[الدكتور أحمد باذيب]

Teaching Professionalism

Medical educators must set expectations, create appropriate learning experiences, and evaluate outcomes. Educators must be clear about professional expectations — both the rationale behind them and the consequences of failing to meet them. Without well-defined expectations, students will not have a clear ideal to strive for. Educators must design clinical experiences that allow students to see how seasoned practitioners negotiate the dilemmas of medical practice. Although we allow students to spend a full hour with a patient to take a history and perform a physical examination, busy physicians do not have that luxury. Inherent conflicts between what we teach and what students see in real-life settings will not promote professionalism.22,51 At a minimum, such conflicts must be explained to students. Efforts to teach the ideals of professionalism can be easily overwhelmed by the powerful messages in the hidden curriculum.7,52

The goal of evaluation should be to reward the best professional behavior, enhance professionalism in all students, identify the few students who show deficiencies in professionalism, and dismiss the rare student who cannot practice professional medicine. However, even the best evaluation strategies will be undermined unless faculty are trained to promote the kind of role modeling that is so essential to a student's professional development. This kind of faculty development is not easy. How do we teach it in real time in the reality of today's academic environment? Professional development is complex1,2; it is a daunting challenge for individual teachers to both recognize the problem53 and respond effectively.54 How do we reach the faculty most in need of instruction in role modeling, who may also be the most resistant to it? Where will the resources for these interventions come from?

The solutions rest not only with developing our skills as teachers25,26,27,28 but also with improving the environment in which we teach.55 Students need to see that professionalism is articulated throughout the system in which they work and learn. In our academic medical centers, this means providing an environment that is consistently and clearly professional not only in medical school but throughout the entire system of care. The challenge becomes even more daunting when the goal is to institute an attitude of professionalism in multiple organizations.56 Some of the most powerful and important interventions can be made at the administrative level57: removing barriers to compassionate care, ensuring access to care, designing efficient health care delivery systems, and acknowledging teamwork as a fundamental principle of health care. Improving the health care system will go a long way toward promoting the professionalism of students and trainees.

As we expect greater professionalism from our students, we need to expect the same from teachers and organizational leaders. Anything else is disingenuous. For example, students have every right to expect that mistreatment by residents and faculty is taken just as seriously as unprofessional behavior on the part of students.58 Expanding the criteria for incentive pay from patient satisfaction alone49 to include learners' satisfaction with professional interactions could serve to link assessment and reward.

Professional organizations must advocate for our identity as a profession that celebrates the primacy of patients' interests over self-interest12,59 while acknowledging that physicians do have legitimate self-interests. Our profession is not a business, and we must resist redefining our patients as "managed care lives" or "consumers." At the same time, licensing boards need to take swifter action against unprofessional behavior because public safety and the public's trust of our profession are at stake.

Physicians are asked to deliver professional care in a complex and ever-evolving health care system, and medical educators have a critical role to play in maintaining and enhancing professionalism. This is, after all, our contract with society. Jordan J. Cohen, president emeritus of the Association of American Medical Colleges, writes, "Failing to deliver on these expectations . . . falling short on the responsibilities of professionalism, will surely result in a withdrawal of the tremendous advantages that now accompany our profession's status."60 What is at stake is nothing less than the privilege of autonomy in our interactions with patients, self-regulation, public esteem, and a rewarding and well-compensated career. In pursuit of the highest ideals of professionalism in service to our patients, as well as in our own self-interest, medical educators would be wise to take a comprehensive view of the task at hand, setting clear expectations for behavior, designing meaningful experiences that promote professional values, and insisting on the widest possible application of robust behavioral outcome measures across the entire continuum of medical education and practice.


No potential conflict of interest relevant to this article was reported.