Factors influencing notions of professionalism: insights from established practitioner narratives

Abstract

The aim of the research is to explore the ways in which the meaning of professionalism is increasingly understood during the process of professional socialisation into medicine. The major work is in the analysis of the accounts of senior doctors and a sociocultural approach looks at their perspectives on the factors in their learning which have impacted on their own practice, on their notions of the meaning of professionalism and on their roles as teachers. Such an analysis is not without its challenges. Much of the existing literature on professionalism has taken a positivistic turn, for example focusing on developing ‘efficient and effective’ ways to teach and developing instruments to assess traits deemed likely to contribute to professionalism. Conflicts faced by students or new doctors when they encounter professional dilemmas are also extensively studied. From some areas of the literature it is increasingly evident that medical professionalism is a complex and dynamic construct ever-changing in meaning depending upon context. Accordingly, interpretive methods are highly suited to give a rich analysis of the central issues of this thesis. Three separate analyses of the data provide new insights into the meaning of professionalism in medicine and how it may best be passed on to new generations of doctors. This work adds to the literature on the nature of professionalism by giving a retrospective perspective from established practitioners. In exploring the complexity of the humanistic and broader professional side of medical practice it seemed appropriate to seek the perceptions of senior clinicians. Unlike medical students or junior doctors, more senior professionals are able to discuss these matters with the benefit of real experience and from a position of relative phronesis. The major educational influences that are investigated are relationships with professional role models, the hidden curriculum and the learning atmosphere. A central tenet of this thesis is that the current dominance of a positivistic paradigm in medicine and the power relationships inherent in medical education run counter to the humanistic environment needed to nurture the development of characteristics essential to deliver patient-centred medical care. The currently prevailing culture in which medical education is conducted is rule-driven, competitive, self-serving and uncaring. I assert that in order to produce the caring, supportive and collaborative doctors needed by a twenty-first-century global society, a radical change in culture within medical education is needed.