Sylvia R. Cruess

Renewing professionalism: an opportunity for medicine.

In recent decades, both the concept and the performance of professionals have been widely questioned. Professionalism and the idea of service have been placed under intense pressure, but they have survived. Medicine may now have an opportunity to reestablish itself as a respected, influential, and useful profession in Western society. The authors believe this could occur (1) because of the strength of the democratic process and the place of organized medicine within it; (2) because medicines role as a source of relatively impartial expertise is being reestablished (because medicine no longer controls the health care system); and (3), most important, because of the importance of the individual physician as healer in both societys view of medicine and medicines view of itself. To take advantage of this opportunity, the authors offer several recommendations, including (1) that medicine must continue current efforts to place first the doctor-patient relationship (the role of the healer) and the idea of service in redefining and fulfilling its obligations to society; (2) that there be a comprehensive education campaign to help physicians understand professionalism and its obligations (which the authors define); and (3) that physicians should assume responsibility for their local and national associations. If the individual medical professional and all the institutions connected with the practice and teaching of medicine truly understand and seek to fulfill their contracts with society and the obligations derived from these, the morality inherent in medical professionalism can be a dominant force, and better health care will result.

Professionalism in surgery

Russell L Gruen, MBBS, Jyoti Arya, MD, Ellen M Cosgrove, MD, Richard L Cruess, MD, Sylvia R Cruess, MD, A Brent Eastman, MD, FACS, P Jeffrey Fabri, MD, FACS, Paul Friedman, MD, FACS, Thomas D Kirksey, MD, FACS, Ira J Kodner, MD, FACS, Frank R Lewis, MD, FACS, Kathleen R Liscum, MD, FACS, Claude H Organ, MD, FACS, Joel C Rosenfeld, MD, FACS, Thomas R Russell, MD, FACS, Ajit K Sachdeva, MD, FACS, Elvin G Zook, MD, FACS, Alden H Harken, MD, FACS

Teaching Medical Professionalism: The Cognitive Base of Professionalism

As physicians, patients, and members of the general public have come to believe that medicines professionalism is under threat, virtually all have concluded that any action to address the issue must include a major educational initiative aimed at ensuring that physicians both understand the nature of contemporary medical professionalism and live according to its precepts. As a result, there is now a substantial literature containing a variety of opinions as to how this can be best accomplished. One of the common themes that has emerged is that the approaches of the past are no longer sufficient. For centuries, professionalism as a subject was not addressed directly. There were no courses on professionalism and it was not included in the standard medical curriculum. This is not because it was deemed unimportant. The Hippocratic Oath, subsequent codes of ethics, and a host of writers including Osler addressed the values and beliefs of the medical profession, often linking them to the word professionalism. However, it was assumed that these values and beliefs, which are the foundation of the profession, would be acquired during the process of socialization of students as they “acquire the complex ensemble of analytic thinking, skillful practice, and wise judgment.” The learning of professionalism depended heavily upon role models where students, residents, and indeed practicing physicians patterned their behavior on “individuals admired for their ways of being and acting as professionals.” While this method remains essential and powerful, by itself it is no longer felt to be adequate.

Teaching Professionalism and Fostering Professional Values during Residency: The McGill Experience

Learning how to be a professional is a vital part of residency training. Although professional socialization starts in medical school, professional attitudes and behaviors are internalized during residency as the resident learns medicine over a period of years of supervised practice. Providing illustrations from McGill University, this chapter will present a model of how professionalism can be taught and evaluated at the postgraduate or residency level and address lessons learned. THE CONTEXT Professionalism is a standard for accreditation of postgraduate programs in most Western countries, as found, for example, in the CanMEDS roles for specialty residencies in Canada, and the Accreditation Council for Graduate Medical Educations competencies in the United States. Other countries use documents such as the General Medical Councils “Good Medical Practice” in the United Kingdom or the Charter on Professionalism to outline appropriate professional behaviors for all physicians. As such, the curricular content for a residency program is broadly outlined, and there is an expectation that residents professional behaviors will be assessed. National residency accrediting bodies usually include a general definition of “professionalism” in their standards. As well, these bodies usually describe elements of professionalism, including concepts relating to professional attributes and humanistic behaviors, professional relationships (e.g., the social contract), the organizational and legal aspects of professionalism (e.g., profession-led regulation), ethical principles and practice, sensitivity to diversity, and physician health and sustainable practice. In Canada, both the Royal College of Physicians and Surgeons and the College of Family Physicians have mandated all residency programs to teach and evaluate professionalism.

