Teaching professionalism - Why, What and How.

Due to changes in the delivery of health care and in society, medicine became aware of serious threats to its professionalism. Beginning in the mid-1990s it was agreed that if professionalism was to survive, an important step would be to teach it explicitly to students, residents, and practicing physicians. This has become a requirement for medical schools and training programs in many countries. There are several challenges in teaching professionalism. The first challenge is to agree on the definition to be used in imparting knowledge of the subjects to students and faculty. The second is to develop means of encouraging students to consistently demonstrate the behaviors characteristic of a professional - essentially to develop a professional identity. Teaching of professionalism must be both explicit and implicit. The cognitive base consisting of definitions and -attributes and medicine's social contract with society must be taught and evaluated explicitly. Of even more -importance, there must be an emphasis on experiential learning and reflection on personal experience. The general principles, which can be helpful to an institution or program of teaching professionalism, are presented, along with the experience of McGill University, an institution which has established a comprehensive program on the teaching of professionalism.

Renewing professionalism: an opportunity for medicine.

In recent decades, both the concept and the performance of professionals have been widely questioned. Professionalism and the idea of service have been placed under intense pressure, but they have survived. Medicine may now have an opportunity to reestablish itself as a respected, influential, and useful profession in Western society. The authors believe this could occur (1) because of the strength of the democratic process and the place of organized medicine within it; (2) because medicine's role as a source of relatively impartial expertise is being reestablished (because medicine no longer controls the health care system); and (3), most important, because of the importance of the individual physician as healer in both society's view of medicine and medicine's view of itself. To take advantage of this opportunity, the authors offer several recommendations, including (1) that medicine must continue current efforts to place first the doctor-patient relationship (the role of the healer) and the idea of service in redefining and fulfilling its obligations to society; (2) that there be a comprehensive education campaign to help physicians understand professionalism and its obligations (which the authors define); and (3) that physicians should assume responsibility for their local and national associations. If the individual medical professional and all the institutions connected with the practice and teaching of medicine truly understand and seek to fulfill their contracts with society and the obligations derived from these, the morality inherent in medical professionalism can be a dominant force, and better health care will result.

Teaching medicine as a profession in the service of healing.

As society, including the medical profession, moves into a new century, the rate of change in the relationship between professions and society is unprecedented. All societies need healers, and in the English-speaking world the services of the physician-healer have been organized around the concept of the professional. The great increase in both state control and corporate involvement has seriously intruded into the traditional autonomy enjoyed by both the medical profession and individual physicians, and further changes can be expected. More physicians are becoming either employees or managers in the state or corporate sector, while others are being forced to compete in a marketplace that rewards entrepreneurial behavior. It is the responsible behavior of the professional that will protect the role of the healer. Medicine has been rightly criticized for placing undue emphasis on both income and power and for protecting incompetent or unethical colleagues; and it has failed to accept responsibility for injustices or inequities in health care systems and has moved slowly to address new diseases or issues. Nonetheless, all evidence indicates that society still values the healer-professional and does not wish to abandon professionalism as a concept--it appears to prefer an independent and knowledgeable professional to deal with its problem rather than the state or a corporation. For this reason, medicine's professional associations and academic institutions must ensure that all physicians understand professionalism and accept its obligations. In doing so, the objective should be to encourage the moral and intellectual growth of physicians by setting standards based on higher aspirations than can or should be enforced. In facing the complex world of our future, such action will both serve society and maintain the integrity of the profession.