Mapping, Modeling, and Mentoring: Charting a Course for Professionalism in Graduate Medical Education

Abstract

Professionalism, like common sense, remains a timeless ingredient in the ethically successful practice of medicine in the twenty-first century. Professional ideals are particularly relevant in times of economic and social upheaval, medicolegal crises, provider shortages, and global threats to the public health. The American Board of Internal Medicine specifies professionalism as “constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.” Because of its transcendent nature, professionalism, like ethics, is also considered “a structurally stabilizing, morally protective force in society.” Professions enjoy tremendous deference and autonomy in exchange for three unwritten but prerequisite promises: expert knowledge, self-regulation, and a fiduciary responsibility to place the needs of the client ahead of self-interest. Many educators suggest that professionalism includes additional characteristics such as honesty, altruism, temperance, commitment, integrity, and suspension of self-interest. However, there are large gaps in providing more user-friendly and operational models of professionalism to learners and evaluators at all levels of the academic hierarchy.

Professionalism in general practice: development of an instrument to assess professional behaviour in general practitioner trainees

“…At first glance, this decision seems to conflict with leading publications on professionalism, such as the ‘physicians’ charter on medical professionalism' 16 in which altruism is put forward as one of the key elements of professionalism. However, the difficult fit between the concept of altruism and clinical practice has been recognised recently by a growing number of authors 5,17–21 …”

“…We believe the root of the problem lies in the highly idealised and abstract nature of altruism, which seems to have turned the altruism debate into a linguistic debate instead of a debate about the subject itself 23 . Historically, practising medicine was considered a vocation, and altruism, an ancient Hippocratic value, was assumed to be the mean motivation for becoming a doctor 20 . The professionalism movement has incorporated this ancient value automatically in its definitions of professionalism, but this suggestion was made with little discussion and no examples of what it means 24 .…”

“…However, the difficult fit between the concept of altruism and clinical practice has been recognised recently by a growing number of authors. 5,[17][18][19][20][21] We believe the root of the problem lies in the highly idealised and abstract nature of altruism, which seems to have turned the altruism debate into a linguistic debate instead of a debate about the subject itself. 23 Historically, practising medicine was considered a vocation, and altruism, an ancient Hippocratic value, was assumed to be the mean motivation for becoming a doctor.…”

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice

“…9 Educational imprinting is the idea that learners model witnessed behaviors and beliefs, sometimes despite what they are taught, and GME is not immune. [10][11][12][13][14][15][16][17][18] Our study demonstrated a durable imprinting effect, lasting at least 16 years after training. A contemporary study revealed similar association between HRR patient management style and general internists' choices of conservative vs aggressive management options in a certifying exam.…”

Beyond the Physician Charter: reflections on medical professionalism

“…These ideas were echoed more recently by Goodfield (1973), who wrote: "It may be that until we manage to recover love of the art and love of people, as opposed to love of the technique, or love of the affluence, or love of the status, as the real motivation for entering medicine, we may not get a satisfactory ethical relationship between doctors and society." Medical professionalism must remain an ingredient in the ethically successful practice of medicine in the 21st century (Larkin 2003). The Physician Charter is one important step toward finding a common ground for understanding medical professionalism, but the profession must move beyond the Charter's somewhat narrow focus on duty and competence to embrace the ideals, the genuine sense of selfless service, and the deep commitment to patients that have for so long epitomized the highest values of medicine.…”