Professional formation: Extending medicine's lineage of service into the next century
Rabow M.W.; Remen R.N.; Parmelee D.X.; Inui T.S.
2010
Academic Medicine
89
10.1097/ACM.0b013e3181c887f7
In his 1910 report on medical education, Flexner emphasized the importance of competency in basic sciences. Less widely recognized is that he also emphasized the necessity of liberal education. On the Flexner Report's 100th anniversary, medicine is challenged to realize Flexner's full vision for medical education to ensure that physicians are prepared to lead lives of compassion and service as well as to perform with technical proficiency. To meet the complex medical and social challenges of the next century, medical educators must continue to promote cognitive expertise while concurrently supporting "professional formation"-the moral and professional development of students, their ability to stay true to their personal service values and the core values of the profession, and the integration of their individual maturation with growth in clinical competency. The goal of professional formation is to anchor students to foundational principles while helping them navigate the inevitable moral conflicts in medical practice. The consequences of inadequate support for professional formation are profound, impacting individual learners, patients, the profession, and society at large.Among the many successful professional formation projects nationally, two long-standing programs are described in modest detail to identify common elements that might guide future developments elsewhere. Key elements include experiential and reflective processes, use of personal narratives, integration of self and expertise, and candid discussion within a safe community of learners. Committing to professional formation within medical education will require transformation of formal and informal curricula and will necessitate a rebalancing of attention and financial support within schools of medicine. Copyright © by the Association of American Medicel Collage.
Flexner A., Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, (1910); Odegaard C.E., Inui T.S., A 1992 manifesto for primary physicians, Pharos Alpha Omega Alpha Honor Med Soc, 55, pp. 2-6, (1992); Cooke M., Irby D.M., Sullivan W., Ludmerer K.M., American medical education 100 years after the Flexner report, N Engl J Med., 355, pp. 1339-1344, (2006); Leach D.C., Professionalism: The formation of physicians, Am J Bioeth, 4, pp. 11-12, (2004); Wear D., Kuczewski M.G., The professionalism movement: Can we pause?, Am J Bioeth, 4, pp. 1-10, (2004); Hamstra S.J., Woodrow S.I., Mangrulkar R.S., Feeling pressure to stay late: Socialisation and professional identity formation in graduate medical education, Med Educ, 42, pp. 7-9, (2008); Haidet P., Hatem D.S., Fecile M.L., Et al., The role of relationships in the professional formation of physicians: Case report and illustration of an elicitation technique, Patient Educ Couns, 72, pp. 382-387, (2008); Coulehan J., Williams P.C., Vanquishing virtue: The impact of medical education, Acad Med, 76, pp. 598-605, (2001); Stern D.T., Practicing what we preach? An analysis of the curriculum of values in medical education, Am J Med, 104, pp. 569-575, (1998); Inui T.S., Cottingham A.H., Frankel R.M., Litzelman D.K., Suchman A.L., Williamson P.R., Supporting teaching and learning of professionalism-Changing the educational environment and students' "navigational skills, Teaching Medical Professionalism, pp. 108-123, (2009); Hafferty F.W., Franks R., The hidden curriculum, ethics teaching, and the structure of medical education, Acad Med, 69, pp. 861-871, (1994); Inui T.S., Flag in the Wind: Educating for Professionalism in Medicine, (2003); Swick H.M., Toward a normative definition of medical professionalism, Acad Med, 75, pp. 612-616, (2000); Spiro H., What is empathy and can it be taught?, Ann Intern Med, 116, pp. 843-846, (1992); Baldwin