Two recent articles on professionalism

This post courtesy of Anne Taylor-Vaisey:

Hilton SR, Slotnick HB. Proto-professionalism: how professionalisation occurs across the continuum of medical education. Med Educ 2005; 39(1):58-65.


Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training.

Thesis and Discussion:

We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis! , or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement.


Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.

What this paper adds:

A concise definition of medical professionalism is offered that incorporates attributes within 6 domains identified from across the literature on the subject. We propose the term 'proto-professionalism' to define the state in which the participant spends the lengthy period of medical education and training when professionalism is acquired. I! t is a product of both attainment and attrition that results from the educational and work environments. There are cognitive, psychosocial and epistemological aspects of proto-professionalism.


Van De Camp K, Vernooij-Dassen.M.J.F.J., Grol RP, Bottema BJ. How to conceptualize professionalism: a qualitative study. Med Teach 2004; 26(8):696-702.

Abstract: The aim of this study was to clarify which themes and elements constitute professionalism in medicine.

Three consecutive steps were taken:

(a) a systema! tic search of the literature to identify constituent elements of professionalism mentioned in definitions and descriptions of the concept;

(b) analysis of these elements using the constant comparison technique to reveal possible themes covering these elements; and

(c) validating the results using an expert panel.

A total of 90 separate elements of professionalism were identified in the 57 articles included in our study.

Three themes within professionalism were uncovered:

(1) interpersonal professionalism;

(2) public professionalism; and

(3) intrapersonal professionalism.

These themes were considered accurate by the expert panel which supports the validity of the results. Our findings show that the concept of professionalism is multidimensional and should be conceptualized as such.

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