ABIM Foundation Recognizes Scholarship on Medical Professionalism

PHILADELPHIA – The ABIM Foundation has awarded the John A. Benson Jr., MD Professionalism Article Prize to five scholarly articles – one commentary and four research pieces – that explore physician burnout, unprofessional behavior and integrity in research. Recipients of the ninth annual awards delved into the effect of disrespectful behavior by physicians on patient safety, quality of care and team function as well as efforts in training, prevention and remediation to address professional violations.

"Unprofessional behavior in the practice of medicine can have a devastating impact on patient care and safety, as well as the trust that is foundational to the physician-patient relationship and well-being of the clinical team," said Richard J. Baron, MD, President and CEO of the ABIM Foundation. "The work of our newest recipients of the John A. Benson Jr., MD article prize expand our understanding of the grave implications of this issue and promising steps that can bring about positive change, aligning with the Foundation's mission to foster medical professionalism as a force to improve patient care."

The ABIM Foundation first announced the annual prize in 2011 to celebrate and encourage outstanding contributions to the growing body of literature on medical professionalism and commitments articulated in the Physician Charter. Over the past nine years, more than 550 articles have been considered for the award and 30 winners declared.

The journal article receiving this year's commentary prize is:

"Confronting unprofessional behaviour in medicine" by Jo Shapiro, MD

In the March 7, 2018 issue of BMJ, Dr. Jo Shapiro, Director of the Center for Professionalism and Peer Support at Brigham and Women's Hospital, Harvard Medical School, delivers a clear call for zero tolerance of disrespectful behavior by health care providers. Shapiro writes that the prevalence of unprofessional behavior threatens the well-being of the health care team as well as patient safety and quality and the clinical learning environment. She states that prevention will require "institutional will and collective responsibility," the setting of clear expectations and confronting and reporting colleagues' lapses of professionalism.

The journal articles receiving this year's research prize are:

"The Professionalism and Integrity in Research Program: Description and Preliminary Outcomes" by James M. DuBois, DSc, PhD, John T. Chibnall, PhD, Raymond Tait, PhD, and Jillon S. Vander Wal, PhD

This article, published in the April 2018 issue of Academic Medicine, describes a remediation program aimed at addressing the root causes of violations of rules and regulations by researchers, the rationale for the program and preliminary outcomes from initial workshops with 39 investigators from 24 U.S. institutions who violated protocols. The Professionalism and Integrity in Research Program (PI Program) helps researchers compensate for bias and foster better oversight of research projects to meet compliance, quality and operation standards. Statistically significant increases in targeted behaviors were found in a follow-up survey of program participants.

"Patterns Of Disrespectful Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation" by Joseph Hopkins, MD, MMM, Haley Hedlin, PhD, Ann Weinacker, MD, and Manisha Desai, PhD

This retrospective analysis, published in the November 2018 issue of Academic Medicine, reviewed reports of disrespectful behavior over four years at Stanford Hospital and Clinics, a nationally ranked academic medical center providing highly specialized care as well as a teaching hospital, to better define the demographics, ethnography and epidemiology of such behaviors. The study found particular patterns of disrespectful actions, differing by role, gender, specialty and location, which can be used to develop focused education and training for specific physician groups and individualized remediation interventions.

"Qualitative Content Analysis of Coworkers' Safety Reports of Unprofessional Behavior by Physicians and Advanced Practice Professionals" by William Martinez, MD, MS; James W. Pichert, PhD; Gerald B. Hickson, MD; Casey H. Braddy, MS; Amy J. Brown, Thomas F. Catron, PhD; Ilene N. Moore, MD, JD; Morgan R. Stampfle, Lynn E. Webb, PhD, and William O. Cooper, MD, MPH

Published in the March 15, 2018 issue of the Journal of Patient Safety, this qualitative content analysis aimed to develop a valid and reliable taxonomy of coworker reports of alleged unprofessional behavior by physicians and advanced practice professions from a patient safety reporting system at Vanderbilt University Medical Center. Working with data from June 2015 to September 2016, researchers created 13 codes organized into four domains reflecting essential elements of medical professionalism, providing an analytical tool for promoting accountability and behavior change.

"Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-Analysis," by Maria Panagioti, PhD; Keith Geraghty, PhD; Judith Johnson, PhD; Anli Zhou, MD; Efharis Panagopoulou, PhD; Carolyn Chew-Graham, MD; David Peters, MD; Alexander Hodkinson, PhD; Ruth Riley, PhD; Aneez Esmail, MD, PhD

In this meta-analysis published in the Oct. 1, 2018 issue of JAMA Internal Medicine, researchers examined 47 studies involving more than 42,000 physicians to determine the degree to which physician burnout is associated with increased risk of patient safety incidents, poorer care outcomes and lower patient satisfaction. The study showed evidence that physician burnout was tied to increased risk of patient safety incidents and suboptimal quality of care due to low professionalism. There was also evidence of reduced patient satisfaction. The study calls for improved methods of reporting care quality and safety outcomes to gauge the outcome of burnout on clinical performance.

About This Year's Award

In 2015, the ABIM Foundation named the article prize in honor of American Board of Internal Medicine and ABIM Foundation President Emeritus John A. Benson Jr., MD. For more than two decades, Dr. Benson taught medical students at the University of Nebraska Medical Center, where he also worked to foster inter-professional education, and at Oregon Health & Science University School of Medicine, where he served at the Center for Ethics in Health Care. He has received several honors for his work in medical education and clinical medicine and has written extensively about professionalism.

Articles published in English language, peer-reviewed journals between January 1, 2018, and December 31, 2018 (online or in print), were eligible for the prize. A committee of physicians and other leaders in health care reviewed 17 articles meeting those criteria and selected the winners based on clarity of writing, thoroughness, methodology and contributions to the field and society.

Members of the selection committee included:<br />

• Louise Arnold, PhD, Professor Emerita, Office of Medical Education, University of Missouri-Kansas City School of Medicine
• John A. Benson Jr., MD, President Emeritus, American Board of Internal Medicine and ABIM Foundation
• Rosemary Gibson, MSc, Senior Advisor, The Hastings Center; Section Editor, Less is More, JAMA Internal Medicine
• Hayley Goldbach, MD, Resident, UCLA
• Harry "Bud" Isaacson, MD, Associate Professor of Medicine, Interim Executive Dean, Cleveland Clinic Lerner College of Medicine
• Lorna Lynn, MD, Vice President, Medical Education Research, American Board of Internal Medicine
• Bernard M. Rosof, MD, MACP, Chief Executive Officer of Quality in Healthcare Advisory Group, LLC
• Daniel Wolfson, MHSA, Executive Vice President and Chief Operating Officer, ABIM Foundation
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