Professionalism in Medicine:Critical Perspectives

The topic of professionalism has dominated the content of major
academic medicine publications (e.g. Journal of the American Medical
Association, New England Journal of Medicine, Academic Medicine,
Annals of Internal Medicine, The Lancet) during the past decade and
continues to do so. The message of this current wave of
professionalism is that medical educators need to be more attentive
to the moral sensibilities of trainees, to their interpersonal and
affective dimensions, and to their social conscience, all to the end
of skilled, humanistic physicians. Urgent calls to address
professionalism from such groups as the Association of American
Medical Colleges (representing the nation's 126 accredited medical
schools and nearly 400 major teaching hospitals), the American Board
of Internal Medicine, and the Accreditation Council for Graduate
Medical Education, among others. In fact, at the 2004 annual meeting
of the AAMC six separate presentations addressed professionalism with
such titles as "Evaluating Humanism and Professionalism,"
Professionalism: Expectation, Education, Evaluation," or "Toward
Assessing Professional Behaviors of Medical Students through Peer
Observations" (note the preoccupation with assessment).
Professionalism, then, has become part of the current academic
medicine parlance, used by administrators, clinical faculty,
residency programs, and professional organizations with an
expectation of shared meanings and goals. All of these stakeholders
focus on what has become a consistent list of attributes deemed to be
the essence of professionalism, which usually include variations on
altruism, duty, excellence, honor and integrity, accountability, and
respect. In fact, most of the scholarly work to date has been listing
(attributes of professionalism), describing (activities that may
foster it), decrying (the environment that works against it), and
measuring/evaluating it.


In this collection of essays, we don’t argue with these attributes.
Instead, we ask questions of the discourse from which they arise, 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 "professional" or "professionalism." This collection aims to be
a critical text, one that questions the profession’s beliefs about
the nature of its work and how such beliefs are enacted (or not) in
medical education, particularly as they fuel the professionalism
discourse. In addition, we will scrutinize how the discourse is
enacted in both the formal and hidden curriculum, and in the larger
medical environment.

차 례
Introduction.- Part One.- Conceptualizing Professionalism.- The
Complexities of Medical Professionalism: A Preliminary Investigation.-
An Analysis of the Discourse of Professionalism.- Professionalism:
Curriculum Goals and Meeting Their Challenges.- Part Two.- Teaching
Professionalism.- Medical Professionalism: The Nature of Story and
the Story of Nature.- Patient Respect: A Case Study of the Formal and
Hidden Curriculum.- You Say Self-Interest, I Say Altruism.- The Role
of Ethics within Professionalism Inquiry: Defining Identity and
Distinguishing Boundary.- Medical Professionals and the Discourse of
Professionalism: Teaching Implications.- Part Three.- Assessing
Professionalism.- Educating for Professionalism at Indiana University
School of Medicine: Feet on the Ground and Fresh Eyes.- The Problem
with Evaluating Professionalism: The Case against the Current Dogma.-
How Medical Training Mangles Professionalism: The Prolonged Death of
Compassion.- Wit is Not Enough.- Professionalism and the Heisenberg
Uncertainty Principle.- Coda .- List of Contributors.- Index .