Professionalism in medicine: definitions and considerations for teaching.

P hysicians and medical educators are expected by a multitude of constituencies to consistently demonstrate professional behavior. Epstein and Hundert’s definition of professionalism is a very useful one. This definition is an entry to considering what professionalism is and demonstrates the lofty goals of professionalism. In this article, I review other definitions of professionalism, consider specific behaviors that demonstrate the values of professionalism, and focus on aspects of teaching professionalism to medical students and residents. At the root of professionalism is our profession. A profession requires acquisition and application of a body of knowledge and technical skills. The individuals in a profession are bound together by a shared commitment. Members of a profession regulate themselves. In medicine, physicians regulate themselves through state medical boards, as well as hospital committees and other peer-review groups. Those in a profession practice in accord with a code of ethics. Finally, a profession has a contract with society. Our profession is to heal. In a patient encounter, we consider a right and good healing action for that patient in his or her particular circumstances. A right healing action is one informed by the scientific and clinical evidence. A good action, in contrast, takes into account the patient’s values and preferences and is consistent with the physician’s own clinical judgment. Clinical judgment consists of three steps, then: 1) the diagnostic question—What is wrong with this patient?—taking into account the patient’s medical history, physical examination, laboratory test results, and other data; 2) the therapeutic question—What can be done for this patient?—which is frequently informed by the scientific evidence and which comprises the array of treatments that might help the patient; and 3) the prudential question—What should be done for this patient?—which clearly needs to involve the patient to determine the option that will work best. In 1999, the Accreditation Council for Graduate Medical Education (ACGME) implemented general competencies, applicable to every specialty, that need to be imparted during residency or fellowship training. One of these six competencies is professionalism (Table 1) (2). The same year that professionalism was listed as an ACGME general competency, the Medical Professionalism Project was launched by the American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine. The result was a professionalism charter, which was published in 2002 (3) and has subsequently been adopted by many major professional physician organizations. The professionalism charter defined three fundamental principles of professionalism: • The primacy of patient welfare: This principle focuses on altruism, trust, and patient interest. The charter states: “MarProfessionalism in medicine: definitions and considerations for teaching