Beyond ‘born not made’: challenging character, emotions and professionalism in undergraduate medical education

Abstract

In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific ‘character’. In the late nineteenth century, an ideal of the medical student as ‘born not made’ was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of ‘character’ becomes ‘characteristics’. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors’ education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.

The Problem and Power of Professionalism: A Critical Analysis of Medical Students’ and Residents’ Perspectives and Experiences of Professionalism

“…The use of professionalism to enforce White standards or ideals has been described outside of medicine [16][17][18] and can be seen, for example, in the negative professionalism connotations around Black hairstyles 19 and the need for legislation to prevent workplace discrimination against natural hair. 20,21 Within medicine, several commentaries note that current standards of medical professionalism are steeped in the historical image of a physician (White, male, Western), [8][9][10][11]22 and AbdelHameid 23 wrote of how the expectations of medical professionalism required her to suppress her identity as a Black woman.…”

“…6,7 Recent critiques of professionalism demonstrate how viewing professionalism through dominant cultural norms disadvantages physicians and trainees from historically marginalized groups. [8][9][10][11] We use the term historically marginalized to mean people or communities that have been historically excluded from medicine due to imbalanced power relationships, including but not limited to people of color, women, and people not identifying as heterosexual and cis-gendered. 12,13 For the medical profession to truly commit to a diverse and inclusive workforce, 14,15 it is necessary to understand how professionalism wields power to reinforce and/or undermine this commitment.…”

Recruiting students to rural Longitudinal Integrated Clerkships: A qualitative study of medical educationists’ experiences across continents

“…While medical students who express an interest in rural placements are more likely to hold "ideal" personality traits, rural and metropolitan medical students exhibit similar trait pro les overall [29]. Caution must be taken if incorporating a concept of ideal characteristics as it may have exclusionary, harmful and discriminatory repercussions [30].…”

“…Caution must be taken if incorporating a concept of ideal characteristics as it may have exclusionary, harmful and discriminatory repercussions [34] on patients, the profession and the well-being of the student [35].…”

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists’ experiences across continents

“…Emphasizing these aspects of rural LIC during recruitment may assist in recruiting students who are most suited to rural practiceWhile medical students who express an interest in rural placements are more likely to hold “ideal” personality traits, rural and metropolitan medical students exhibit similar trait profiles overall [ 33 ]. Caution must be taken if incorporating a concept of ideal characteristics as it may have exclusionary, harmful and discriminatory repercussions [ 34 ] on patients, the profession and the well-being of the student [ 35 ].…”