Whole Person Care, Professionalism, and the Medical Mandate

The evolution of the practice of medicine, whose history is firmly rooted in the art of healing, is paradoxical. Society has always required and been served by healers since before history was recorded. In Western society, one can trace the roots of the healer to Hellenic Greece with its Aesculapian and Hippocratic traditions. Other cultures have their own traditions, and all appear to be based firmly in a commitment to selfless service to those in need. Prior to the appearance of modern science, curing was rare, but patient satisfaction appeared to be high. From this, one can surmise that whole patient care was being dispensed long before the term was coined. The advent of the scientific revolution in the middle of the nineteenth century, which was essential to the development of the modern medical profession, initially did not appear to significantly alter the relationship between a physician and a patient.

Teaching Medical Professionalism: Index

Part I. What Is to Be Taught: 1. The cognitive base of professionalism Sylvia Cruess and Richard Cruess Part II. Theory: 2. Educational theory and teaching methods in the teaching of professionalism Yvonne Steinert 3. Professionalism and the socialization of medical students Frederic Hafferty Part III. Principles: 4. Principles for designing a program for the teaching and learning of professionalism at the undergraduate level Richard Cruess and Sylvia Cruess 5. Resident formation: a journey into authenticity David Leach 6. Supporting professionalism in the educational setting: changing the educational environment and the students navigational skills T. Inui, A. H. Cottingham, R. M. Frankel, D. K. Litzelman, A. L. Suchman and P. R. Williamson 7. Assessment and remediation in programs of teaching and learning professionalism Louise Arnold and Christine Sullivan 8. Developing professionalism across the generations Sharon Johnston and Mark Peacock 9. Faculty development for teaching and evaluating professionalism Yvonne Steinert 10. The relationship between teaching professionalism and licensing and accrediting bodies Sir Donald Irvine 11. Educating the public about professionalism Jordan Cohen and Linda Blank Part IV. Practice: Case Studies in Teaching Professionalism Across the Continuum: 12. Learning professionalism in a traditional or organ-based curriculum Erika Goldstein 13. Learning professionalism in a problem-based learning curriculum Gillian Maudsley and C. M. Taylor 14. Learning and fostering professionalism during residency Linda Snell 15. Continuing professional development: a focus on professionalism Dave Davis.

Teaching Medical Professionalism: PRINCIPLES

Part I. What Is to Be Taught: 1. The cognitive base of professionalism Sylvia Cruess and Richard Cruess Part II. Theory: 2. Educational theory and teaching methods in the teaching of professionalism Yvonne Steinert 3. Professionalism and the socialization of medical students Frederic Hafferty Part III. Principles: 4. Principles for designing a program for the teaching and learning of professionalism at the undergraduate level Richard Cruess and Sylvia Cruess 5. Resident formation: a journey into authenticity David Leach 6. Supporting professionalism in the educational setting: changing the educational environment and the students navigational skills T. Inui, A. H. Cottingham, R. M. Frankel, D. K. Litzelman, A. L. Suchman and P. R. Williamson 7. Assessment and remediation in programs of teaching and learning professionalism Louise Arnold and Christine Sullivan 8. Developing professionalism across the generations Sharon Johnston and Mark Peacock 9. Faculty development for teaching and evaluating professionalism Yvonne Steinert 10. The relationship between teaching professionalism and licensing and accrediting bodies Sir Donald Irvine 11. Educating the public about professionalism Jordan Cohen and Linda Blank Part IV. Practice: Case Studies in Teaching Professionalism Across the Continuum: 12. Learning professionalism in a traditional or organ-based curriculum Erika Goldstein 13. Learning professionalism in a problem-based learning curriculum Gillian Maudsley and C. M. Taylor 14. Learning and fostering professionalism during residency Linda Snell 15. Continuing professional development: a focus on professionalism Dave Davis.

