reprinted from Issue 11, Fall 2010 of Frontiers of Medicine (PDF)
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Maxine Papadakis, MD, associate dean for student affairs at the School of Medicine, was selected as the recipient of the 2010 John P. Hubbard Award by the National Board of Medical Examiners. The award is given to individuals who have made outstanding contributions to the pursuit of excellence in the field of evaluation in medicine.
Papadakis has led extensive research demonstrating that physicians who are disciplined by state licensing boards are more likely to have demon-strated unprofessional behavior in medical school, such as irresponsibility, diminished capacity for self-improvement, or impaired relationships with faculty, students, nurses or patients. She also conducted a study of all internal medicine diplomates who were in U.S. residency programs from 1990 to 2000 and confirmed the importance of professionalism in trainees as a predictor of subsequent disciplinary actions by state licensing boards.
“Her work is viewed by many as a breakthrough in assessment technology and theory, achieving hard evaluation methods and rigorous decisions for a soft competency,” says Lynn M. Cleary, MD, chair of the 2010 Hubbard Award Committee. “The impact of her work on medical school policies regarding professionalism has been enormous.”
“Consensus lists of the professional attributes of the ideal physicians tend to be long, internally inconsistent and full of idealizations and wishful thinking,” says UCSF School of Medicine Vice Dean for Education David M. Irby, PhD. “What we have needed is an empirically derived set of professional attributes of the physician that are critical to the practice of medicine… Dr. Papadakis’s work has … reveal[ed] the few essential elements of professionalism.”
Papadakis first became interested in this area when she served as medicine clerkship director at UCSF. “During that time, I would run across an occasional student who was having challenges in demonstration of the professional behavior that we want,” says Papadakis. In speaking with other clerkship directors, she often found that unprofessional behavior occurred more than once; yet there was no process in place to address such patterns. “These were missed opportunities to bring these observations to the students’ attention and do our best to help remediate them,” she says.
Papadakis supported efforts at UCSF to make professionalism a core competence, along with areas like patient care and medical knowledge, which are taught, evaluated and required for graduation. “Just like some of us might have trouble hearing heart sounds and need particular help, or have trouble working through a differential diagnosis, we now put professionalism in that same area,” says Papadakis.
She strongly believes that the next step is to identify and develop best practices for remediating unprofessional behavior. “All this work is for naught unless we can help our trainees get better,” says Papadakis. “We need outcome data to guide us, just as we have outcome data for important health issues. None of us is perfect, and our goal in identifying unprofessional behaviors is not to dismiss students – that is a last resort – but to guide them.”