Professionalism for a new era: The challenge for medical education

In a changing world, the AMA has joined with medical schools to teach what it means to be a doctor.

Editorial. Oct. 20, 2003.

Professionalism is defined by Webster's dictionary as "the concept, aims or qualities that characterize or mark a profession or a professional person."

It's a fairly nebulous definition. Rightly so, it leaves further refinement up to a profession itself and allows for fine-tuning as progress -- and the complexities that often accompany it -- make their presence felt. But nebulousness can be a curse as well, most notably when the profession's definition becomes increasingly open to debate and outside forces threaten to intervene.

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It is in this state that medical professionalism now lies. Modes of practice are changing. It's not really all that surprising that individuals practicing medicine under vastly different circumstances may hold vastly different views on the "concepts, aims or qualities" that mark their profession as a whole.

Precisely because medicine is under siege, that lack of consensus within the physician community is especially alarming. If the profession doesn't get a better grip on its own sense of professionalism, it will be one more area vulnerable to attack.

Recognizing that, the American Medical Association created Strategies for Teaching and Evaluating Professionalism, or STEP. The association has partnered with 10 medical schools with the goal of developing innovative, effective methods for teaching professionalism to future generations of physicians.

Nearly one-third of the medical schools in the United States and Canada were interested in partnering with the AMA in this program -- a sure indication of the importance of the issue to the profession.

The Association -- as the largest professional organization of physicians -- is the organization best suited to lead this two-year effort. The AMA has underscored its commitment by providing $15,000 in seed money to each of its medical school partners to get their individual case studies under way.

In putting the plan for STEP together, the AMA recognized the challenge to medicine in crafting a definition of medical professionalism for a new era. It also seized an opportunity to use its expertise to assist medical educators -- much as it did nearly a century ago when it led the call for the reform of medical education

Not only are the economics of medicine daunting, even the rise of biomedical science has stolen a bit of professionalism's thunder. Science and technology have so changed medicine that the physician is threatened with becoming simply viewed as an intermediary for the delivery of tremendous medical therapies, rather than a partner in a therapeutic relationship.

Individual patients, and society as a whole, have a profound stake in keeping the doctor a physician and not just merely a talented technician in the service of a health plan. In re-examining the role of professionalism at such a crucial juncture in medicine, the topics the AMA and its partners will explore include: providing end-of-life care, the rationing of expensive medical technologies, addressing potential financial conflicts of interest and disclosing medical errors.

Another challenge they will confront: measuring their success. The project runs until the end of May 2005. But the AMA is hoping to form a consortium that will follow students who have participated in STEP into residency and beyond to get a true feel for whether they are able to implement what they've learned. The schools began implementing their proposals at the start of the 2003-04 school year. They run the gamut from having students keep log books of exemplary and negative models of professional behavior they observe in the health care team to testing whether students have the requisite knowledge to practice professionalism.

Outcomes measurement is key to the success of STEP. Programs with a successful track record provide a model to be cloned at other medical schools, giving professionalism a foot in the door among the next generation of physicians, just as the program intends.

The AMA and its partners have taken up an important cause with enthusiasm. Professionalism and scientific advancement have been what has carried medicine to the best of where it is today. While it is certain that science will continue to move forward, only a concerted effort will ensure that professionalism keeps pace.