Teaching Medical Professionalism: List of Contributors

Part I. What Is to Be Taught: 1. The cognitive base of professionalism Sylvia Cruess and Richard Cruess Part II. Theory: 2. Educational theory and teaching methods in the teaching of professionalism Yvonne Steinert 3. Professionalism and the socialization of medical students Frederic Hafferty Part III. Principles: 4. Principles for designing a program for the teaching and learning of professionalism at the undergraduate level Richard Cruess and Sylvia Cruess 5. Resident formation: a journey into authenticity David Leach 6. Supporting professionalism in the educational setting: changing the educational environment and the students navigational skills T. Inui, A. H. Cottingham, R. M. Frankel, D. K. Litzelman, A. L. Suchman and P. R. Williamson 7. Assessment and remediation in programs of teaching and learning professionalism Louise Arnold and Christine Sullivan 8. Developing professionalism across the generations Sharon Johnston and Mark Peacock 9. Faculty development for teaching and evaluating professionalism Yvonne Steinert 10. The relationship between teaching professionalism and licensing and accrediting bodies Sir Donald Irvine 11. Educating the public about professionalism Jordan Cohen and Linda Blank Part IV. Practice: Case Studies in Teaching Professionalism Across the Continuum: 12. Learning professionalism in a traditional or organ-based curriculum Erika Goldstein 13. Learning professionalism in a problem-based learning curriculum Gillian Maudsley and C. M. Taylor 14. Learning and fostering professionalism during residency Linda Snell 15. Continuing professional development: a focus on professionalism Dave Davis.

Teaching Medical Professionalism: Frontmatter

Part I. What Is to Be Taught: 1. The cognitive base of professionalism Sylvia Cruess and Richard Cruess Part II. Theory: 2. Educational theory and teaching methods in the teaching of professionalism Yvonne Steinert 3. Professionalism and the socialization of medical students Frederic Hafferty Part III. Principles: 4. Principles for designing a program for the teaching and learning of professionalism at the undergraduate level Richard Cruess and Sylvia Cruess 5. Resident formation: a journey into authenticity David Leach 6. Supporting professionalism in the educational setting: changing the educational environment and the students navigational skills T. Inui, A. H. Cottingham, R. M. Frankel, D. K. Litzelman, A. L. Suchman and P. R. Williamson 7. Assessment and remediation in programs of teaching and learning professionalism Louise Arnold and Christine Sullivan 8. Developing professionalism across the generations Sharon Johnston and Mark Peacock 9. Faculty development for teaching and evaluating professionalism Yvonne Steinert 10. The relationship between teaching professionalism and licensing and accrediting bodies Sir Donald Irvine 11. Educating the public about professionalism Jordan Cohen and Linda Blank Part IV. Practice: Case Studies in Teaching Professionalism Across the Continuum: 12. Learning professionalism in a traditional or organ-based curriculum Erika Goldstein 13. Learning professionalism in a problem-based learning curriculum Gillian Maudsley and C. M. Taylor 14. Learning and fostering professionalism during residency Linda Snell 15. Continuing professional development: a focus on professionalism Dave Davis.

Teaching Medical Professionalism: WHAT IS TO BE TAUGHT

Part I. What Is to Be Taught: 1. The cognitive base of professionalism Sylvia Cruess and Richard Cruess Part II. Theory: 2. Educational theory and teaching methods in the teaching of professionalism Yvonne Steinert 3. Professionalism and the socialization of medical students Frederic Hafferty Part III. Principles: 4. Principles for designing a program for the teaching and learning of professionalism at the undergraduate level Richard Cruess and Sylvia Cruess 5. Resident formation: a journey into authenticity David Leach 6. Supporting professionalism in the educational setting: changing the educational environment and the students navigational skills T. Inui, A. H. Cottingham, R. M. Frankel, D. K. Litzelman, A. L. Suchman and P. R. Williamson 7. Assessment and remediation in programs of teaching and learning professionalism Louise Arnold and Christine Sullivan 8. Developing professionalism across the generations Sharon Johnston and Mark Peacock 9. Faculty development for teaching and evaluating professionalism Yvonne Steinert 10. The relationship between teaching professionalism and licensing and accrediting bodies Sir Donald Irvine 11. Educating the public about professionalism Jordan Cohen and Linda Blank Part IV. Practice: Case Studies in Teaching Professionalism Across the Continuum: 12. Learning professionalism in a traditional or organ-based curriculum Erika Goldstein 13. Learning professionalism in a problem-based learning curriculum Gillian Maudsley and C. M. Taylor 14. Learning and fostering professionalism during residency Linda Snell 15. Continuing professional development: a focus on professionalism Dave Davis.