Saturday, February 12, 2005

Professionalism in Medical Education

Professionalism is a favorite topic at my medical school. We are warned that not filling out certain forms will result in a letter about professionalism in our files. Our clinical foundations of medicine course has ill-defined "professionalism" points for things such as attendance.

Professionalism in my medical school is defined by a number of factors including proper dress in clinical (or mock clinical) encounters, attendance at required sessions, timely completion of assignments, ethical learning behavior, and good behavior in general. Our clinical foundations course includes modules on ethics, death, dying and grieving, and cultural competency which could be construed as a way of teaching professionalism in different situations. During orientation, we were lectured on the importance of acting "professionally" outside of the classroom.

But what really defines an education in professionalism? Is it as simple as discouraging bad behavior at a formal and loosely encouraging professional behavior, or should it be more explicitly taught?

AMSA suggests that the teaching of professionalism should include elements of the PharmFree campaign and how to resolve professional conflicts. Many schools introduce the concept of professionalism with a white coat ceremony and continue teaching the concepts of professionalism by integrating them within other courses to varying degrees.

The issue of professional behavior is a critical one. A relatively recent study showed that unprofessional behavior in medical school is correlated with later disciplinary action by a state medical board. Fortunately, a number of studies have been done to investigate different educational approaches to teach the concepts professionalism (just check out academic medicine.)

The question that must be addressed is how an education in professionalism will be reflected in how we eventually practice medicine. The ABIM Foundation stresses the need for such an education in a world of "managed care and for-profit medicine...." Is my medical school properly preparing me for such a world? I'm not sure. Granted, I'm only in my first year, but I can't see how stressing that we do what I consider to be common sense (doing things on time, proper attire when appropriate, not cheating, etc.) in the name of professionalism is really preparing me for a life in professional medicine. On the other hand, our clinical foundations of medicine course, while not explicitly stressing acting in the name of "professionalism," has probably taught me more about how to be a medical professional by discussing ethical issues and exploring our own personal feelings regarding death, cultural stereotypes, sex, and the more.

I am of the personal opinion that professionalism is best developed through experience, and is poorly served by using the term as a catch phrase and catch-all for acts that might be better covered by using a conventional honor code. (Or is "professionalism" simply a euphemism for honor code in the preclinical years of medical education?) But with numerous studies showing that medical students become increasingly cynical as the years go by, it seems logical that an education in professionalism should start early, before we have many concrete experiences in professional behavior. I believe that preclinical discussions of professionalism should focus more on issues such as the influence of pharmaceutical companies, the atmosphere of managed care, common ethical dilemmas, etc.

Obviously, there is only so much you can squeeze into the preclinical years. I can only hope that as more investigation into the efficacy of different methods teaching professionalism is done, medical schools will do a better job at preparing us for the future medical environment. Until then, I plan on finding myself the best role models I can, and learning about professionalism from them.

Wow, I dont think I've ever used the word "professionalism" so often! I must admit that replacing the word madlib-style in this post is quite entertaining!