B-29© 360 Assessment of a Physician’s Workplace Behavior
William H. Swiggart1, M.S., Michael V. Williams2, Ph.D., Betsy White Williams3, Ph.D., MPH,
Kenneth A. Wallston4, Ph.D., Charlene M. Dewey1, M.D., M.Ed., Marine V. Ghulyan1, M.A.
Vanderbilt University School of Medicine1, Professional Renewal Center2, Rush University Medical Center3, Vanderbilt University School of Nursing4
Results
Background, Purpose & Methods
Background: The unprofessional behavior of
physicians continues to be a nationally recognized
problem affecting a culture of safety.1,2 Physicians
need objective assessments on competencies
that lead to behavior change and remediation.3,4
Purpose: Physicians with unprofessional behavior
can benefit from specific and clear feedback about
their behavior to make needed changes. We
created a valid and reliable instrument to track
and assess behavior change over time that can
be used to complement and augment patient
complaint data within the institution.
The B-29© is a 360°assessment of a physician’s
workplace behavior. It provides objective data for
both the physician and the institution or practice
setting. The B-29© is based on the American
Board of Medical Specialties and the Accreditation
Council for Graduate Medical Education
(ABMS/ACGME) six core competencies.5 We
present the psychometric properties of the B-29©.
Methods: Using a matched case–control design
(N=9 pairs) we conducted analysis to determine
whether there is a significant difference between
the physicians referred to the CME Distressed
Physicians Program at the Center for Professional
Health4 and the control physicians. Participants
were matched for age ± 5 yr., specialty,
graduation date from a medical college, and
gender. Human subjects' approval was obtained
from the Institutional Review Board at Vanderbilt
University.
The four factors were derived from a previous
validation study:6
Factor 1-General Personal Demeanor
Factor 2-Willingness or Ability to Meet Hospital/
Clinical Timeliness and Tasks
Factor 3-Avoids Egregious Behavior
Factor 4-Patient & Family Orientation &
Empathy (see Table 1.)
Conclusions & References
Conclusions:
Table 1. Differences between Control and Index Cases
Type
FACTOR 1. General Personal
Demeanor
FACTOR 2. Willingness or
Ability to meet
Hospital/Clinical Timeliness &
Tasks
FACTOR 3. Avoids Egregious
Behavior
FACTOR 4. Patient and
Family Orientation and
Empathy
Control Cases
N=9
M=4.5
M=4.55
M=4.8
M=4.7
Table 2. The B-29© Sample Page
Index Cases
N=9
Pair *Type
M=3.6
R2
Adjusted R 2
F
P
M=4.3
R2
Adjusted R 2
F
P
M=4.3
R2
Adjusted R 2
F
P
M=4.2
R2
Adjusted R 2
F
P
0.481
0.421
3.276
0.002
0.234
0.144
2.510
0.014
0.370
0.294
2.657
0.010
0.224
0.130
1.781
0.085
Physicians referred to the CME course have
consistently scored below average on all four
factors compared to the control group (see Table 1).
The B-29© is a validated and easy to use 360°
assessment instrument (see Table 2) that can
provide the basis of discriminating between those
who have been identified as unprofessional and
those who are not. Utilizing a core competency
framework lends itself to remedial efforts.
We believe that physicians deserve and need
clear, objective, behaviorally-based feedback in
order to make necessary changes and contribute
positively to the culture of safety.
Further investigation along with larger and more
heterogeneous samples should allow determination
as to whether a method can be developed that
meets the empirical needs of workplace application.
References:
1. AMA Code of Ethics: E-9.045 Physicians with Disruptive Behavior. December
2000. Available at http://www.ama-assn.org/ama/pub/category/8533.html
2. Hickson GB, Pichert JW, Webb LE. A complimentary approach to promoting
professionalism: identifying, measuring, and addressing unprofessional behaviors.
Acad Med.2007 Nov;82(11):1040-8
3. Papadakis MA, Paauw DS, Hafferty FW, Shapiro J, Byyny RL; Alpha Omega Alpha
Honor Medical Society Think Tank. Perspective: the education community must
develop best practices informed by evidence-based research to remediate lapses of
professionalism. Acad Med. 2012 Dec;87(12):1694-8.
4. The Center for Professional Health, Vanderbilt University Medical Center.
http://www.mc.vanderbilt/cph
5. Accreditation Council for Graduate Medical Education (ACGME) Core
Competencies.
Available
at
http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/540_hos
pice_and_palliative_medicine_companion_09_2009.pdf
6. Williams M.V, Swiggart W.H, Vickers K. L, Ghulyan M.V, Williams B.W.
Toward an applied measure of physician performance to support remediation in the
behavioral competencies. In preparation 2013.