Professionalism

Abstract

Professionalism lies at the heart of clinical practice and this issue of Medical Education is dedicated to papers exploring aspects of the educational processes involved in learning about being a ‘good’ doctor. The ways in which doctors behave, how they think, and how they interpret the problems presented to them all reflect the standards they believe underpin their professional practice. These standards are made explicit by governing or regulating bodies such as the General Medical Council in the United Kingdom. Good doctors accept these standards and the principles they are based on and conduct their practice accordingly. Medical students learn about professional practice by seeing others do it, by reflecting on what they see, and by shaping their own behaviour to mirror the models their senior colleagues portray. The effects of this hidden or informal curriculum are powerful and long lasting and may influence the ways in which students and young doctors behave for many years. Recently, pressures from the growth of consumer awareness, from patient choice, from greater calls for professional accountability and from the increasingly important role of other highly skilled health care professionals in health care delivery, have put pressure on doctors to rethink and take stock of what being a medical professional is and what it means. Concerns about the need for change in perspective about the nature of professional practice have led many medical teachers to introduce courses or themes addressing personal and professional development. Often these courses are integrated with or derived from earlier existing courses in medical ethics. and for many schools, the rise in interest in the medical humanities reflects concerns that, whilst the medical profession may not have lost its way, there is a danger of derailment or diversion from the core business of altruistic clinical practice. The topic of professionalism is important and rightly causes concerns that are being constructively and rigorously addressed in debate and through research. This is significant and the quality of the debate can only be improved by the provision of evidence. The literature on professionalism has grown rapidly in recent years and there is a lot to read, although much of this literature consists of opinion pieces or descriptions of courses. There is now a pressing need for work that provides the evidence to support practice and teaching. Thomas Inui has suggested that the literature about professionalism is good at setting out the ideal attributes of professional practice. Where it is not so good is in taking descriptions of what actually happens in practice, and recognising and exploring the reasons for what, on occasion, may be significant gaps between the ideal and the real. Whilst the hidden curriculum shapes the behaviour of future clinicians, it also causes conflicts between what students see doctors doing and what they hear doctors tell them about the concept of professionalism.1 The processes involved, and the factors that contribute towards the construction of professional identity are largely unexplored areas in medical education. Research in these areas will pay rich rewards in helping to develop and maintain the integrity of the profession. So it is good to see a recent initiative started by Professor Carol Black, the President of the Royal College of Physicians in England, who has convened a working party to define the nature and role of medical professionalism in today's society. The working party held its first meeting in October 2004 in London, and will report in a year's time. It will take evidence from a wide range of stakeholders drawn from the professions and from the public about perspectives on the key tenets and values of professionalism in medicine. It will also explore evidence about how professional values in medicine are changing. The working party hopes to report on ways of defining medical professionalism that are important for the 21st century and is especially keen to take into account how medical professionalism may be strengthened in the service of both patients and the wider public.2 The work of this group and of others in the systematic analysis of professionalism and in charting the future course is of great interest to medical students, teachers and clinicians alike.