The Josiah Macy Jr. Foundation and the Institute on Medicine as a Profession (IMAP) have recently forged a collaboration to improve the education of physicians. Macy president George Thibault, M.D., and IMAP president David J. Rothman, Ph.D., recently announced a $250,000 Education and Training to Professionalism Initiative (ETPI). Under the initiative, five medical school faculty members would get $50,000 over two years to strengthen professionalism education in undergraduate and graduate medical schools.
The Initiative merges Macy’s focus on health professions education and IMAP’s expertise on medical professionalism to promote a sense of professionalism among a new generation of doctors. Medical professionalism comprises a broad commitment to putting patients first, self-governance amongst physicians, maintenance of knowledge and technical competence, and participation in civic action to advocate for the general well-being.
Thibault and Rothman reflected on the new Initiative and its first round of grantees.
Why does there need to be a focus on professionalism in medical education?
Thibault: We think that it is something that needs to be taught. Professionalism is more than a set of attitudes. It’s a set of behaviors and actions that we’ve taken for granted for too long. With the kind of pressures that the health professions are under—from business pressure to complicated employment arrangements—there’s more reason than ever to be explicit about it. This partnership with IMAP and Macy is a great opportunity.
Rothman: Professions stand out against two very powerful forces that structure our lives as citizens. One is the marketplace and the other is the government. The marketplace works to its own satisfactions, and states often have overriding interests of their own. Professionalism helps keep a focus on patients’ well-being.
What does medical professionalism look like?
Thibault: There are three tenets of professionalism. Professionalism involves passing on and advancing specialized knowledge, self-regulation, and altruism.
Rothman: Professionals should also be engaged in civic action. It is not only the well-being of particular patients that you should be concerned about. Advocacy for general well-being joins with the other points to form the core of professionalism. So, professionalism refers to these internal commitments.
Thibault: Which in real terms means, for example, means being concerned with issues like social Justice, equity, and the responsible use of resources.
What were you looking for in applications?
Thibault: We didn’t presuppose the area that grants would address—we wanted a spread across geography, public and private institutions, and the kinds of innovations proposed. We are very pleased that proposals came from such a range of institutions for a variety of different kinds of projects.
What are the obstacles to incorporating professionalism education into graduate study? How do these grants bring down those barriers?
Rothman: There are barriers that are external to the education process like misguided bonus payment systems, where a group or practice might say ‘do more even if it’s not good for the patient.’ You also have longstanding cultural attitudes. Professionalism requires that however strong your commitment to your buddy you have a stronger obligation to the profession. That can cause tension as well. You’ve got kids to send to college, you’ve got a mortgage, can’t I take advantage of that potential gift/speaking engagement/larger salary?
Professionalism isn’t easy. It may mean giving up money. It may mean breaking codes of friendship. It may mean taking the time to master a new skill. It may mean taking time to go into the world of advocacy. This isn’t simple. But the returns are to make the profession of medicine that much more respected within the larger community
Thibault: There are also some obstacles particular to medical education. For instance, there’s never enough time in the curriculum to teach what you want to. There’s also the question of whether faculty are prepared to teach something they were never taught themselves in a formal way. That’s why it’s significant that one winning grant proposal focuses on faculty development, which is very important.
By drawing attention to professionalism we hope to elevate its status and get people thinking creatively. And the results will help guide future products and identify best practices.
Why should medical professionalism matter to the average health care consumer?
Rothman: Patients’ stake in medical professionalism is fundamental. They want to be certain that their doctor is putting their interests first. Patients should appreciate that professionalism means health care that is both patient-centered and quality.
Thibault: Patients expect their doctors to be their advocates and do not want to believe self-interest is involved in their decisions. They also expect competency and honesty which means being as good as you can be at what you do and knowing when to involve others in their care.