Correspondence

Professionalism

N Engl J Med 2007; 356:966March 1, 2007

Article

To the Editor:

With regard to the editorial on professionalism by Hafferty (Nov. 16 issue),1 fueling the “hidden curriculum” is the day-to-day disconnect between academic leaders, who establish standards, and trainees, who are expected to meet them. In medical education, the distance between these goals and actual practice can be vast. For example, how do trainees respond to real-time challenges to professionalism?

Role modeling is one response, although it may be insufficient alone.2 In his editorial, Hafferty rightly stresses personal reflection; at least one medical school encourages trainees and faculty to record signal clinical events when they occur for active reflection later.3 The benefits of role modeling and reflection might best be combined in organized reflection groups, facilitated by experienced clinicians chosen for their high standards of professionalism. Such “master clinical professionals” should be fundamental to the next wave of teaching professionalism, their time and expertise sought and rewarded.

Clayton J. Baker, M.D.
University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
clayton_baker@urmc.rochester.edu

3 References

1. 1

   Hafferty FW. Professionalism -- the next wave. N Engl J Med 2006;355:2151-2152
   Full Text | Web of Science | Medline

2. 2

   Stern DT, Papadakis M. The developing physician -- becoming a professional. N Engl J Med 2006;355:1794-1799
   Full Text | Web of Science | Medline

3. 3

   Inui TS, Cottingham AH, Frankel RM, et al. Educating for professionalism at Indiana University School of Medicine: feet on the ground and fresh eyes. In: Wear D, Aultman JM, eds. Professionalism in medicine: critical perspectives. New York: Springer, 2006:165-84.
   

Author/Editor Response

Baker's concerns about the “day-to-day disconnect” between ideals and their manifestation on the shop floor and his comments about the remedial importance of “signal clinical events,” role modeling, organized reflection groups, and “master clinical professionals” are excellent points. I would add only that all sociocultural and occupational groups routinely normalize their life and work practices and settings. One consequence is that appreciable segments of a group's daily routines slip uncritically beneath (in this case) any such “professionalism radar.” Efforts to monitor the workplace for issues of professionalism should therefore be not only organized and proactive but also hypervigilant. Outsiders (those who are not part of the occupational group with its assumptions about the way things are and should be) thus need to be involved in the monitoring process. Patients are one such group. Others include new recruits, members of other (related and unrelated) occupational groups, and trained social observers such as anthropologists and sociologists. The ultimate goal is high-quality patient care, and professionalism is too important a part of this praiseworthy effort to be left solely to insiders.

Frederic W. Hafferty, Ph.D.
University of Minnesota Medical School, Duluth, MN 55812
fhaffert@d.umn.edu