D.C., Daugherty S.R., Rowley B.D., Unethical and unprofessional conduct observed by residents during their first year of training, Acad Med, 73, pp. 1195-1200, (1998); Ginsburg S., Regehr G., Stern D., Lingard L., To be and not to be: The paradox of the emerging professional stance, Med Educ, 4, pp. 350-357, (2003); Hafferty F.W., Professionalism-The next wave, N Engl J Med., 355, pp. 2151-2152, (2006); Palmer P.J., A Hidden Wholeness: The Journey Toward An Undivided Life, (2004); Litzelman D.K., Williamson P.R., Suchman A.L., Et al., Fostering faculty well-being through personal, community and cultural formation at an academic medicine center: Indiana University School of Medicine as a case study, Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success, pp. 183-204, (2009); Testerman J.K., Morton K.R., Loo L.K., Worthley J.S., Lamberton H.H., The natural history of cynicism in physicians, Acad Med, 71, 10 SUPPL., (1996); Haglund M.E., Aanhet Rot M., Cooper N.S., Et al., Resilience in the third year of medical school: A prospective study of the associations between stressful events occurring during clinical rotations and student well-being, Acad Med, 84, pp. 258-268, (2009); Rabow M., Gargani J., Cooke M., Do as i say: Curricular discordance in medical school end-of-life care education, J Palliat Med, 10, pp. 759-769, (2007); Newton B.W., Barber L., Clardy J., Cleveland E., O'Sullivan P., Is there hardening of the heart during medical school?, Acad Med, 83, pp. 244-249, (2008); Hojat M., Vergare M.J., Maxwell K., Et al., The devil is in the third year: A longitudinal study of erosion of empathy in medical school, Acad Med, 84, pp. 1182-1191, (2009); Solomon M.Z., O'Donnell L., Jennings B., Et al., Decisions near the end of life: Professional views on life-sustaining treatments, Am J Public Health, 83, pp. 14-23, (1993); Branch W.T., Supporting the moral development of medical students, J Gen Intern Med, 15, pp. 503-508, (2000); Feudtner C., Christakis D.A., Christakis N.A., Do clinical clerks suffer ethical erosion? Students' perceptions of the ethical environment and personal development, Acad Med, 69, pp. 670-679, (1994); Papadakis M.A., Teherani A., Banach M.A., Et al., Disciplinary action by medical boards and prior behavior in medical school, N Engl J Med., 353, pp. 2673-2682, (2005); Novack D.H., Suchman A.L., Clark W., Epstein R.M., Najberg E., Kaplan C., Calibrating the physician: Personal awareness and effective patient care, Journal of the American Medical Association, 278, 6, pp. 502-509, (1997); Shanafelt T.D., Bradley K.A., Wipf J.E., Back A.L., Burnout and self-reported patient care in an internal medicine residency program, Ann Intern Med, 136, pp. 358-367, (2002); Borrell-Carrio F., Epstein R.M., Preventing errors in clinical practice: A call for selfawareness, Ann Fam Med, 2, pp. 310-316, (2004); Sullivan W., Work and Integrity: The Crisis and Promise of Professionalism in America, (2005); Accreditation Standards; Stern D.T., Papadakis M., The developing physician-Becoming a professional, N Engl J Med., 355, pp. 1794-1799, (2006); Charon R., The patient-physician relationship. Narrative medicine: A model for empathy, reflection, profession, and trust, JAMA, 286, pp. 1897-1902, (2001); Center for Mindfulness in Medicine, Health Care, and Society Web Site; Gold Humanism Honor Society; Burack J.H., Irby D.M., Carline J.D., Root R.K., Larson E.B., Teaching compassion and respect. Attending physicians' responses to problematic behaviors, J Gen Intern Med, 14, pp. 49-55, (1999); Maheux B., Beaudoin C., Berkson L., Cote L., Des Marchais J., Jean P., Medical faculty as humanistic physicians and teachers: The perceptions of students at innovative and traditional medical schools, Med Educ, 34, pp. 630-634, (2000); Branch Jr. W.T., Frankel R., Gracey C.F., Et al., A good clinician and a caring person: Longitudinal faculty development and the enhancement of