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Concerns about medicine’s status as a profession have been growing for the past 80 years. By the late 1990s, many experts felt that medicine had become self-serving and insular, had violated its social trust, and was in danger of losing its vaunted professional status. The slowness of medicine’s awakenings notwithstanding, the inaugural decade of the twenty-first century was marked by a flurry of actions deigned to define, assess, and institutionalize professionalism within the classrooms of medical education and hallways of clinical practice. By 2000, for example, virtually every medical school and residency program had implemented some type of formal professionalism curriculum.

Medical professionalism faces a number of challenges. Perhaps the most important is the need to reconcile professionalism being taught in the “classroom” (which includes the professionalism embedded in the codes, charters, competencies, and curricula) with professionalism being observed by learners in the clinical settings modeled on a day-to-day basis by more senior clinicians and faculty. At root is a classic hidden curriculum problem of the gap between efforts to formalize professionalism instruction and the day-to-day or moment-to-moment lived experience of trainees. In some cases, the gap has been great enough to cause some trainees to “push back” against and disavow the formal professionalism curriculum. Successfully developing and implementing approaches to teaching professionalism that integrate elements of the formal and informal or hidden curriculum remain elusive.

Competency-based medical education has further defined, benchmarked, and assessed professionalism. The Accreditation Council for Graduate Medical Education (ACGME) professionalism competency emphasizes the development of professional character, high standards of accountability, humanism in all dealings with others, and altruism—putting the interests of the patient before self-interest. There are now a large number of readily available formal professionalism curricula, assessment tools, and literature (see web links and Suggested Readings). Although the challenge of formal versus informal curricula remain, these resources identify important aspects of professionalism and point to areas for further curricular development.

Professionalism requires attention to several domains of physician behavior, including truth-telling, confidentiality, disruptive behavior, assuming responsibility, respectful communication with patients and colleagues, giving and receiving feedback, bullying, sexual harassment, personal appearance and attire, and others. In this chapter, we focus on three major professionalism issues: inappropriate use of social media, plagiarism, and boundary violations. We first define each challenge, then illustrate each with one or more cases. We end the discussion of each challenge with commentary regarding educational and institutional implications in four areas: (1) formal/informal curriculum; (2) faculty development; (3) institutional response; and (4) remediation.

Social Media

The explosive growth in information technology, especially the adoption of social media, presents a new challenge to professionalism. Concerns about sharing confidential patient information on public social media web sites, posting of inappropriate personal information, using social media at inappropriate times such as on rounds or during lectures and other educational activities, and failure ...

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