Professionalism: five articles (Clinical Orthopaedics and Related Research)

corr.gif The following collection of articles on professionalism was edited by Sylvia R. Cruess and Richard L. Cruess, and published in the August 2006 issue of Clinical Orthopaedics and Related Research: [subscription only]

Cruess SR. Professionalism and medicine’s social contract with society. Clin Orthop Relat Res 2006; 449:170-176.
Abstract: Medicine’s relationship with society has been described as a social contract: an “as if” contract with obligations and expectations on the part of both society and medicine, “each of the other”. The term is often used without elaboration by those writing on professionalism in medicine. Based on the literature, society’s expectations of medicine are: the services of the healer, assured competence, altruistic service, morality and integrity, accountability, transparency, objective advice, and promotion of the public good. Medicine’s expectations of society are: trust, autonomy, self-regulation, a health care system that is value-driven and adequately funded, participation in public policy, shared responsibility for health, a monopoly, and both non-financial and financial rewards. The recognition of these expectations is important as they serve as the basis of a series of obligations which are necessary for the maintenance of medicine as a profession. Mutual trust and reasonable demands are required of both parties to the contract.
PubMed Record    Author affiliation: Centre for Medical Education,
McGill University, Montreal, Quebec, Canada.

Cruess RL. Teaching professionalism: theory, principles, and practices. Clin Orthop Relat Res 2006; 449:177-185.
Abstract: Professionalism as a subject must be taught explicitly. This requires an institutionally accepted definition which then must be learned by both students and faculty. This directs what will be taught, expected, and evaluated. Of equal importance, and more difficult to achieve, is the incorporation of the values and attitudes of professionalism into the tacit knowledge base of physicians in training and in practice. This requires learning experiences which encourage self-reflection on professionalism throughout the continuum of medical education. Because of the great influence of role models and because most physicians do not fully understand professionalism and the obligations required to sustain it, faculty development is essential to the success of any program on professionalism. Also important are strong institutional support including adequate resources, the presence of a longitudinal program which ensures repeated exposure throughout the educational process, a supportive environment, and a system of evaluation which reinforces teaching.
PubMed Record  Author affiliation: Centre for Medical Education,
McGill University, Montreal, Quebec, Canada.

Johnston S. See one, do one, teach one: developing professionalism across the generations. Clin Orthop Relat Res 2006; 449:186-192.
Abstract: Individuals develop their professional values and identity as they progress through the hierarchical career stages of medicine. At the same time, the collective values of the profession evolve with changes in the wider society. This leads to recurring small but significant generation gaps in professional values. For the past half century, this gap has centered on the concept of altruism and quality of life. In order for professionalism to develop at the individual level as well as for the community of physicians, the generational differences must be bridged and negotiations for change must build on common ground. This requires a long-term developmental approach including teaching strategies which are career stage appropriate and adapt to the different learning styles of the younger generation.
PubMed Record  Author affiliation: Department of Family Medicine,
University of Ottawa, Ottawa, Ontario, Canada. Sharon.Johnston@alum.

Dartmouth.orgHafferty FW. Definitions of professionalism: a search for meaning and identity. Clin Orthop Relat Res 2006; 449:193-204.
Abstract: 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.
PubMed Record  Author affiliation: University of Minnesota Medical School,
Duluth, MN 55812-2487, USA.

Arnold L. Responding to the professionalism of learners and faculty in orthopaedic surgery. Clin Orthop Relat Res 2006; 449:205-213.
Abstract: Recent developments in assessing professionalism and remediating unprofessional behavior can curtail the inaction that often follows observations of negative as well as positive professionalism of learners and faculty. Developments include: longitudinal assessment models promoting professional behavior, not just penalizing lapses; clarity about the assessment’s purpose; methods separating formative from summative assessment; conceptual and behavioral definitions of professionalism; techniques increasing the reliability and validity of quantitative and qualitative approaches to assessment such as 360-degree assessments, performance-based assessments, portfolios, and humanism connoisseurs; and systems-design providing infrastructure support for assessment. Models for remediation have been crafted, including: due process, a warning period and, if necessary, confrontation to initiate remediation of the physician who has acted unprofessionally. Principles for appropriate remediation stress matching the intervention to the cause of the professional lapse. Cognitive behavioral therapy, motivational interviewing, and continuous monitoring linked to behavioral contracts are effective remediation techniques. Mounting and maintaining robust systems for professionalism and remediating professional lapses are not easy tasks. They require a sea change in the fundamental goal of academic health care institutions: medical education must not only be a technical undertaking but also a moral process designed to build and sustain character in all its professional citizens.
PubMed Record    Author affiliation: University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108,


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