the human dimensions of care, Acad Med, 84, pp. 117-125, (2009); Steinert Y., Cruess R.L., Cruess S.R., Boudreau J.D., Fuks A., Faculty development as an instrument of change: A case study on teaching professionalism, Acad Med, 82, pp. 1057-1064, (2007); Remen R.N., O'Donnell J.F., Rabow M.W., The healer's art: Education in meaning and service, J Cancer Educ, 23, pp. 65-67, (2008); Remen R.N., Rabow M.W., The healer's art: Professionalism, service and mission, Med Educ, 39, pp. 1167-1168, (2005); Rabow M.W., Wrubel J., Remen R.N., Authentic community as an educational strategy for advancing professionalism: A national evaluation of the healer's art course, J Gen Intern Med, 22, pp. 1422-1428, (2007); Rabow M.W., Wrubel J., Remen R.N., The promise of professionalism: Mission statements among a national cohort of medical students, Ann Fam Med, 7, pp. 336-342, (2009); Cottingham A.H., Suchman A.L., Litzelman D.K., Et al., Enhancing the informal curriculum of a medical school: A case study in organizational culture change, J Gen Intern Med, 23, pp. 715-722, (2008); Suchman A.L., Williamson P.R., Litzelman D.K., Frankel R.M., Mossbarger D.L., Inui T., Toward an informal curriculum that teaches professionalism: Transforming the social environment of a medical school, J Gen Intern Med, 19, pp. 501-504, (2004); Karnieli-Miller O., Vu T.R., Holtman M.C., Clyman S.G., Inui T.S., Medical students' professionalism narratives: A window on the informal and hidden curriculum, Acad Med; Brater C., Infusing professionalism into a school of medicine: Perspectives from the dean, Acad Med, 82, pp. 1094-1097, (2007); Gracey C.F., Haidet P., Branch W.T., Et al., Precepting humanism: Strategies for fostering the human dimensions of care in ambulatory settings, Acad Med, 80, pp. 21-28, (2005); Stern D.T., Cohen J.J., Bruder A., Packer B., Sole A., Teaching humanism, Perspect Biol Med, 51, pp. 495-507, (2008); Fins J.J., Gentilesco B.J., Carver A., Et al., Reflective practice and palliative care education: A clerkship responds to the informal and hidden curricula, Acad Med, 78, pp. 307-312, (2003); Branch Jr. W.T., Use of critical incident reports in medical education. A perspective, J Gen Intern Med, 20, pp. 1063-1067, (2005); Epstein R.M., Mindful practice, JAMA, 282, pp. 833-839, (1999); Farnan J.M., Paro J.A., Higa J., Edelson J., Arora V.M., The YouTube generation: Implications for medical professionalism, Perspect Biol Med, 51, pp. 517-524, (2008); Chretien K., Goldman E., Faselis C., The reflective writing class blog: Using technology to promote reflection and professional development, J Gen Intern Med, 23, pp. 2066-2070, (2008); Morris K., Turell M.B., Ahmed S., Et al., The 2003 anatomy ceremony: A service of gratitude, Yale J Biol Med., 75, pp. 323-329, (2002); Branch Jr. W.T., Kern D., Haidet P., Et al., The patient-physician relationship. Teaching the human dimensions of care in clinical settings, JAMA, 286, pp. 1067-1074, (2001); Assessment of Professional Behaviors; Walrath J.M., Muganlinskaya N., Shepherd M., Et al., Interdisciplinary medical, nursing, and administrator education in practice: The Johns Hopkins experience, Acad Med, 81, pp. 744-748, (2006); Mc Gee J.B., Begg M., What medical educators need to know about "web 2.0, Med Teach, 30, pp. 164-169, (2008); Jain S.H., Practicing medicine in the age of Facebook, N Engl J Med., 361, pp. 469-1451, (2009); Hafferty F.W., Beyond curriculum reform: Confronting medicine's hidden curriculum, Acad Med, 73, pp. 403-407, (1998); Hafferty F.W., Levinson D., Moving beyond nostalgia and motives: Towards a complexity science view of medical professionalism, Perspect Biol Med, 51, pp. 599-615, (2008); Cruess R.L., Cruess S.R., Teaching medicine as a profession in the service of healing, Acad Med, 72, pp. 941-952, (1997); Palmer P.J., The Heart of A Teacher: Identity and Integrity in Teaching
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