Leaders in Medical Education

Dr. Peter Katsufrakis of the National Board of Medical Examiners

Osmosis Team
May 9, 2014

We first met Dr. Peter Katsufrakis at the AAMC annual meeting in Philadelphia and have had the pleasure to interact with him a few times since then (it helps that our office in Philadelphia's University City is located only a few blocks from his). Dr. Katsufrakis, who has both an MD and MBA, serves as Senior Vice President of the National Board of Medical Examiners. We had the opportunity to speak with him about his path to a career in medical education and ask his advice for current medical students.

How did you decide to pursue medical education as a career?
As a teenager, I had a best friend whose father was a doctor and whose mother worked as the receptionist in his solo practitioner office. Over time, I came to know them well and they came to know me, and I very much enjoyed being a part of their extended family.Early in my sophomore year of college, I stopped by my friend’s house for a visit. I knew that he wasn't there, but went because I enjoyed visiting with his parents. During a somewhat unfocused discussion of how college was going, my plans for the future, etc., and somewhat out of the blue (to me, anyway) my friend's mother said, "Pete, you ought to become a doctor. You like people, you're good at science, and you'd make a good doctor." In all honesty, I had not at that point given much thought to a specific career and her suggestion was somewhat surprising. However, the more I reflected on our conversation and on what I knew about myself, the more excited I became about this possibility.
Besides helping determine the course of my professional life, our conversation had one more very significant impact: it taught me how powerful the influence of a respected adult can be upon the life of a young person.

What does an "average" day look like for you?
"Average" may not be the best way for me to describe my work life. It makes me think of the camper with his head lying in the snow and his feet in the fire, who is on average comfortable.When I am working at the NBME’s headquarters, much of my day is spent in meetings with other staff or working at my desk on various projects. As a part of our organization's senior leadership team, I am also responsible for helping to determine strategy, monitor organizational performance, and participate in governance. Some of the most enjoyable work I have at the NBME involves interacting with our national faculty of medicine, individuals who come to the NBME from medical schools and other organizations across the country to help us develop examination content and manage our various assessment programs.

My work involves a fair amount of travel, typically 20 to 25% of my time. When traveling, I may be attending conferences of other professional organizations, visiting medical schools, participating in committees or other task forces of our sister organizations, or teaching other health educators and professionals. In these activities I may be serving as the NBME's official representative to advance our business interests; as an individual with expertise in assessment; or as a stakeholder in health education, training, and practice looking to identify ways that the NBME can better protect the health of the public through assessment. These activities provide terrific opportunities to explore how we can collaborate to improve health care, and are very rewarding professionally.

The NBME is coming up on its Centennial next year. In your opinion what do the second 100 years look like for the organization?
That is an excellent question! In early April, we kicked off our Centennial year at our Annual Meeting with a retrospective of the first 100 years. While the NBME is perhaps best known as one of the parent organizations (in collaboration with the Federation of State Medical Boards) for the USMLE, and the NBME was founded to certify the excellence of its diplomates, over the course of our history we have continued to advance our mission of ensuring competent physicians while extending our service to dozens of other organizations and millions of examinees. As we look to the future, we hope to build on our expertise to develop high-quality assessments in realms that have previously been resistant to good measurement. The ACGME/ABMS competency framework provides a blueprint for this work, but we look at this as a beginning and not the end.Additionally, I expect that the future will show the NBME to be more closely tied to the public. Protecting the public has been and will remain the primary mission of the NBME. One of the tenets of a profession is its right and responsibility to self-regulate; the NBME is one of the organizations that serves as an embodiment of this precept, the manifestation of Medicine’s contract with society. We are working and will continue to work to ensure that our day-to-day activities reflect the priorities interests of society.

The first modules of NBME-U were just launched in April. Can you describe who should be watching these and what they can hope to learn from them?
Thank you for asking about these. As part of our Centennial celebration, the NBME wishes to give back to the medical education community by providing resources that will benefit multiple stakeholders. NBME-U is a means by which the expertise of volunteers and staff can be shared with an international audience of medical educators who have the desire and responsibility to conduct high-quality assessments of their learners.Because the topics covered span a wide range of education and assessment, different modules may be appropriate for an individual wishing to learn how to write good multiple-choice questions, to develop a clinical skills examination, to understand reliability and validity in the context of assessments, to provide effective feedback to learners, and a host of other topics. The modules of NBME-U could be appropriate for a junior faculty member just beginning his career as an educator, as well as a seasoned professor wishing to enhance her knowledge or skill in one or more aspects of assessment.
New modules will continue to be released over the course of the coming year. We expect that during our Centennial year individuals may use this resource free of charge, and we hope to continue to make it available after we conclude our Centennial.

Given all of the news about clinician burnout and physicians not recommending medicine as a field anymore, do you have any advice for current medical students?
I believe students are well advised to think carefully about pursuing a career in Medicine, or any other career for that matter. More than many careers, Medicine can be consuming, both because of the demands to remain current in the face of continued scientific advances, the long hours required in many current health care settings, and because of the emotional impact of caring for others. However, these characteristics also make Medicine one of the most exciting and rewarding professions I can imagine.While I have been consistently happy with my career choice, I am not blind to its challenges. I recall that as an undergraduate who was newly admitted to medical school, I was counseled by a third year student having second thoughts about her choice. She advised me to carefully consider the wisdom of going to medical school. Later in my career, I faced friends and colleagues who – often at times of personal crisis – regretted their choice to become a physician. Every year national surveys demonstrate significant numbers of physicians who report they would have chosen another specialty, or another career, in place of what they had chosen. Despite all this, I cannot imagine another career that would have provided me with a comparable degree of opportunity, challenges, rewards, or ability to grow and learn. While becoming a physician is most certainly not for everyone, it was most definitely the correct choice for me.

What was/were the most memorable experience(s) from your time as a medical student?
I'm not sure this was the most memorable experience from my time as a medical student, but it was certainly a meaningful experience…As a fourth-year student, I completed a medicine subinternship at a private community hospital under the supervision of an excellent second year resident, Helane S. She had assigned me the care of a moderately ill ventilator-dependent patient. During the course of the hospitalization, the patient developed fever in association with an unusual pattern of laboratory abnormalities. Although the details escape me today, I recall that the etiology of these findings was not immediately apparent to other physicians on the team and required me to search quite a bit (through printresources!) before identifying a likely cause. Flush with self-importance, I sought out Helane to report my discovery. She listened patiently as I enthusiastically described my search and conclusions, a slight smile playing at the corners of her mouth. When I finished, I looked expectantly for her congratulations and praise. Rather than celebrating my success, correcting my error, or commending my clinical acumen, she looked me straight in the eye and said, "Peter, to be a good doctor you don't have to be brilliant. You just have to be diligent, work hard, and make sure you take care of every problem the patient has." As my balloon slowly deflated, I felt measurable growth and maturation occur during the rest of the day. It was such a gentle, enduring lesson – in humility, in effective teaching, and in the importance of conscientiousness