Undoing of Professionalism Training in Clinical Practice: Dear Educators, Thanks for the Effort, But Is It “Real”?
- Undoing of Professionalism Training in Clinical Practice:Dear Educators, Thanks for the Effort, But Is It “Real”?
Dear Sir,
In the current age of commercialism in the healthcare environment, professionalism is hard to define. We are bombarded with talk of professionalism and its importance in shaping the public’s perception of today’s physicians.1 Yet it seems that few people have a concrete understanding of what professionalism means. How do we transform the current culture of medicine from one of monetary and power struggles to one of compassion and exceptional medical care? It is our goal to create a new generation of physicians who serve as professional role models for future physicians. “Professionalism is the enactment of the values and ideals of individuals who are called, as physicians, to serve individuals and populations whose care is entrusted to them, prioritizing the interests of those they serve above their own”.2 At the same time, as ACGME and medical school curricula make professionalism training an integral part of training over the past years, medical journals and the popular press alike have commented on “an erosion of medical professionalism” and “faltering public trust in physicians”.
It has been shown in study after study that medical students are more cynical at the end of their clinical years than when they started school. It is easier to impart didactic lectures on professionalism and walk away than to “walk the walk and talk the talk”. In the clinical years, when students and junior doctors follow and emulate the so-called role models or seniors, it is but natural that they pick up the bad habits that they see in this age of smartphone distractions—lack of empathy, sexism, hypocrisy, racism, bullying and hierarchism—that is rampant in clinical medicine. Putting patients first is far from the priorities of ego-strapped physicians, even among the very senior ones who practise with their pockets and with blinders on to criticism.3 Dr. Jordan Cohen, former president of the AAMC, stated that “we have tended [End Page 338] to assume that the good people we admit to medical school will remain good no matter what kind of behavior we visit on them or parade in front of them. All of the evidence points the other way.”4
The energies spent on teaching professionalism and empathy in medical college is not translatable to practice unless sustained by sincere and humble role models who practise what they preach in the clinical field. More attention must be placed on faculty development and stricter performance guides for senior doctors, who should be held accountable for their behaviour. As Cohen stated, it is necessary to “convert our learning environments from crucibles of cynicism into cradles of professionalism.”5
Notes
1. R.M. Epstein and E.M. Hundert, “Defining and Assessing Professional Competence”, JAMA 287, 2 (2002): 226–35.
2. Accreditation Council for Graduate Medical Education, General Competencies, Chicago: ACGME 1999. Available at http://www.acgme.org/outcome/comp/compFull.asp#5 [accessed 16 August 2006].
3. American Board of Internal Medicine Foundation. American College of Physicians-American Society of Internal Medicine Foundation. European Federation of Internal Medicine, “Medical Professionalism in the New Millennium: A Physician Charter”, Ann Intern Med 136, 3 (2002): 243–6.
4. M.A. Papadakis, A. Teherani, M.A. Banach, T.R. Knettler, S.L. Rattner, D.T. Stern, J.J. Veloski and C.S. Hodgson, “Disciplinary Action by Medical Boards and Prior Behavior in Medical School”, N Engl J Med. 353, 25 (2005): 2673–82.
5. J.J. Cohen, “The Work Ahead”, AAMC’s President Address, 6 November 2005. Available at http://www.aamc.org/newsroom/reporter/july06/word.htm [accessed 28 August 2006]. [End Page 339]
