Skip to main content
  • 1057 Accesses

Conclusions: Beyond Medical School

Beyond the challenges of professionalism education in medical school, ensuring the maintenance of competencies during a physician’s professional life presents even greater hurdles. Medical students are “captive” learners, and teachers regularly engage them in formal learning environments, but there are no traditional classrooms for practicing physicians, and there is no teacher who is watching over them. Questions about what should be the core elements of a lifelong curriculum for physicians are not fully answered. Who should and how to effectively assess that physicians continually possess the competencies to deliver quality patient care remain largely unresolved. Addressing these and other challenges is critical because physicians are students of medicine for life, but only medical students for a relatively brief period in their professional career.

Like all professions, medicine has long possessed special rights and privileges that are recognized by society. This cherished status is grounded in the expectation that professions will ensure that its practitioners are competent in carrying out its craft. As we approach the 100th anniversary of the Flexner report, the medical profession recognizes that the time has arrived to fundamentally examine how physicians acquire and maintain the knowledge, skills, behavior, and judgment essential to the delivery of ethical, science-based, and compassionate care, and to make the necessary changes to strengthen the three stages of the educational continuum—medical school, residency training and fellowship, and continuing physician professional development. A concerted effort to change the culture of medicine and transform the infrastructure to support and promote lifelong learning and constructive assessment must be undertaken, lest parties outside of medicine deem it appropriate for them to intervene. With such a profession-wide commitment to promote excellence in patient care through advances in physician learning, the medical profession will reaffirm its obligation to advocate for the sick and injured, and, in turn,strengthens the public’s trust in medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Accreditation Council for Graduate Medical Education (ACGME). (2001). Outcomes project. Retrieved July 8, 2005 from ACGME website: http://www.acgme.org

    Google Scholar 

  • American Medical Association Step Program. (2005). Unpublished qualitative data.

    Google Scholar 

  • Association of American Medical Colleges (AAMC). (2005). Medical school graduation questionnaire, 1978–2005. Retrieved July 27, 2005 from AAMC website: http://www.aamc.org/data/gq/

    Google Scholar 

  • Arnold, L. (2002). Assessing professional behavior: Yesterday, today, and tomorrow. Academic Medicine, 77, 502–515.

    Google Scholar 

  • Barrows, H.S. (1993). An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine, 68, 443–451.

    Article  Google Scholar 

  • Bessinger, C.D. (1988). Doctoring: The philosophic milieu. Southern Medical Journal, 81, 1558–1562.

    Google Scholar 

  • Bloom, S.W. (1998). Structure and ideology in medical education: An analysis of resistance to change. Journal of Health and Social Behavior, 29, 294–306.

    Article  Google Scholar 

  • Bonebakker, V. (2003). Literature and medicine: Humanities at the heart of health care. Academic Medicine, 78, 963–967.

    Article  Google Scholar 

  • Branch, W.T. (2001). Small group teaching emphasizing reflection can positively influence medical students’ values. Academic Medicine, 76, 1171–1172.

    Article  Google Scholar 

  • Branch, W.T., Kern, D., Haidet, P., Weissman, P., Gracey, C.F., Mitchell, G., et al. (2001). Teaching the human dimensions of care in clinical settings. Journal of the American Medical Association, 286, 1067–1074.

    Article  Google Scholar 

  • Buxbaum, R.C. (1966). Toward human values in medical practice. Journal of Medical Education, 41, 516–520.

    Google Scholar 

  • Carney, P.A., Nierenberg, D.W., Pipas, C.F., Brooks, W.B., Stukel, T.A., Keller, A.M. (2004). Educational epidemiology: Applying population-based design and analytic approaches to study medical education. Journal of the American Medical Association, 292, 1044–1050.

    Article  Google Scholar 

  • Charon, R. (2000). Literature and medicine: Origins and destinies. Academic Medicine, 75, 23–27.

    Article  Google Scholar 

  • Coulehan, J., & William, P.C. (2001). Vanquishing virtue: The impact of medical education. Academic Medicine, 76, 5998–605.

    Google Scholar 

  • Crain, W.C. (1985). Theories of development. Englewood Cliffs, NJ: Prentice-Hall.

    Google Scholar 

  • Cruess, S.R., Johnston, S., & Cruess, R.L. (2004). Profession: A working definition for medical educators. Teaching and Learning in Medicine, 16, 74–76.

    Article  Google Scholar 

  • Davidoff, R., Haynes, R.B., Sackett, D.L., & Smith, R. (1995). Evidence based medicine: A new journal to help doctors identify the information that they need. BMJ, 310, 1085–1086.

    Google Scholar 

  • Davis, E., O’Brien, M.A., Freemantle, N., Wolf, F.M., Mazmanian, P., & Taylor-Vaisey, A. (1999). Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing educational activities change physician behavior or health outcomes? Journal of the American Medical Association, 282, 867–874.

    Article  Google Scholar 

  • Eggly, S., Brenna, S., & Wiese-Rometsch, W. (2005). “Once when I was on call...”: Theory versus reality in training for professionalism. Academic Medicine, 80, 371–375.

    Article  Google Scholar 

  • Epstein, R.M. (1999). Mindful practice. The Journal of the American Medical Association, 282(9), 833–839.

    Article  Google Scholar 

  • Epstein, R.M., & Hundert, E.M. (2002). Defining and assessing professional competence. JAMA, 287, 226–235.

    Article  Google Scholar 

  • Flexner, A. (1910). Medical education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching.

