Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

Introduction: Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.

Method: In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a “brief” and “extended” professionalism checklist for monitoring physician misconduct.

Results: This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.

Discussion: Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.     

Drugs for all: the future of global AIDS treatment

I am interested in the arts of government that accompany economic globalization and in the remaking of populations as market segments (specifically therapeutic markets). Using the Brazilian response to AIDS as an ethnographic baseline, I examine the systemic relations between pharmaceutical commerce and public health care and the value systems that underscore global AIDS treatment initiatives. The pharmaceuticalization of governance and citizenship, obviously efficacious in the treatment of AIDS, nonetheless crystallizes new inequalities.     

How organs are distributed

A computerized system known as United Network Organ Sharing (UNOS) was established in 1977 to facilitate the procurement of kidneys, hearts, and livers for transplantation. Used primarily for kidney transplants, the publicly-funded UNOS computer system enables transplant centers across the country and in Canada to match available kidneys with potential recipients. Due to the shorter preservation time for hearts and livers, a service of the North American Transplant Coordinators Organization (NATCO) was developed in 1982 to complement the computer system. This 24-ALERT phone system provides a recording of the needs of heart and liver centers, categorized by priority codes indicating those patients who are critically ill.     

Goodbye to all that. The end of moderate protectionism in human subjects research

Federal policies on human subjects research have undergone a progressive transformation. In the early decades of the twentieth century, federal policies largely relied on the discretion of investigators to decide when and how to conduct research. This approach gradually gave way to policies that augmented investigator discretion with externally imposed protections. We may now be entering an era of even more stringent external protections. Whether the new policies effectively absolve investigators of personal responsibility for conducting ethical research, and whether it is wise to do so, remains to be seen.     

Fitting it all in: integration of 12 cross-cutting themes into a School of Medicine curriculum

Changing demographic, social, economic and technological trends have impacted the expectations of the Academic Health Center in preparing physicians to serve the needs of the American society, resulting in revisions to current curricula. In addition to the traditional basic sciences and clinical disciplines, accredited medical schools are required to provide curriculum exposure in behavioral health, communication skills, diversity and cultural awareness, ethics, evidence-based medicine, geriatrics, integrative medicine, pain management, palliative care, public health, socio-economic dynamics, and domestic violence. These themes are considered 'cross-cutting' since it is recognized these important curricular components apply across all years of medical school. In this article, the authors describe a strategic model developed at the University of New Mexico School of Medicine (UNMSOM) to integrate horizontally and vertically 12 cross-cutting themes as an evolving interdisciplinary curriculum reform process. These areas were defined through a combination of internal self-study, external requirements, and student and faculty interest. In the early stage of use of this model at UNMSOM, the authors describe the new cross-cutting themes that have been integrated. Minimal disruption and a spirit of cooperation and acceptance have characterized the curricular change that has been required. Preliminary assessment indicates that the program has been successful.