Council on Medical Student Education in Pediatrics


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Transforming Unprofessional Behaviors
Transformative Learning in a Professional Development Course Aimed at Addressing Disruptive Physician Behavior: A Composite Case Study. Samenow CP et al. Acaemic Medicine 2013;88:117-123.
Reviewed by Linda Lewin

What was the study question?
This paper describes a program developed at Vanderbilt University to address disruptive behaviors in physicians. Disruptive physician behavior is defined as that which “negatively affects or that potentially may negatively affect patient care.”

How was the study done?
The program is a six-day course broken down into three consecutive days followed by 3 one-day follow up sessions over six months. It uses “transformative learning” principles that lead participants to identify the problem, explore reasons for the behaviors in question, and come up with solutions that can be tested and then adopted. The detailed steps are described in the article.

What were the results?
The article presents a composite case study of a disruptive physician who is referred to the program - a surgeon in an academic medical center who is difficult to work with who is mandated to attend after throwing a piece of equipment in the OR that injures a nurse. The case is used as a framework to describe how the 10 steps of transformative learning are applied during the program. A composite testimonial from past participants in the program is also provided.

What are the implications of these findings?
This case study points out that many of us behave in the ways we were raised to believe are correct, and that by taking the time to explore those assumptions people can change. It is important for us to remember this, and to offer help and support to those among us who display their frustrations in a disruptive manner.

Editor’s Note: It’s nice to hear about a program that successfully remediates professionalism issues (although the skeptic in me wants to know more about the program’s success rates). The challenge will be to take some of the successful components of this course (eg role-playing, skills-building) and use them to address deficiencies in our learners before they get to the stage of the physician in this case study (JG).

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