The American Journal of Bioethics 4.2 (2004) Web Only
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The Professionalism Movement:
A Pause Might Not Be Sufficient
Delese Wear and Mark G. Kuczewski (2004) raise important and timely issues posed by the current professionalism movement, including the use of abstractions in the discourse regarding the construct and the need to consider various instructional elements. While Wear and Kuczewski stress the centrality of the learner and note the importance of other selected instructional elements (e.g., the learning environment and an organizing theme), it is the other system elements that might prove most challenging to the professionalism movement.
Historically, three data sources have guided curriculum decisions: the organized subject matter, society, and the learners who will experience the curriculum (Tyler 1949). Sound educational practice mandates that these decisions be addressed to accommodate the development of the intended cognitive, affective, and behavioral outcomes that are essential to guiding instructional planning, implementation, and evaluation. However, in the professionalism movement consensus regarding the subject matter is lacking, attention to society's interests appears underweighted, and an emphasis on promoting medical professionalism via educational efforts targeted primarily at trainees might not yield the desired outcomes for the profession.
The concept of professionalism extends beyond training to an individual's entire medical career. Individually, few physicians are aware of ethical guidelines relevant to areas, such as capital punishment (Farber et al. 2001), in which their profession interacts with society. More broadly, the medical profession itself appears to lack consensus regarding its core values (e.g., the extent to which it will promote healthcare under a social-justice framework), is fragmented into various subspecialty organizations with their own codes of ethics and conduct, operates in a society based on capitalism and an ethos of individualism, and is facing serious challenges such as reducing a medical error rate that, even when using the lower mortality estimates, is surprising as well as daunting. Essentially, "most professionals, as individuals, are inarticulate about their profession's ethical standards; and ... most professions, as collective voices of their members, are inarticulate as well" (Ozar 1993, 149); medicine is no exception. This is particularly problematic in the professionalism movement because the medical profession not only comprises the individuals who will lead and implement the movement's educational initiatives and who might themselves lack training in effective educational practices for working in the notably challenging affective domain, but also provides the primary environment for its trainees' professional socialization.
While generally effective in its political lobbying efforts, the medical profession has not yet assumed the lead role in addressing access to healthcare, which remains one of the predominant moral challenges to the profession in the United States at a time when "almost all other nations in the industrialized world have social policies that make core healthcare services available to all or virtually all of their citizens" (Murray 2003, 43). Quality healthcare provision is the one area in which the medical profession's values distinguish it and its members from others with a service orientation. While Wear and Kuczewski note the usefulness of social justice as an organizing theme for the medical-professionalism movement, caution is warranted because there have been numerous instances throughout history in which the concept of social justice has been twisted and used to justify political actions that were extremely detrimental to a specific group while purportedly promoting a "good" for society overall. Challenges in clarifying the profession-specific values of the medical community might be part of the reason why most of the abstractions codified by various medical organizations and reflected in the current professionalism movement (e.g., honesty, respect for others, compassion, integrity, accountability, altruism, and a commitment to ethical principles) are not unique to the medical profession per se but are essentially desirable character traits, supportive of developing a person of good moral character regardless of the application of those skills in a...