Advances in Health Sciences Education

, Volume 18, Issue 3, pp 463–484 | Cite as

The utility of vignettes to stimulate reflection on professionalism: theory and practice

  • E. C. BernabeoEmail author
  • E. S. Holmboe
  • K. Ross
  • B. Chesluk
  • S. Ginsburg


Professionalism remains a substantive theme in medical literature. There is an emerging emphasis on sociological and complex adaptive systems perspectives that refocuses attention from just the individual role to working within one’s system to enact professionalism in practice. Reflecting on responses to professional dilemmas may be one method to help practicing physicians identify both internal and external factors contributing to (un) professional behavior. We present a rationale and theoretical framework that supports and guides a reflective approach to the self assessment of professionalism. Guided by principles grounded in this theoretical framework, we developed and piloted a set of vignettes on professionally challenging situations, designed to stimulate reflection in practicing physicians. Findings show that participants found the vignettes to be authentic and typical, and reported the group experience as facilitative around discussions of professional ambiguity. Providing an opportunity for physicians to reflect on professional behavior in an open and safe forum may be a practical way to guide physicians to assess themselves on professional behavior and engage with the complexities of their work. The finding that the focus groups led to reflection at a group level suggests that effective reflection on professional behavior may require a socially interactive process. Emphasizing both the behaviors and the internal and external context in which they occur can thus be viewed as critically important for understanding professionalism in practicing physicians.


Professionalism Qualitative research Reflection Self assessment 



We gratefully acknowledge Frederic Hafferty, Ph.D. for his incredibly thoughtful review of the manuscript. We also acknowledge Siddharta Reddy, MPH for participating in the conceptualization of the project and review of manuscript, and Robin Guille, Ph.D for helping us think through important aspects of the design. We also wish to thank the participants for opening up so candidly, without them this kind of exploratory work would not be possible. This project was funded by the American Board of Internal Medicine Foundation.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • E. C. Bernabeo
    • 1
    • 2
    Email author
  • E. S. Holmboe
    • 1
  • K. Ross
    • 1
  • B. Chesluk
    • 1
  • S. Ginsburg
    • 3
  1. 1.American Board of Internal MedicinePhiladelphiaUSA
  2. 2.Graduate School of Social Work and Social ResearchBryn MawrUSA
  3. 3.Wilson Centre for Research in EducationUniversity of TorontoTorontoCanada

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