APB Development
Development of the APB Program began in 2001, when the NBME Board identified the assessment of professional behaviors as a priority. Advances in the science of assessment made such a development possible, while heightened attention to professionalism created a receptive environment within the medical profession. Since then, NBME has conducted multiple field trials and continues to do research to ensure a program that encourages thoughtful reflection and dialogue about professional behaviors at individual, departmental, and institutional levels.
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Invitational Conference
In 2002, a conference on the assessment of medical student professionalism, co-sponsored by NBME and the Association of American Medical Colleges (AAMC), brought together 25 experts in broad areas of measurement and professionalism from North America and Europe. This community of experts identified multisource feedback as the best method to assess professional behaviors in real-world environments. They generated an initial list of behaviors that were then expanded substantively by NBME staff.
Item and Instrument Development
In September 2003 and January 2004, NBME convened a task force to design the survey. Beginning with a list of approximately 150 behaviors, the task force pruned the list to approximately 60 behaviors, which were then further refined. The resulting list appeared relevant to “professionalism” and was amenable to sampling by a survey instrument. The task force embraced a conceptual design that mapped behaviors into specific survey forms that, in turn, defined expected behaviors across the education and practice continuum. Field trial experiences have led to further refinements of the APB instrument.
2004-2005
During the 2004-05 academic year, NBME conducted a pilot study with two residency programs and two medical schools. The purpose of this pilot was to gather data on the relevance, usefulness, and measurement of the identified behaviors. The observees included medical students, residents, and faculty. Observers included people from these groups as well as nurses, administrative staff, and other health care professionals.
2006-2009
In 2006-8, NBME worked with three residency programs and a medical school, while continuing to refine the instrument as well as implementation and feedback processes. Qualitative research conducted during this pilot indicated the need for standardizing and simplifying the orientation and training across participating programs.
During 2007-9, NBME conducted a pilot study with seven residency programs. The physicians observed included residents and faculty. Observers included residents, nurses, faculty members, and staff. A particular focus was the feasibility of training for observers to improve the distribution of ratings. Findings from this field trial led to significant streamlining of the APB implementation process.
2009-2011
Conducted in collaboration with five medical schools and twenty-one residency training programs in multiple specialties, ongoing field trials help NBME continue to fine-tune the instrument’s value as a formative and supportive system for multisource feedback, develop versions of the instrument that are applicable to the medical school environment, and further refine the implementation process.
Market Research Study
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