How PBI’s “Maintenance and Accountability Seminar” Course Supports Long-Term Success

How PBI’s “Maintenance and Accountability Seminar” Course Supports Long-Term Success

March 2020

For more than 20 years, PBI graduates from around the U.S. and Canada have been meeting on weekly conference calls to continue their remedial education. Led by experienced faculty members, these Maintenance and Accountability Seminars (MAS) are provide increased accountability through real-time faculty feedback, and engagement in a multi-disciplinary community of peer review and support. Through participation, course participants deepen their understanding of the topics learned in their initial course and their potential for relapse is minimized.

How the MAS Course Works

The PBI Maintenance and Accountability Seminars (MAS) course improves the likelihood of a clinician’s long-term success in multiple ways. Each time participants share their stories, they refresh and expand their understanding of the challenges that got them into trouble in the first place. They recommit to the plans they developed in class for reducing their risk of future boundary violations, and they hold each other accountable for implementing those plans. Finally, by joining a community of peers, participants protect themselves from the professional isolation that so often leads to renewed problems and recidivism. 

PBI limits the number of participants in any one seminar to ensure in-depth discussions. The content of these discussions varies depending on the particular challenges and concerns participants bring to each meeting. But the focus is always the same—helping participants incorporate into their daily lives and clinical practice what they learned in their live courses.

Because seminars draw members from all PBI courses—professional boundaries, ethics, communication, prescribing, and record keeping—individuals also gain additional information and insights from courses they haven’t even taken. 

Except for the few state licensing boards that require it, participation in MAS is voluntary. Not everyone who takes a PBI course enrolls in the seminars. Many who do, re-enroll for additional 12-week cycles, often for extended periods of time. The following account combines the experiences of several such MAS members to offer an inside look at the MAS experience.

One Participant’s Experience

Dr. Davenport had learned so much during PBI’s three-day Professional Boundaries and Ethics course that she had trouble imagining at first what more she could possibly learn from MAS. But based on how helpful the live course had been, she went ahead and enrolled. 

Looking back now, Davenport sees that original in-person class as even more important than she realized at the time—not as an end in itself but as a beginning. Those initial three days laid the foundation for the new career MAS has been helping her build ever since.

“When I first went back to work, it felt a little like being dropped out of a helicopter onto a mountaintop where the air was too thin to breathe. I needed time to acclimate to the new surroundings. MAS helped me catch my breath and build up my endurance,” she said.

During her first call, Davenport shared both her history and the Personalized Protection Plan she had created in class to prepare for the challenges ahead. One challenge, however, had caught her by surprise. Soon after returning to her job, she met with the senior partner in her practice to explain the changes she would need to make going forward. It was crucial, she told him, that she establish healthy boundaries between her personal and professional lives. 

At first the physician, whom she thought of as a mentor, seemed to understand. But when Davenport said she would no longer be working nights and weekends, he stopped her. Her job demanded complete dedication, he told her, and if she wasn’t up to it there were plenty of equally qualified physicians he could hire to replace her. 

After listening to her story, several people on the MAS call suggested she might need to find a different job. Davenport didn’t want to hear it at first. She had been working in the same practice for years and was on track to become a senior partner herself. She would figure something out. 

But over the next few weeks, several MAS classmates began pointing out troubling patterns they were all too familiar with. The faculty member facilitating the group guided discussions so Davenport could hear from and talk to others who had struggled with similar challenges. Eventually, Davenport decided she did indeed need a fresh start. With more advice and encouragement from her colleagues, she left her old job and found a new practice that was much more supportive of what she needed in order to protect herself, her license, and—most importantly—her patients. As she told the others, she wasn’t sure she would have been able to make the change if she hadn’t been participating in MAS. 

The Value of Long-term Accountability

A recent study in the journal Perspectives on Medical Education found abundant evidence in numerous fields supporting “the benefits of longitudinal intervention and follow-up.” According to the authors, the programs that were most successful included regular meetings to assess progress, provide high-quality feedback, and determine if mid-course corrections were needed. In other words, says Stephen Schenthal, Founder of PBI Education, “Programs like MAS improve outcomes by extending and enhancing accountability.”

When people think of accountability, they tend to think of an authority figure in a judgmental role, Schenthal explained. “But the kind of collaborative effort you find in MAS actually provides an even more effective form of accountability.” Everyone on the weekly calls knows from personal experience how important it is to listen without being judgmental, to provide a safe place where members can admit their problems and discuss their concerns. But because they also know how easy it is to miss the warning signs of impending disaster and how tempting it can be to duck difficult challenges, MAS participants don’t shy away from confronting colleagues when they need a push. 

The MAS facilitator plays a critical role in guiding the group. When someone needs time to absorb what is happening, as Davenport did, the facilitator can modulate the discussion to provide gentle but persistent feedback. At other times, when someone is especially resistant to important concerns, the facilitator can elicit the kind of bolder comments that are likely to be more effective. 

After her first 12 calls, Davenport decided to revise her protection plan by extending her participation in MAS throughout her probationary period. “After the experience with the partner in my practice, I knew it was important to boost my accountability through other means. MAS gets the job done.”

Gauging the Needs of Each Participant

MAS faculty also work to ensure that everyone on a call gets all they can from each discussion. During a recent call, someone talked about being disciplined for a misunderstanding that started with a patient hug. Knowing another participant’s history, the facilitator asked if she had experienced anything similar. After a moment, she recalled walking a male patient out to the front desk and offering him a handshake. He told her he was “a hugger” and laughed as he embraced her. She told the group that she had dismissed it at the time, but now after hearing how a simple hug had sparked someone else’s violation, she realized how uncomfortable the experience made her. At the facilitator’s suggestion she and the others brainstormed how she might work with that patient in the future.

Others have benefitted from hearing about issues they had not previously considered. When a graduate of PBI’s record keeping course described how much trouble she got into because of poor documentation by her staff, another physician rethought his supervision of his own staff. Someone else revised their office procedures after learning about pain management protocols from a participant who had attended the course on prescribing.

Even when stories do not relate directly to others’ experiences, they can serve as powerful reminders of just how easy it is to violate a boundary. As one MAS participant said, “The more stories you hear, the more you realize there’s always a new way to get in trouble. There are so many pitfalls that you’re just not aware of until something bad happens. MAS really keeps you on your toes.”

As important as accountability is, people recovering from a violation also need help maintaining their equilibrium. It is all too easy to give into despair over what you have done, especially in the early days before or just after a board hearing. At such times, the achievements and success stories MAS members share with each other are like the sight of land to a drowning sailor. “Just hearing about the process of recovery helps people endure the emotional trauma,” said Dan Tennenhouse, MD, JD, a PBI faculty member. “They benefit tremendously by hearing from other people in their situation who are doing something to help themselves and making progress,” he said.

Asked recently to explain the importance of MAS, Davenport compared it to the rehabilitation her surgery patients have to pursue after they leave the hospital. The surgical repair is essential, she tells them, but it is just the first step. It is up to them to build on what she has done by doing the prescribed exercises, listening to the rehab specialist’s advice and developing new, safer habits. “That’s what MAS is like,” she says.

“The initial class is essential, but it is only a first step. You have to do a lot of hard work to rebuild your career and your life. I guess you can do it on your own. I feel a lot more confident knowing I can count on the help MAS provides.”