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  • PROFESSION:
  • The place where
  • your deep gladness meets the
  • world's deep needs
    • Frederick Buechner

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Case Illustration 1

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A basic science course director is concerned that a second-year medical student is "heading for trouble" because he has made verbal statements in class such as, "I hate this course" and "The course instructor is really stupid."

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Case Illustration 2

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Several male residents are overheard by a female medical student talking at the nurse's station about sexually explicit matters, most of which are unrelated to medicine. A group of male medical students on service join in the conversation.

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Case Illustration 3

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A surgical resident who has been asked to begin a procedure refuses because the attending surgeon is not present and he has never done the procedure before. When the attending arrives (30 minutes late) he proceeds to scream and publicly humiliate the resident for not having followed his orders.

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What do these three cases have in common? They are all about professionalism. Case 1 involves a student who expresses emotion inappropriately. Case 2 involves male residents who are unable to recognize appropriate boundaries for when and where to talk about patients and private matters. Case 3 involves a question of hierarchy and power. The cases also involve different levels of training and responsibility (medical student, resident, attending physician). Finally, all three cases involve the so-called "hidden" or informal curriculum of medical education (see Chapter 38).

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Our goals in brief chapter are to: (1) provide a broad overview of the current state of professionalism in medical education; (2) describe the competency curriculum in professionalism at one institution using the cases above; and (3) suggest some unifying themes and activities to teach professionalism in undergraduate, graduate, and continuing medical education.

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Background

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Codes of ethical and professional conduct for physicians have been in existence for millennia. Hippocrates, for example, counseled physicians to, "first, do no [biological] harm." Some 2500 years later, the first code of medical ethics published by the American Medical Association in 1847 recognized that harm could stem from communication as well as physical acts and opined that, "The life of a sick person can be shortened not only by the acts, but also by the words or the manner of a physician. It is, therefore, a sacred duty to guard himself carefully in this respect, and to avoid all things which have a tendency to discourage the patient and to depress his spirits." One hundred and sixty years later, in 2007, the idea that physicians should hide the truth, assuming that it will invariably depress the patient's spirits and shorten life, has largely been replaced by the principle of patient autonomy and the duty of physicians to tell the truth and support patients as they deal with its implications. In sum, definitions of professionalism ...

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