PROFESSIONALISM: THE “AGAIN, AGAIN, AGAIN” MINDSET

In this era of "binge-watching" series, it would be rare to have not come across one of the medicine-based series like Grey's Anatomy, House MD or Scrubs, etc.  Undoubtedly, the picture they paint of the profession is very alluring. Some of us might have aspired to be like one of the characters from the series. However, on scrutinizing the same narratives, we would see the questionable nature of their conduct as medical professionals.

According to the Merriam-Webster Dictionary, professionalism means the “conduct, aims, or qualities that characterize or mark a profession or a professional person.” Let us take a deep dive and dissect the word to see what it entails. The term can be divided into three parts: first, "profess" which means to declare or admit openly. The second part of the word "ion" denotes the action of the individual or conditions the individual is experiencing. The last part of the word "ism" indicates principles and/or doctrine that are adhered to. It signifies that individuals within a particular profession are willing to profess their belief in the principles/doctrine, explicitly or implicitly associated with the social category of those who practice similar skills. Despite carefully deconstructing the definition, professionalism and what it entails can be a subjective matter.

At Glocal Academy, we collected different views on what professionalism meant to people within our community, through an activity on Instagram1. Empathy, responsibility, commitment, clinical knowledge, technical expertise and effective communication were some of the virtues that were found to be at the heart of most of the definitions provided. Skills like equanimity, despite all odds and appropriate body language, while engaging in any conversation with the patient or a colleague were imperative. The beautiful sentiment of being a source of motivation and inspiration to create a positive working environment for everyone was also impeccably highlighted. Most importantly, everyone used the phrase "again, again, again" in their definitions because they recognize that these qualities and skills aren't situation specific but are to be put into use consistently.

As we grow, we register various experiences, which help us develop a very subjective concept of what it means to be a good doctor. With time, as students, we devote all our efforts into being ‘right’, to the point that it becomes the sole aspect of our professional identity. It is one of the reasons we see a rise of "expert professionalism" and a parallel decline in the older sense of "social-trustee professionalism," as observed by Steven Brint 2. He also argues that "without a strong sense of the public and social purposes served by professional knowledge, professionals tend to lose their distinctive voice in public debate."1 In many ways, that is the position in which the profession of medicine now finds itself. Thus, strengthening medical professionalism becomes one way to restore medicine's distinctive voice.

In the literature, there are two approaches to teaching professionalism; to teach it explicitly as a series of traits (Swick, 2000) or as a moral endeavor, stressing reflection and experiential learning (Coulehan, 2005; Huddle, 2005). Neither alone is enough. Teaching it by providing a definition and listing a series of traits gives students only theoretical knowledge of the subject. Relying solely on role modeling and experiential learning is selective, often disorganized, and represents what was done in the past. Both approaches must be combined so that students both understand the nature of professionalism and internalize the values (Ludmerer, 1999).

Various esteemed organizations have provided their own set of responsibilities and principles that medical personnel must imbibe. The Accreditation Council for Graduate Medical Education (ACGME) has described six core clinical competencies required for a physician to be competent to practice medicine independently and without supervision: -patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, system-based practice. Dr Herbet M. Swick, through his extensive research on medical professionalism, suggests that it comprises the following set of behaviors: -

• Physicians subordinate their interests to the interests of others.

• Physicians adhere to high ethical and moral standards.

• Physicians respond to societal needs, and their behaviors reflect a social contract with the communities served.

• Physicians evince core humanistic values, including honesty and integrity, caring and compassion, altruism and empathy, respect for others, and trustworthiness.

• Physicians exercise accountability for themselves and their colleagues.

• Physicians demonstrate a continuing commitment to excellence.

• Physicians exhibit a commitment to scholarship and to advancing their field.

• Physicians deal with high levels of complexity and uncertainty.

• Physicians reflect upon their actions and decisions.3

In India, there is no consensus on what is meant by medical professionalism or how it should be integrated into the curriculum. The assessment of professionalism is an even more contentious territory as it is such an intangible entity. The undergraduate curriculum focuses mainly on theoretical knowledge and brushes through ethics. Communication skills are learned merely by observing senior doctors. It gives rise to lot of internal conflicts and increases the chances of inculcating wrong behavioral patterns. This issue has been addressed in various meetings and conferences. Dr Tejinder Singh has discussed it  at a deliberation on professionalism held at Karamsad in April 2013, where these aspects were discussed in depth.4 Also, a workshop and meeting of the Indian physicians from all over the world (Global Indian Doctors) were held in Kolkata in January 2014 to address the worrisome decline in professionalism and ethics. They noted the critical role of education and mentorship in inculcating right values from the start of medical training.5

Professionalism is integral to the medical profession, and it should be an explicit part of the medical curriculum. There is a pressing need to encourage and highlight discussions for the same, eventually achieving a degree of consensus enough to enable the medical community to strengthen professionalism in medical education and medical practice.

 At Glocal Academy, we have embarked on a journey to bring the intricate subtleties of the healthcare system to the forefront. We aspire to engage young minds by having open discussions in a safe shared space (Instagram) about challenging subjects like professionalism, responsibility, integrity, etc. Our goal is to help students gain a more in-depth insight into these subjects so that they can learn vital skills like clinical communication, attentive listening, etc. which are repressed under the weight of the current medical curriculum. We encourage everyone to take up this moral endeavor and stress on reflection and experiential learning because medicine and society are both changing at a fast pace. Furthermore, as they are changing, the discourses associated with it must evolve.

References:

1. https://www.instagram.com/glocalacademyuk/

2. Brint S. In an Age of Experts: The Changing Role of Professionals in Politics and Public Life. Princeton, NJ: Princeton University Press,1994

3. Swick H.: Towards a Normative Definition of Medical Professionalism. Acad. Med. 2000; 75:612–616

4. Teaching and Assessing Professionalism in the Indian Context. Indian Pediatric 2014;51: 713-717

5. Madhok R. The Global Indian Doctor: Workshop on Promoting Professionalism and Ethics - Brief Notes and Next Steps. 2014 Jan 10; Kolkata, India. Available from: http://leadershipforhealth.com/wp-content/uploads/2014/02/Event-report.pdf

Author:

Name:- Rajvee R. Rao

Year of study :- 3rd year

Name of college :- P.D.U Medical college,Rajkot