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06/30/2015

Professionalism in Medicine: I Know it When I See it

by Jennifer Chevinsky, BS

A medical student comes into the hospital wearing his favorite pair of old, ripped, dirty jeans.

A physician ‘pimps’ a medical student and publicly shames her when she doesn’t know the answer.

A nurse tells the patient that he really does not like working with the case manager on the medical service.

A resident presents her patient to the attending, including a complete physical exam that she did not perform.

In recent years, increased focus has been placed on the concept of professionalism in medicine by the Association of American Medical Colleges (AAMC), Liaison Committee for Medical Education (LCME), Accreditation Council of Graduate Medical Education (ACGME), and Accreditation Council of Continuing Medical Education (ACCME). But, what do they mean by ‘professionalism?’ Is professionalism just a list of behaviors and attitudes that can be placed into columns of “appropriate” or “inappropriate”? How can we assess professionalism, how can we teach it – can it even can be taught?

Although every medical school includes some judgment about their students’ professionalism, there is little standardization across universities or even medical departments. Unsurprisingly, there are large differences among individual perceptions. In order to reach a more unified approach, an in-depth analysis of the concept of professionalism is vital. Many assert that there is a connection between medical ethics, medical humanities, and professionalism, but the exact nature of this connection is far from clear. Last month, I was fortunate to have the opportunity to explore some of these questions through attending and presenting at the Academy for Professionalism in Health Care (APHC) conference as a Romanell Educational Fellow (May 7 – 9, 2015).

The APHC is one of the products of the Project to Rebalance and Integrate Medical Education (PRIME), spearheaded by Dr. David Doukas in 2010. Embarking on a journey of continued reflection, learning, and revision, five years later the APHC has now hosted their third successful annual conference. Appropriately, the theme of the conference was “The Role of Professionalism in Health Care: Essential Elements, Perspectives, and What’s at Risk.” The plenary speakers, an accomplished group, included representation from the Presidential Commission for the Study of Bioethical Issues, Johns Hopkins Berman Institute of Bioethics, Center for Biomedical Ethics and Humanities at the University of Virginia Health Systems, as well as an interdisciplinary group from Drexel University.

Throughout the conference, attempts were made to dissect this loaded concept of professionalism by using multiple lenses including values, virtues, relationships, reflection, religion, etc. Sessions ranged from the theoretical and abstract to grounded discussions on data analysis and reviews of current educational programs. Professionalism was described in a positive light – as a characteristic that healthcare professionals can and should aspire to, not just an ever-growing list of ‘do not’s.’

I recognize, however, that the way professionalism seems to be discussed in medical schools is quite different from how those who are researching these concepts portray professionalism. From the perspective of an average medical student, I would imagine that the term professionalism would be considered not much more than the catchall term used to penalize students for frowned-upon actions that aren’t explicitly mentioned in any syllabus or university code. Thus, for medical students, professionalism is viewed more as a list of crimes and punishments than as aspirational.

After learning from the conference presenters and attendees, I have started to think about professionalism as a descriptor that is tightly bound with the nature of a given profession – for instance, the qualities needed to maintain professionalism for an athlete would be very different from those needed for a lawyer, banker, actor, or physician. For healthcare providers, I believe that our professionalism is rooted in the sanctity of the doctor-patient relationship. Our patients trust us with their lives, and in return, we take an oath to respect their privacy, their dignity, and their autonomy. Acting with professionalism involves acting in a way that honors and maximizes that doctor-patient bond within the context of an often-complex healthcare system.

While the conference was very informative, I still do not have all of the answers to the aforementioned questions; what I do have is a heightened appreciation for the intricacies held within the term ‘professionalism’ as well as recognition that more attention and research is needed to help define, assess, and teach professionalism to healthcare learners across all levels and disciplines. My hope is that this process can continue to engage healthcare providers, bioethicists, students, patients, and other relevant persons. Together we can elevate discussions of professionalism beyond a list of “thou shalt not” commandments for medical students and vague “I know it when I see it” judgments.

 

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