News and Commentary George Thibault on the Importance of Medical Professionalism

The Macy Foundation and the Institute on Medicine as a Profession (IMAP) recently extended the proposal deadline for the Education and Training to Professionalism Initiative. Macy President GeorgeThibault shares why professionalism in medicine is more important than ever before.

Is medical professionalism a lost component of health professions education?
In times past, people didn’t think we needed to talk about or teach professionalism. People thought professionalism was something health professions students acquired through traditional education. It wasn’t that we weren’t teaching it well, it’s that we weren’t teaching it or talking about it at all.

Over the years, it has become more apparent to people that professionalism is an important issue to talk about, and institutions no longer assume students are just going to get it. There is also a realization that there are professional traits you can teach, such as attitudes, behaviors and values. Now we have to learn a new language that everyone can understand. This is the stimulus for our work with IMAP. We are learning what approaches to teaching professionalism are effective and how professionalism can be incorporated and legitimized in the education process.

How do you define professionalism in health care?
There is no single, agreed upon definition. The ABIM Foundation has its definition, and I have carried with me a fairly simple definition that Justice Louis Brandeis offered a century ago about the learned professions. He said they have three characteristics:

    1. A learned profession possesses a special set of knowledge and skills, and is responsible for mastering, for improving, and for passing that on to the next generation. This has to do with competency, continuous improvement and generational responsibility.
    2. A learned profession is altruistic; it exists to serve society. Our foremost responsibility is to better serve others, whether it disrupts us or makes things more difficult.
    3. A learned profession is self-regulating. We earn the right to self-regulation by fulfilling the first two principles.

To me, these tenets encompass most of the behaviors and principles that we want to instill in health professionals.

Is there an urgency to focus on professionalism in health professions education?
There are a lot of forces in the world today that are undermining professionalism, especially in terms of financial and economic pressures. Today, we have increasing competition, commercialization and advertising. Organizational structures are more complex than ever before, and all of these things are threats to professionalism. We need to identify these threats so that people are armed against them and can fight to keep professionalism in health care.

What are new frontiers in professionalism?
One feature of the changing landscape today is interprofessionalism. What does professionalism look like when we are talking about the new team approach, and how does professionalism look now that the physician is not at the center? We need to get a better understanding of these sorts of questions and understand how professionalism is shared across all the health professions.

We also need to understand how organizations play a role. Most health professionals are operating within an institution and not just as individuals. We need to ensure organizations are upholding the right professional ideals so that the individuals under that authority are able to practice at the highest professional level.

Learn more about the Macy-funded professionalism initiative and the three cohorts to date.

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