    Google Scholar 

  • Frankford, D.M., Patterson, M.A., & Konrad, T.R. (2000). Transforming the practice organizations to foster lifelong learning and commitment to medical professionalism. Acadaemic Medicine, 2000, 708–717.

    Google Scholar 

  • Friedson, E. (1994). Professionalism reborn. Chicago: University of Chicago Press.

    Google Scholar 

  • Gardiner, P. (2003). A virtue ethics approach to moral dilemmas in medicine. Journal of Medical Ethics, 29, 297–302.

    Article  Google Scholar 

  • Gracey, C.F., Haidet, P., Branch, W.T., Weissmann, P., Kern, D.E., Mitchell, G., et al. (2005). Precepting humanism: Strategies for fostering the human dimensions of care in ambulatory settings. Academic Medicine, 80, 21–28.

    Article  Google Scholar 

  • Hafferty, F., & Franks, R. (1991) The hidden curriculum, ethics teaching and the structure of medical education. Academic Medicine, 69, 861–871.

    Google Scholar 

  • Hundert, E.M. (1996). Characteristics of the informal curriculum and trainees’ ethical choices. Academic Medicine, 71, 624–633.

    Article  Google Scholar 

  • Hunter, K.M., Charon, R., & Coulehan, J.L. (1995). The study of literature in medical education. Academic Medicine, 70, 787–794.

    Article  Google Scholar 

  • Jones, T., & Verghese, A. (2003). On becoming a humanities curriculum: The Center for Medical Humanities and Ethics at the University of Texas Health Science Center at San Antonio. Academic Medicine, 78, 1010–1014.

    Article  Google Scholar 

  • Kenny, N.P., Mann, K.V., & MacLeod, H. (2003). Role modeling in physicians’ professional formation: Reconsidering an essential but untapped educational strategy. Academic Medicine, 78, 1203–1210.

    Article  Google Scholar 

  • Knowles, M. (1996). Andradgogy: An emerging technology for adult learning. In R. Edwards, A. Hanson, & P. Raggatt (Eds.), Boundaries of adult learning (pp. 82–98). New York: Routledge.

    Google Scholar 

  • Larson, M. (1977). The rise of professionalism: A sociological analysis. Berkeley: University of California Press.

    Google Scholar 

  • Lave, J., & Wegner, E. (1991). Situated learning: Legitmate peripheral participation. Cambridge: Cambridge University Press.

    Google Scholar 

  • Lewis, S. (1925). Arrowsmith. New York: Harcourt, Brace.

    Google Scholar 

  • Lieb, S. (2001). Principles of adult learning. Retrieved April 15, 2005 from the University of Hawaii website: http://www.hcc.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm

    Google Scholar 

  • Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C, et al. (2001). Preferences of patients for patient centered approach to consultation in primary Care: Observational study. BMJ, 322, 468–472.

    Article  Google Scholar 

  • Miles, S., Weiss Lane, L. Bickel, J., Walker, R., & Cassel, C. (1989). Medical ethics education: Coming of age. Academic Medicine, 64, 705–714.

    Article  Google Scholar 

  • Misch, D.A. (2002). Evaluating physicians’ professionalism and humanism: The case for humanism “connoisseurs.” Academic Medicine, 77, 489–495.

    Article  Google Scholar 

  • Murray, T.J. (1998, June). Why the medical humanities? The Dalhousie Medical Journal. Retrieved April 26, 2005 from the website: http://medjournal.medicine.dal.ca/DMJONLIN/spring98/human2.htm

    Google Scholar 

  • Niemi, R.G., & Phillips, J.E. (1980). On nonscience premedical education: Surprising evidence and a call for clarification. Academic Medicine, 55, 194–200.

    Article  Google Scholar 

  • Parsons, T. (1939). The professions and social structure. Social Forces, 17, 457–467.

    Article  Google Scholar 

  • Pellegrino, E. (1974). Educating the humanist physician: An ancient ideal reconsidered. Journal of the American Medical Association, 227, 1288–1294.

    Article  Google Scholar 

  • Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. New York: Norton.

    Google Scholar 

  • Roche, W.P., Scheetz, A.P., Dane, F.C., Parish, D.C., & O’Shea, J.T. (2003). Medical Students’ attitudes in a PBL curriculum: Trust, altruism, and cynicism. Academic Medicine, 78, 398–402.

    Article  Google Scholar 

  • Rodenhauser, P., Strickland, M.A., Gambala, C.T. (2004). Arts-related activities across U.S. medical schools: A follow-up study. Teaching and Learning in Medicine,_16(3), 233–239.

    Article  Google Scholar 

  • Schoen, D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey-Bass.

    Google Scholar 

  • Shapiro, J., & Rucker, L. (2003). Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine. Academic Medicine, 78, 953–957.

    Article  Google Scholar 

  • Shapiro, J., Morrison, E.H., & Boker, J.R. (2004). Teaching empathy to first year medical students: Evaluation of an elective literature and medicine course. Education for Health, 17(1), 73–84.

    Article  Google Scholar 

  • Starr, P. (1982). The transformation of American Medicine. New York: Basic Books.

    Google Scholar 

  • Wear, D., & Kuczewski, M.F. (2004). The professionalism movement: Can we pause? American Journal of Bioethics, 4(2), 1–10.

    Article  Google Scholar 

  • Wilensky, H.L. (1964). The professionalization of everybody? American Journal of Sociology, 70, 137–158.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Kao, A., Reenan, J. (2006). Wit is not Enough. In: Wear, D., Aultman, J.M. (eds) Professionalism in Medicine. Springer, Boston, MA. https://doi.org/10.1007/0-387-32727-4_12

Download citation

Publish with us

Policies and ethics