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Perspective: The Education Community Must Develop Best Practices Informed by Evidence-Based Research to Remediate Lapses of Professionalism

Papadakis, Maxine A. MD; Paauw, Douglas S. MD; Hafferty, Frederic W. PhD; Shapiro, Jo MD; Byyny, Richard L. MD; for the Alpha Omega Alpha Honor Medical Society Think Tank

doi: 10.1097/ACM.0b013e318271bc0b

In July 2011, the Alpha Omega Alpha Honor Medical Society sponsored a think tank of experts in the field of medical professionalism to focus on interventions and remediation strategies for those—medical students, residents, faculty, and practicing physicians—who demonstrate lapses in professional performance, particularly if the lapses are repeated. Several participants have produced scholarly work on the assessment of professionalism. However, assessment has a limited purpose unless it leads to improvements at both the organizational and individual levels. The field of professionalism has matured enough to recognize that one of the contemporary issues within the self-regulation framework is the task of remediation. Yet there is a paucity of evidence to inform best practices to help those who have lapses. Ultimately, the most effective response to an individual’s lapse in professionalism may not be simply to gather knowledge about remedial practices but also to understand organizational responses to the information about such practices already possessed by the institution.

The authors report the think tank participants’ recommendations on (1) how to use existing data on professionalism remediation and (2) what new evidence is needed to advance approaches to remediation of professional performance. Participants also recommended that the education community can focus on interventions and remediation by (1) performing studies about improving medical professionalism when lapses occur, (2) identifying best evidence-based remediation practices, (3) widely disseminating those practices, and (4) moving over time from a best-practices approach to remediation (which does not yet exist) to a best-evidence model.

Dr. Papadakis is professor of medicine, Department of Medicine, University of California, San Francisco, and San Francisco Veterans Association Medical Center, and associate dean of students, School of Medicine, University of California, San Francisco, San Francisco, California.

Dr. Paauw is professor of medicine, Department of Medicine, and Rathmann Family Foundation Endowed Chair for Patient-Centered Clinical Education, University of Washington School of Medicine, Seattle, Washington.

Dr. Hafferty is professor of medical education and associate director, Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota.

Dr. Shapiro is associate professor of otology and laryngology, Harvard Medical School, and director, Center for Professionalism and Peer Support, Brigham and Women’s Hospital, Boston, Massachusetts.

Dr. Byyny is executive director, AΩA Honor Medical Society, Menlo Park, California.

Correspondence should be addressed to Dr. Papadakis, University of California, San Francisco, 513 Parnassus Ave., S-245, San Francisco, CA 94143-0454; telephone: (415) 476-1216; fax: (415) 502-1320; e-mail:

© 2012 Association of American Medical Colleges