Medical Professionalism: Introduction

Perhaps no topic has consumed physician leaders and medical educators in the 21st century as much as the idea that the profession of medicine is under threat. Many of us have wrestled with what must be done to protect the values on which our profession was founded and how we might best inculcate these core values in our students and residents so that they are well-prepared to withstand the stormy waters ahead. The Medical Professionalism Project—a collaborative initiative of the American Board of Internal Medicine Foundation, the American College of Physicians, and the European Federation of Internal Medicine—culminated with the publication of the Physician Charter in 2002, with the intended goal of defining medicine’s 21st-century obligations under the social contract—preserving medicine’s traditional values but adapting them to contemporary reality.

If anyone expected the Physician Charter would be the last word on the topic, it is clear from the more than 1,500 publications in the medical literature on professionalism published in the intervening six years that the complicated and controversial issues of professionalism—defining it, teaching it, measuring it—continue to absorb and occupy our attention. Therefore, when the editors of Perspectives in Biology and Medicine invited me to serve as the guest editor for a special issue devoted to this topic, I was eager to ensure that the subject would be discussed from a variety of perspectives and across a spectrum of approaches.

I was challenged and inspired by two recent and valuable publications that addressed the topic of professionalism in medicine: Professonalism in Medicine: Critical Perspectives, edited byDelese Wear and Jule Aultman (2006), and a special issue of Academic Medicine published in November 2007. I wanted to ensure that the articles in this issue provided the useful examples and models that we found in the issue of Academic Medicine, and I also wanted to incorporate voices that had not traditionally been heard in this discussion—including those of residency program directors, as well as the approaches taken by other professional schools—and thereby provide an even more robust context through which individuals and institutions could engage in this dialogue. I was impressed by the high level of critical theorizing employed by the authors in Professionalism in Medicine, and I wanted this issue of Perspectives in Biology and Medicine to similarly challenge readers to consider professionalism from critical vantage points ranging from individual obligations to the context in which medical professionalism must be considered, and to link these critical perspectives to specific recommendations and suggestions.

The articles in this issue are organized in four main groups. The first group explores strategies, responses, and potential issues in educating our students and residents for professionalism. The second looks at professionalism in terms of the doctor-patient relationship. The third section considers how the social contract of medicine or medicine’s obligations to society have evolved. The issue ends with a consideration of how we might frame inquiries into professionalism in the future, in order to take into account the complexity and highly interactive nature of the factors affecting professionalism and further advance our discourse and dialogue on this important topic.

As dean for Medical Education at the University of Chicago Pritzker School of Medicine, I am engaged in institutional efforts to ensure that faculty, residents, and students both understand the core values of our profession and reflect those values in their behavior and daily interactions. Until now, the primary response to the perceived threat to the profession of medicine has been to focus on improving the way in which we educate students for professionalism. In fact, all of us who are involved in medical education are grappling with mandates from oversight organizations—including both the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education—that we educate our physicians to “learn the importance of demonstrating the attributes (attitudes, behavior, professional identity) of a professional and understand the balance of privileges and obligations that the public and the profession expect of a medical doctor” (LCME 2007, p. 24).

In the special issue of Academic Medicine on professionalism, Jordan Cohen (2007) wrote that...