Professionalism in medicine. What is it and how can it be taught?

Abstract

This study examines the conceptual framework and teaching of medical professionalism from the perspectives of the literature on the subject, clinicians engaged in clinical teaching regarding professionalism, and medical students. I begin with a brief history and overview of the concepts of professionalism in medicine. I follow that with a Best Evidence in Medical Education (BEME) systematic review of the literature to identify the best evidence for how professionalism should be defined and taught. This review found that there is as yet no overarching conceptual context that is universally agreed upon. The development of ways to teach and assess professionalism has been encumbered, and failed to progress, in large part because of this amorphous nature of the various definitions promoted. The review also found no unifying accepted theory or set of accepted practice criteria for teaching professionalism. Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in current teaching programs, and are widely believed to be the most effective techniques for developing professionalism. While it is generally agreed that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory. No teaching methodology has been demonstrated in the literature to be effective or accepted for use across a wide range of medical schools. I next developed and carried out qualitative studies to discover what conceptual understanding (mental models) of professionalism medical students and clinical educators held, how these two groups view current professionalism training as a component of medical education, and how they think it should be taught. I found that medical students achieve professionalism through the influence of their exposure to seasoned professionals and through informal peer reflection. The doctors in my study group achieved professionalism not through any formal training they received, but as a result of the actions and attitudes they witnessed during their training, which created a path to reflective practice that they have sustained. I conclude by proposing a conceptual model for instilling professionalism through medical education. This model captures the formative influences on professionalism and provides a framework for understanding professional performance. The teaching of professionalism should be integrated into all years of the medical curriculum, and across all disciplines included in the curriculum. Some attributes of professionalism, such as ethics and communication skills, can be introduced in early years. Mentoring and exposure to positive role models hold the most promise as effective teaching methods. Guided reflection turns transient incidents and experiences into true learning moments, solidifying and honing professionalism. Ultimately professionalism should be viewed as an ethos. I hope that my findings will improve our ability to instil professionalism in our students.