Justice, Courage, and Truthfulness: Virtues That Medical Trainees Can and Must Learn.

BACKGROUND Medical educators and powerful physician organizations agree on the importance of professionalism for the formation of good physicians. However, the many definitions of professionalism found in the literature lack content and differ significantly, undermining attempts to describe and implement professionalism curricula. The work of the contemporary moral philosopher Alasdair MacIntyre on the virtues may help provide some of the content that the concept of professionalism currently lacks. MacIntyre shows the importance of the virtues, particularly justice, courage, and truthfulness, for the success of any "practice," defined as a form of cooperative human activity. Medicine fits his definition of a practice, and accordingly, medical trainees require these virtues, among others, to succeed. This analysis may provide a foundation for a new form of ethical instruction, in which excellent clinician-educators model the virtues for students and residents, thereby combating the "hidden curriculum" that sometimes corrodes these values. This educational model resembles the way in which masters of other practices, such as music, teach their students and help them become lifelong learners. Such an approach requires leaders at academic medical centers to commit to the establishment of communities in which the virtues flourish. Instruction in the virtues could supplement the emphasis on principles and rule following that predominates in medical education. It would also allow physicians and students to engage with the various cultural and religious traditions in which virtue ethics has flourished, enriching the diversity of medical ethics education and promoting trainees' professional development.