The professionalism movement: Can we pause?
ACGME outcomes; Biomedical Social Sciences; education; justice; medical; Medical Ethics; Medical Ethics; medical humanities; medical-student abuse; mistreatment; perceptions; professionalism; professionalism professional development; school; social; Social Issues; Social Sciences - Other Topics; virtue
The topic of developing professionalism dominated the content of many academic medicine publications and conference agendas during the past decade. Calls to address the development of professionalism among medical students and residents have come from professional societies, accrediting agencies, and a host of educators in the biomedical sciences. The language of the professionalism movement is now a given among those in academic medicine. We raise serious concerns about the professionalism discourse and how the specialized language of academic medicine disciplines has defined, organized, contained, and made seemingly immutable a group of attitudes, values, and behaviors subsumed under the label of "professionalism." In particular, we argue that the professionalism discourse needs to pay more attention to the academic environment in which students are educated, that it should articulate specific positive behaviors, that the theory of professionalism must be constructed from a dialogue with those we are educating, and that this theoretical and practical discourse must aim at a deeper understanding of social justice and the role of medicine within a just society.
Wear D; Kuczewski M G
American Journal of Bioethics
2004
2004
Journal Article
<a href="http://doi.org/10.1162/152651604323097600" target="_blank" rel="noreferrer noopener">10.1162/152651604323097600</a>
Medical Humanities and Their Discontents: Definitions, Critiques, and Implications
clerkship; curriculum; education; Education & Educational Research; ethics; Health Care Sciences & Services; mindful; narrative medicine; physician; practice; professionalism; school-of-medicine; students perceptions
The humanities offer great potential for enhancing professional and humanistic development in medical education. Yet, although many students report benefit from exposure to the humanities in their medical education, they also offer consistent complaints and skepticism. The authors offer a pedagogical definition of the medical humanities, linking it to medicine as a practice profession. They then explore three student critiques of medical humanities curricula: (1) the content critique, examining issues of perceived relevance and intellectual bait-and-switch, (2) the teaching critique, which examines instructor trustworthiness and perceived personal intrusiveness, and (3) the structural/placement critique, or how and when medical humanities appear in the curriculum, Next, ways are suggested to tailor medical humanities to better acknowledge and reframe the needs of medical students. These include ongoing cross-disciplinary reflective practices in which intellectual tools of the humanities are incorporated into educational activities to help students examine and, at times, contest the process, values, and goals of medical practice. This systematic, pervasive reflection will organically lead to meaningful contributions from the medical humanities in three specific areas of great interest to medical educators: professionalism, "narrativity," and educational competencies. Regarding pedagogy, the implications of this, approach are an integrated required curriculum and innovative concepts such as "applied humanities scholars." In turn, systematic integration of humanities perspectives and ways of thinking into clinical training will usefully expand the range of metaphors and narratives available to reflect on medical practice and offer possibilities for deepening and strengthening professional education.
Shapiro J; Coulehan J; Wear D; Montello M
Academic Medicine
2009
2009-02
Journal Article
<a href="http://doi.org/10.1097/ACM.0b013e3181938bca" target="_blank" rel="noreferrer noopener">10.1097/ACM.0b013e3181938bca</a>
Physician views on practicing professionalism in the corporate age.
Education; Human; Interviews; Qualitative Studies; Professionalism; Professional Practice; Audiorecording; Medical; Business – Methods
Arnold Relman argues that medical education does not prepare students and residents to practice their profession in today's corporate health care system. Corporate health care administrators agree: Physicians enter the workforce unskilled in contract negotiation, evidence-based medicine, navigating bureaucratic systems, and so forth. What about practicing physicians? Do they agree as well? According to this study, they do. Feeling like decentered double agents and unprepared, physicians find themselves professionally lost, struggling to balance issues of cost and care and expressing lots of negativity toward the cultures of medicine and managed care. However, physicians are resilient. A group of physicians, who may be called proactive, are meeting the professional demands of corporate health care by becoming sophisticated about its bureaucratic organization and the ways in which their professional and personal commitments fit within the system. Following the lead of proactive physicians, the authors support Relman's thesis that education for both students and physicians requires a major overhaul.
Castellani B; Wear D
Qualitative Health Research
2000
2000-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/104973200129118598" target="_blank" rel="noreferrer noopener">10.1177/104973200129118598</a>
Teaching fearlessness: a manifesto.
Humans; Adaptation; Mentors; *Curriculum; Students; Education; *Learning; Interpersonal Relations; Teaching/*methods; Attitude; Fear/*psychology; Knowledge; Mentorship; Professionalism; Stress; Psychological; Medical/*psychology; Medical/*methods; Faculty-Student Relations – Evaluation; Medical – Evaluation; Role Models – Evaluation
CONTEXT: Negative role modeling is a plague medical educators fight once students enter the clinical arena. The literature is replete on the fact that students routinely encounter faculty who display attitudes and behaviors inconsistent with the values taught throughout the medical curriculum, particularly in the preclinical years. APPROACH: Using a back and forth between the text of a third-year student's reflective essay and two of her faculty's observations on her negative encounters with several clinical faculty, the authors propose 'teaching for fearlessness.' DISCUSSION: Using Papadimos and Murray's use of 'fearless speech' derived from Foucault's thinking on parrhesia, the authors build a case that students should be encouraged to expose and challenge inequities on behalf of their patients, themselves and the profession at large. CONCLUSIONS: Medical educators should model and provide students with opportunities to develop and use 'fearless speech' as a way to reshape the culture of medical education and patient care.
Wear D; Zarconi J; Dhillon N
Education for health (Abingdon, England)
2011
2011-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Derogatory and cynical humour directed towards patients: views of residents and attending doctors.
*Attitude of Health Personnel; *Social Identification; *Wit and Humor as Topic; Culture; Education; ETHICS; Hospital/*psychology; Humans; HUMOR in the workplace; MEDICAL personnel & patient; Medical Staff; Medical/methods; Medical/psychology; Physician-Patient Relations; PROFESSIONALISM; Social Perception; Students; WIT & humor; WIT & humor in medicine
CONTEXT: A study of medical students' perspectives on derogatory and cynical humour was published in 2006. The current study examines residents' and attending doctors' perspectives on the same phenomenon in three clinical departments of psychiatry, internal medicine and surgery. METHODS: Two focus groups were conducted in each of the three clinical departments, one with residents and one with attending doctors,during the 2006-07 academic year. Seventy doctors participated, including 49 residents and 21 attendings. The same semi-structured format was used in each group. Questions focused on characterisations of derogatory and cynical humour along with motives and rules for its use.All focus groups were audiotaped and the tapes transcribed. Each transcript was read independently by each researcher as part of an inductive process to discover the categories that describe and explain the uses, motives and effects of such humour. RESULTS: Three categories that appeared in the first study with medical students - locations for humour, the humour game, and not-funny humour - emerged as virtually identical,whereas two others–objects of humour and motives for humour - were more fully elaborated. DISCUSSION: Discussions of derogatory and cynical humour should occur in any department where teaching and role modelling are priorities. In addition, the tenets of appreciative inquiry and the complex responsive process,particularly as they are used at the Indiana University School of Medicine, offer medical educators valuable tools for addressing this phenomenon.
Wear Delese; Aultman Julie M; Zarconi Joseph; Varley Joseph D
Medical education
2009
2009-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1365-2923.2008.03171.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2923.2008.03171.x</a>