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What is Professionalism?

What is Professionalism?
Author Information (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

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I think character judgments are strongly related to medical education, but how are medical schools and residency programs supposed to teach professionalism and assess whether their trainees possess it, if it is so ill-defined?
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A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior.

A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation.

In that post, I said, “‘Professionalism’ is difficult to define, especially when trying to do so in a courtroom.”

In the comments section, a medical student wrote that he had been given a 2-week suspension for unprofessional behavior for silencing his phone during an exam.

Another commenter told of several students who were caught colluding on a take-home final exam in statistics. Their punishment was that they had to agree to do their residencies at the medical school. [Digression: What does that say about the school?]

The Accreditation Council for Graduate Medical Education defines professionalism, one of its six core competencies, as follows:

Professionalism—Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

I’m always a bit confused when the definition of a term contains the term itself, and this is no exception.

Three internal medicine foundations combined to publish a somewhat clearer definition that is two pages long, but does not mention specific behaviors like cheating on a test, falsifying a medical record, or being arrested for driving under the influence of alcohol.

The American Board of Internal Medicine Foundation produced this “Word Cloud,” which is supposed to help one better understand what professionalism is.

Professionalism2

It is said to depict “words physicians most associate with medical professionalism.”

If you are having trouble reading some of them, I can help. Here are a few: empathize, compassion, respect, responsibility, ethics, integrity, caring, honor.

Those sound pretty good, but here are some more: tougher, smoker, diet, sick, job, prevent, financial, good insurance, disease, death. What do those words have to do with medical professionalism?

Since we have trouble defining professionalism, we can hardly blame the judge in the case I wrote about before for ruling in the student’s favor.

He said, “Although courts should give almost complete deference to university judgments regarding academic issues, the same deference does not follow university character judgments, especially on character judgments only distantly related to medical education.”

I disagree with the last part of his statement. I think character judgments are strongly related to medical education, but how are medical schools and residency programs supposed to teach professionalism and assess whether their trainees possess it, if it is so ill-defined?

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 10,300 followers on Twitter.

3 Comments

  1. Great insight, not only honesty phillip but a practitioner should adhere to all the the virtues in medical practice.

    Reply
  2. The most important lesson I ever learned in Medicine I learned before medical school. My school interviewed 3 applicants at the time, judging not only individual personalities but how each related to peers. One of the 4 professors on the other side of the table asked “What do you think is the most important quality in a physician?” Our responses included ‘intelligence,’ ‘compassion,’ ’empathy,’ ‘work ethic’ and ‘integrity.’ As we spoke the professor swiveled his chair and gazed out the window; when we finished he spun around, leaned over the table, looked over his glasses and pointed a big finger at each in turn as he drove home his point – “Honesty” – “Honesty” – “Honesty.” That lesson stuck and carried me safely through 40+ yrs of practice (10 yrs GP, 30+ yrs ortho/spine). When interviewing the top 50 of the 400 applicants for our orthopedic residency, I always ask that question- and then share my story, hoping to give the same career-long benefit that I had received. PGB

    Reply
    • Thanks very much for the comment. That is an excellent way to look at it. Program directors and faculty take note.

      Reply

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