Talking About Professionalism Through the Lens of Professional Identity

Abstract

Professionalism is one of the Accreditation Council for Graduate Medical Education's (ACGME) Core Competencies, but the breadth of its content often makes this a difficult topic, both in remedial counseling and when presenting the topic to medical trainees and practicing clinicians. Physician professionalism encompasses both clinical competence and the virtues that comprise the physician's social contract. This difficult subject may best be approached tangentially, through the lens of professional identity. Professional identity describes clinicians' affinity for, acculturation into, and identification with the practice of medicine. One method to highlight the benefits that individuals accrue by adopting professionalism's elements is to pose questions that optimize listeners' self-reflection about their lives and aspirations-in essence, their professional identity. Discussing professionalism this way often yields in-depth discussions of how trainees believe their professional identity was formed and will impact their long-term goals. Both in teaching and in counseling, educators can frame their discussions using professionalism and professional identity's overlapping and reinforcing elements to show listeners how to advance their personal and professional goals and avoid the short-and long-term consequences of unprofessional behavior. To engage the audience, educators and supervisors can emphasize how adhering to the elements of professionalism may determine their career opportunities, the professional respect they receive, and their career fulfillment and, ultimately, longevity. In this way, educators can better guide trainees and clinicians to understand their personal reasons for acting professionally, that is, doing the right thing, at the right time, in the right way, and for the right reason.

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

“…PIF is a necessary foundation to professionalism 62 while also contingent upon it. Professionalism in medicine is a process of adopting a shared belief system that focuses on improving the health of patients 63,64 by attaining technical and cognitive clinical competencies [65][66][67][68][69] , meeting high ethical and moral standards 64,[67][68][69][70][71] , and displaying behaviours consistent with professional principles and values 9,64,69,72-74 . To exemplify the profession's expectations as a lifelong ideal, students must be able to reconcile their personal and professional identities.…”

“…Factors that influence professional behaviour include mentorship and role-modeling 81,82 , prevailing codes of conduct 67 and social and cultural concepts of the "good physician" 82 . Manifesting such professional values and behaviours can further foster professional identity 2,5,64,[75][76][77]80,83 , through which medical students identify as a member of the profession 67,84,85 and aim to embody its roles and responsibilities 2,6,8,9,62,63,65,66,68,69,[72][73][74][75]80,83,[85][86][87][88][89][90][91][92][93][94][95][96] .…”

“…• Negative portrayal of profession by mainstream media or glamorization of traits such as cynicism 68,99,124 • Lack of opportunities or expectations to assume patient care responsibilities • Open and supportive discussions with faculty and peers 65,73,74,81,129,131 • Access to appropriate mentorship, advising and role modeling 72,128 • Guided reflective opportunities with feedback 7,10 • Mismatch between personality and values with those of team members or patients 72,82,91,100 • Challenging relationships with team member, patients or peers 88 • Hierarchical structures in clinical environment deterring students from seeking help or speaking up 7,9,72,101 • No mentors or role models 72,128 Individual Ring • Show desire and sustain motivation to gain competence and engage in life-long learning 88,101 • Attend to emotions and engage in critical thinking and reflection • Access to support systems including mentors and role models 5,69,71,80,93,121 • Exposure to challenging clinical experiences such as death and suffering 118 • Outlets for emotional and/or creative expression 89,92,119 • Tension between existing personal identity and aspiring professional identity 7,65,81 • Uncertainty or lack of confidence in clinical interactions that cast doubt on ability to fu...…”

Interprofessional teamwork: the role of professional identity and signature pedagogy – a mixed methods study

“…The influence of the professional and regulatory bodies will be central for professionals learning to act with integrity because these bodies establish what is deemed acceptable in professional practice. Setting an expectation or acceptability of working and sharing roles and accountability with other professions will facilitate individuals to act with integrity (Iserson, 2019).…”

Reflections on State Medical Board Visits as a Tool for Multi-Level Teaching of Professionalism in Medical Education

“…Here professional identity refers to "clinicians' affinity for, acculturation into, and identification with the practice of medicine." 7,8 Professional activities become the indirect medium by which students transform from laypersons to medical professionals who personally bear and manifest the "roles, responsibilities, values, and ethical standards" of the medical profession. 8,9 Historical Trends in Teaching Professionalism Historically, ever since William Osler's revolutionary vision from 1903 to transform patients' bedsides into classrooms, 10 medical traineeship under clinician-educators was the primary pathway for learners' acculturation of professionalism.…”