Alternate Views of Professionalism In Medicine: From “A Flag In The Wind” by Thomas S. Inui MD (AAMC, 2003)

The following lists appear in:. Inui, TS. A Flag In The Wind: Educating For Professionalism In Medicine. February, 2003. AAMC.

Reference numbers have been changed but correspond to original source references.

Table 1. Alternative Views of Professionalism in Medicine: AAMC Medical School Objectives (1)

■ Knowledgeable (scientific method, biomedicine)
■ Skillful (clinical skills, reasoning, condition managing, communication)
■ Altruistic (respect, compassion, ethical probity, honesty, avoidance of conflicts
of interest)
■ Dutiful (population health, advocacy and outreach to improve non-biologic
determinants of health, prevention, information management, health systems
management)

A similar (high level of abstraction) table from the ACGME Outcome Project has similar content (Table 2).

Table 2. Alternative Views of Professionalism in Medicine:
Accreditation Council for GME (2)

■ Medical knowledge
■ Practice-based learning and improvement
■ Patient care
■ Systems-based practice
■ Interpersonal and communication skills
■ Professionalism (respect, compassion, integrity; responsiveness to needs; altruism; accountability; commitment to excellence; sound ethics; sensitivity to culture, age, gender, disabilities)

The “Physician Charter” of the ABIM/ACP-ASIM/EFIM emphasizes many of the same values, while framing them in the language of principles and commitments (Table 3).

Table 3. Alternative Views of Professionalism in Medicine: A Physician Charter (ABIM, ACP-ASIM, EFIM) (3)

■ Professionalism – a foundation of the social contract for medicine
■ Principles: primacy of patient welfare, patient autonomy, social justice
■ Commitments:
Professional competence
Scientific knowledge
Professional responsibilities
Managing COIs
Patient confidentiality
Honesty with patients
Improving quality of care
Improving access to care
Appropriate relationships
Just distribution of finite resources

Finally, two compelling statements about what physicians are expected to do (normative behaviors as members of their profession) constitute their own functional description of professionalism in action (Tables 4 and 5).

Table 4. Alternative Views of Professionalism in Medicine: A “normative definition” (H. Swick) (4)

Physicians:
■ Subordinate their own interests to those of others
■ Adhere to high ethical and moral standards
■ Respond to societal needs
■ Evince core humanistic values (honesty, integrity, caring, compassion, altruism, empathy, respect for others, trustworthiness)
■ Exercise accountability
■ Demonstrate continuing commitment to excellence
■ Exhibit commitment to scholarship
■ Deal with complexity and uncertainty
■ Reflect on their actions and decisions

Table 5. Alternative Views of Professionalism in Medicine:
“The duties of a doctor” (General Medical Council) (5)

■ Make the care of your patient your first concern.
■ Treat every patient politely and considerately.
■ Respect patients’ dignity and privacy.
■ Listen to patients and respect their views.
■ Give patients information in a way they can understand.
■ Respect the right of patients to be fully involved in decisions.
■ Keep your professional knowledge and skills up-to-date. Recognize the limits of your competence.
■ Be honest and trustworthy.
■ Respect and protect confidential information.
■ Make sure that your personal beliefs do not prejudice your patients’ care.
■ Act quickly to protect patients from risk (from physicians).
■ Avoid abusing your position as a doctor.
■ Work with colleagues in the ways that best serve patients’ interests.

Finally, yet another, and even more recent taxonomy of domains of professionalism was used in a recent joint meeting of AAMC and NBME representatives and academicians with relevant expertise.(6) The aims of this meeting were to work within the domains to examine the potential for measurement and evaluation. That taxonomy, derived largely from the work of the Group on Educational Affairs within the AAMC (7), but acceptable for the purposes of the meeting to all, also included now-familiar content:

■ altruism, honor and integrity (e.g., ethical, honest, moral),
■ caring and compassion (e.g., sensitivity, tolerance, openness, communication),
■ respect (e.g., for patient’s dignity and autonomy, for other health professionals and staff, relationship building),
■ responsibility (e.g., for self-evaluation, motivation, insight),
■ accountability (e.g., dedication, duty, legality, service),
■ excellence and scholarship, and
■ leadership

References:

1.Anderson MB, Cohen JJ, Hallock JE, Kassebaum DG, Turnbull J, Whitcomb M. Learning objectives for medical student education – guidelines for medical schools. Report I of the Medical School Objectives Project. Acad Med 1999;74:13-18.

2.Accreditation Council for Graduate Medical Education. ACGME Outcome Project. , 1999.

3. Members of the Medical Professionalism Project (ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine). Medical professionalism in the new millennium: A physician charter. Ann Int Med 2002;136:243-246.

4. Swick HM. Toward a normative definition of medical professionalism. Acad Med 2000;75: 612-616.

5. British Medical Council. Good Medical Practice: Protecting Patients, Guiding Doctors. London, British Medical Council, 1998.

6.Embedding Professionalism in Medical Education: Assessment as a Tool for Implementation, an invitational conference of the National Board of Medical Examiners and the Association of American Medical Colleges. Baltimore, May 15-17, 2002. Also see: NBME Examiner 2002 (Spring/Summer);49: 4-5.

7. Wong RY, Hemmer PA, Szauter K. Student professionalism: A CDIM commentary. Am J Med 1999;107: 537-541.