Professionalism in Context: Insights From the United Arab Emirates and Beyond.

Abstract

O ver the past decades, professionalism education has become a key competency in the medical education continuum. The rising focus on professionalism has been paralleled by an increasing interest in competency-based medical education in graduate medical education globally. However, as professionalism reflects a contract between the medical profession and society, the definition of professionalism in globally accepted competency frameworks developed in Anglo-Saxon contexts may not reflect the societal expectations of other cultures. In this issue of the Journal of Graduate Medical Education, Abdel-Razig and colleagues reported a qualitative study to develop a locally derived consensus definition of medical professionalism for the United Arab Emirates (UAE). They used an innovative combination of methods, including world cafe, nominal group technique, the Delphi method, and interpretive thematic analysis. The main finding was that 9 professionalism attributes derived from their consensus definition overlapped considerably with known Western definitions. However, 3 important differences were noted: (1) the primacy of social justice; (2) the role of personal faith in guiding professional practices; and (3) the extension of professional attributes to personal life. While the study of Abdel-Razig et al is limited by the small number of participants, it invites us to consider professionalism beyond Arab cultural contexts. The study concludes that the definitions of professionalism and the contract between the society and the profession made up of expectations and obligations between both parties should be relevant to local, social, and cultural contexts. For decades, Western models have been adopted as the benchmark for conceptualizing professionalism globally. Yet the study by Abdel-Razig and colleagues serves as an important reminder that these models may not be applicable to non-Western cultures. For instance, the third attribute not found in Western frameworks (the extension of professional attributes to personal life) resonates well with the traditional role of Arab physicians, as they are expected to act as community leaders, not only as health providers. Studies of stakeholders’ expectations of professionalism from Taiwan and China that report the influence of Confucian values also support the argument that, when it comes to the definition of professionalism, one size does not fit all. Furthermore, although some elements of professionalism are informed by universal humanistic values, interpretations vary across cultures. For instance, an aspect of humanism is respect for patients. However, different interpretations of these values are evident in aspects of medical practice, such as varying physician-patient relationships. For example, in Western models the interpretation of respect emphasizes patient autonomy, in which patients make their own medical decisions. In contrast, paternalistic models convey respect to patients by entrusting physicians to make decisions, as professionals, on behalf of patients. For instance, Arab physicians are perceived as ‘‘masters’’ who are supposed to know and decide what is best for their patients; they are perceived to lack confidence if they express diagnostic uncertainty. This paternalistic model of patient care is not exclusive to the Arabian context, and is also reported in studies from Pakistan, Ughanda, Malaysia, and India. These models are based on different interpretations of humanism, specifically respect toward patients, in comparison to models prioritizing patient autonomy. The study by Abdel-Razig et al invites us to pay attention to the roles of faith, values, and history in shaping professionalism in various cultures. Studies from Japan, Taiwan, and the Arab world support these roles. For instance, the 7 virtues of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors, have been used to interpret professionalism in Japan. In Taiwan and China, Confucian values, including integrity, morality, and relationalism, are reflected in the perception and practice of professionalism. In an Arabian context, the Four-Gates Model conceptualizes professionalism at 4 levels (gates) of professional conduct while dealing with (1) self, (2) task, (3) others, and (4) God. There is some overlap between DOI: http://dx.doi.org/10.4300/JGME-D-16-00103.1