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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
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
American Medical Association Step Program. (2005). Unpublished qualitative data.
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/
Arnold, L. (2002). Assessing professional behavior: Yesterday, today, and tomorrow. Academic Medicine, 77, 502–515.
Barrows, H.S. (1993). An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine, 68, 443–451.
Bessinger, C.D. (1988). Doctoring: The philosophic milieu. Southern Medical Journal, 81, 1558–1562.
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.
Bonebakker, V. (2003). Literature and medicine: Humanities at the heart of health care. Academic Medicine, 78, 963–967.
Branch, W.T. (2001). Small group teaching emphasizing reflection can positively influence medical students’ values. Academic Medicine, 76, 1171–1172.
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.
Buxbaum, R.C. (1966). Toward human values in medical practice. Journal of Medical Education, 41, 516–520.
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.
Charon, R. (2000). Literature and medicine: Origins and destinies. Academic Medicine, 75, 23–27.
Coulehan, J., & William, P.C. (2001). Vanquishing virtue: The impact of medical education. Academic Medicine, 76, 5998–605.
Crain, W.C. (1985). Theories of development. Englewood Cliffs, NJ: Prentice-Hall.
Cruess, S.R., Johnston, S., & Cruess, R.L. (2004). Profession: A working definition for medical educators. Teaching and Learning in Medicine, 16, 74–76.
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.
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.
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.
Epstein, R.M. (1999). Mindful practice. The Journal of the American Medical Association, 282(9), 833–839.
Epstein, R.M., & Hundert, E.M. (2002). Defining and assessing professional competence. JAMA, 287, 226–235.
Flexner, A. (1910). Medical education in the United States and Canada. New York: Carnegie Foundation for the Advancement of Teaching.
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.
Friedson, E. (1994). Professionalism reborn. Chicago: University of Chicago Press.
Gardiner, P. (2003). A virtue ethics approach to moral dilemmas in medicine. Journal of Medical Ethics, 29, 297–302.
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.
Hafferty, F., & Franks, R. (1991) The hidden curriculum, ethics teaching and the structure of medical education. Academic Medicine, 69, 861–871.
Hundert, E.M. (1996). Characteristics of the informal curriculum and trainees’ ethical choices. Academic Medicine, 71, 624–633.
Hunter, K.M., Charon, R., & Coulehan, J.L. (1995). The study of literature in medical education. Academic Medicine, 70, 787–794.
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.
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.
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.
Larson, M. (1977). The rise of professionalism: A sociological analysis. Berkeley: University of California Press.
Lave, J., & Wegner, E. (1991). Situated learning: Legitmate peripheral participation. Cambridge: Cambridge University Press.
Lewis, S. (1925). Arrowsmith. New York: Harcourt, Brace.
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
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.
Miles, S., Weiss Lane, L. Bickel, J., Walker, R., & Cassel, C. (1989). Medical ethics education: Coming of age. Academic Medicine, 64, 705–714.
Misch, D.A. (2002). Evaluating physicians’ professionalism and humanism: The case for humanism “connoisseurs.” Academic Medicine, 77, 489–495.
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
Niemi, R.G., & Phillips, J.E. (1980). On nonscience premedical education: Surprising evidence and a call for clarification. Academic Medicine, 55, 194–200.
Parsons, T. (1939). The professions and social structure. Social Forces, 17, 457–467.
Pellegrino, E. (1974). Educating the humanist physician: An ancient ideal reconsidered. Journal of the American Medical Association, 227, 1288–1294.
Porter, R. (1997). The greatest benefit to mankind: A medical history of humanity. New York: Norton.
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.
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.
Schoen, D. (1987). Educating the reflective practitioner. San Francisco, CA: Jossey-Bass.
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.
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.
Starr, P. (1982). The transformation of American Medicine. New York: Basic Books.
Wear, D., & Kuczewski, M.F. (2004). The professionalism movement: Can we pause? American Journal of Bioethics, 4(2), 1–10.
Wilensky, H.L. (1964). The professionalization of everybody? American Journal of Sociology, 70, 137–158.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights 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
DOI: https://doi.org/10.1007/0-387-32727-4_12
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-32726-6
Online ISBN: 978-0-387-32727-3
eBook Packages: Humanities, Social Sciences and LawEducation (R0)