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LEARNING OBJECTIVES

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  1. To provide an overview of educational theories and best practices that can be leveraged to create a comprehensive educational program in professionalism.

  2. To describe elements of a formal curriculum for teaching professionalism.

  3. To explain the relationship between the formal and informal curriculum within professionalism education.

  4. To analyze the primary components of the informal curriculum related to professionalism.

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INTRODUCTION

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Dr. Fraser, a senior faculty member, was frustrated by his latest teaching assignment. For years he has taught clinical skills to medical students in small group sessions, but this year they added on a module on professionalism, which all preceptors were required to teach. It includes definitions of professionalism along with expected behaviors for students. Dr. Fraser felt that these did not belong in a “skills” workshop, because, in his view, “You can’t teach this stuff—students will either be professional or they won’t. Besides, they should already know how to behave appropriately, by watching their attending physicians and residents.”

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Dr. Fraser does not consider professionalism a competency or skill that can be learned—rather, he thinks of it as a trait that one possesses (or fails to possess). The evidence does not support this view, and one goal of this book is to demonstrate that if professionalism is properly viewed as a competency, it follows that it can be taught, learned, and developed over time. Dr. Fraser also mistakenly assumes that professionalism is easily learned by watching more senior physicians. This is partly true, in that excellent positive (and unfortunate negative) role models can certainly imprint on learners and affect their behavior. But it is also clear that relying on passive observation is insufficient at best, and potentially harmful at worst (also see Chapter 8, The Hidden Curriculum and Professionalism).

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Of interest, there is some suggestion that students are also unhappy with current educational approaches to professionalism. One school reported on their experience in teaching professionalism and found that a large portion of students felt the word professionalism itself was overused, and that the course content felt like “a collection of excessive directives, lectures, rules, and moral pronouncements that they found repetitive and patronizing” (Goldstein et al, 2006). Some educators focus heavily on evaluation and espouse a zero tolerance policy for transgressions. This leads students to be fearful of admitting difficulty. Students also frequently describe a disconnect between lessons learned in the classroom and lessons based on (and behavior modeled in) the clinical environment. This can be disorienting and confusing, and may lead to cynicism and a sense of futility (e.g., why learn about it if it doesn’t occur in practice?). Another reason for the backlash is that professionalism is often taught in a negative manner, focusing on “lapses” and when things go wrong—medical errors, disruptive physicians, impairment, intimidation and harassment, andso on. This may set students up to expect the worst rather than the best from their preceptors and ...

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