physicians was 51.1%. Lowest-rated items improved an average of 53.5% overall. T-scores increased (also improved) for 24 of 28 physicians over the six-month period. CONCLUSION: Unprofessional behavior by physicians, as observed and reported by their peers and colleagues, can be positively modified by a relatively brief education program focused on teaching professionalism.

Validity of the Medical College Admission Test for predicting MD-PhD student outcomes.

The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD-PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD-PhD students at a single institution. The study population consisted of 153 graduates of the Vanderbilt Medical Scientist Training Program (combined MD-PhD program) who matriculated between 1963 and 2003 and completed dual-degree training. This population was divided into three cohorts corresponding to the version of the MCAT taken at the time of application. Multivariable regression (logistic for binary outcomes and linear for continuous outcomes) was used to analyze factors associated with outcome measures. The MCAT score and undergraduate GPA (uGPA) were treated as independent variables; medical and graduate school grades, time-to-PhD defense, USMLE scores, publication number, and career outcome were dependent variables. For cohort 1 (1963-1977), MCAT score was not associated with any assessed outcome, although uGPA was associated with medical school preclinical GPA and graduate school GPA (gsGPA). For cohort 2 (1978-1991), MCAT score was associated with USMLE Step II score and inversely correlated with publication number, and uGPA was associated with preclinical GPA (mspGPA) and clinical GPA (mscGPA). For cohort 3 (1992-2003), the MCAT score was associated with mscGPA, and uGPA was associated with gsGPA. Overall, MCAT score and uGPA were inconsistent or weak predictors of training metrics and career outcomes for this population of MD-PhD students.

A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.

BACKGROUND: Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers. METHODS: We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3. RESULTS: Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P < 0.001) and trained dyads (P < 0.001). Similar patterns were observed in the pediatric PACU. Three years later, the unadjusted estimate of the probability of an acceptable handover was 87% (72%-95%) in the adult PACU and 56% (40%-72%) in the pediatric PACU. CONCLUSIONS: A multimodal intervention substantially improved interprofessional PACU handovers, including those by clinicians who had not undergone formal simulation training. An effect appeared to be present >3 years later.

Effectiveness of a clinical intervention for MD/PhD students re-entering medical school.

BACKGROUND AND PURPOSE: For MD/PhD students, the transition to medical school following graduate research can be difficult. We developed a clinical intervention, the Clinical Preceptorship Program (CPP), for MD/PhD students at Vanderbilt to ease the transition to the core clinical clerkship year (the 3rd medical year) following graduate training. In this study, we determined whether the CPP prepared MD/PhD students adequately for medical school reentry. METHODS: Clerkship grades were obtained for 680 medical students and 50 MD/PhD students for academic years 2004-2010. A student's unpaired t test was used to analyze differences between group grades. RESULTS: We did not detect significant differences in the grades of the MD versus MD/PhD students. No differences in individual clerkships were detected with the exception of the Surgery clerkship. CONCLUSIONS: These data suggest that the CPP intervention was successful in preparing MD/PhD students for the core clerkship year. Such a clinical intervention can be an effective preparation for MD/PhD students returning to medical school.