Professionalism--the next wave.
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Education, Medical↗
Biomedical subjects
Frederic W Hafferty
Publications and source records attributed to Frederic W Hafferty.
Definitions of professionalism: a search for meaning and identity.
This paper examines issues of medical professionalism using definitions and meanings as its analytic lens. It explores similarities, differences, and changes in meaning and interpretation over time and across three primary literatures of professionalism: sociology, medicine, and education. In compiling these literatures, three stages in the evolution of medical professionalism emerged: the first (1980s-early 1990s) was dominated by the polemics of professionalism and commercialism; a second (1900s) was dominated by calls to define medical professionalism as a concept and as a competency; the third (late 1990s-current) quickly superseded calls to define by highlighting the need to develop measures and metrics. Across these three stages, two sets of "authoritative voices" emerged in the medical literature with certain medical organizations and journal articles beginning to dominate, and in certain cases dictate, agendas and debates. The paper closes with an extended discussion of the largely US based and sociologically focused "new professionalism" literature, and contrasts this with a parallel UK medically based literature. The paper closes with a set of six conclusions covering the lessons learned in compiling this literature.
Clinical Medicine↗
Learning disabilities, professionalism, and the practice of medical education.
The authors use the interface of learning disabilities (LDs) and medical education to explore several issues relevant to medical professionalism and the training of future physicians. First, they examine arguments given by Little (in the preceding article) that a successful suit for accommodations on a state bar exam is generalizable to LDs and medical education, and suggest ways in which this may not be true. They then explore two frameworks for understanding medical education: (1) as a process of academic achievement linked to degree attainment, and (2) as a process of professional acculturation linked to competencies. Within this dichotomy, they then explore (1) the legitimacy accorded to different types of accommodations, (2) differing meanings of a "level playing field," and (3) the legal standard of "otherwise able." They also examine the use of intermediaries (e.g., a reader) as a "leveling" strategy and how, in clinical settings, this might violate core standards of autonomous decision making. The authors investigate the nature of "technical standards" in training across medicine and nursing and find a number of differences, particularly in the intent and levels of detail of standards. Across these two domains, they observe a status hierarchy, medical hubris, and the emergence of a "right to fail" as one travels down that hierarchy. The authors also examine medicine as an undifferentiated degree and consider arguments that medical school course requirements should be unbundled. They close by insisting that medical schools have a social responsibility to shift their pedagogic gaze from identifying handicaps in individuals to understanding how the education of physicians can become, quite literally, "handicapping."
Clinical Competence↗
What medical students know about professionalism.
Three different sources of data are used to explore how medical students think about the physician as a professional. The data include exercises employed by the University of Minnesota-School of Medicine to foster professionalism among its medical students, such as the skills of peer review and self reflection, a 20-hour course for first-year medical students in which approximately two-thirds of the course focuses directly (e.g., topic-specific readings and class exercises) and indirectly (e.g., medical training and socialization) on the topic of professionalism, and a set of questions asked during admissions interviews which highlight issues of professionalism. Although the data are neither definitive nor generalizable, they do suggest that medical school applicants approach the admissions process well versed in academic and related (e.g., service activities) requirements, but without having given much thought to what it means to be a physician, particularly in terms of professional values. Once in medical school, students express great enthusiasm for being service oriented and doing good but are not necessarily receptive to the notion that they are obliged in these respects. Instead, students express a variety of utilitarian views on things like codes of ethics and medical oaths to support their stance on nonobligation (sometimes directly and sometimes indirectly). Furthermore, students do not draw distinctions among the values commonly associated with professionalism. In particular, they foresee numerous problems associated with integrating the values of altruism and dutifulness into their future practice of medicine.
Ethics, Medical↗