When Joel Bervell thought about professionalism in undergraduates, he thought of Grey’s Anatomy. Specifically, he considered how the residents on the show are expected to do so (even though that’s often not the case): be on time, be prepared for their cases, and be respectful to everyone around them.
“That’s my only criteria for being a doctor, especially someone like me who doesn’t come from a family of doctors,” Mr. Bevell said. 28, Fourth-year medical student at Washington State University. Mr. Belleville, who is Ghanaian-American, was one of the first black medical students at the medical school, which opened in 2017.
From the moment students step into medical school, they are instilled with the idea of medical professionalism: the sacred responsibility to act with professional values that automatically earns society’s trust. “That’s the first thing they tell you: You’re actually a medical professional now,” Mr. Bevell said.
The same indicators can be used to determine whether a medical student will become a doctor.
Mr Bevill understands that from third year onwards he and his classmates will be assessed regularly professional conduct, as well as other attributes such as communication skills. Faculty, staff and other students can also report specific concerns about an individual’s professionalism, creating a record whose contents can be attached to their permanent record, following them like a scarlet letter.
The problem, as many medical students also learn, is that the word “professional” is vague, and “unprofessional” is even vaguer.Depending on the person making the call, unprofessional behavior may mean Embrace Your project director, let Bra strap displaywear braidwearing swimsuit weekend or wear “Black Lives Matter” Sweatshirt in the emergency room
Therefore, professionalism exists on two levels, both as a lofty standard of conduct and as (sometimes literally) A list of do’s and don’ts that blurs morality and appearance. The second connotation could be particularly harmful to residents of color, said Dr. Adaira Landry, a consultant at Harvard Medical School and co-author of the paper. recent journal articles On the “over-policing” of black residents.
This article was published in the New England Journal of Medicine, There is a growing body of literature documenting the lifestyles of residents of color disciplined or roll out medical. In 2015-16, 20% Although black students make up only 5% of residencies, 7% of fired interns were black, according to unpublished data from the Accreditation Council for Graduate Medical Education (ACGME)
For students who didn’t grow up in a medical culture or who don’t like outdated ideas of what a doctor should look like (white, male, elite), these opaque rules can present a minefield. “The environment is so restrictive about allowable behavior that it can feel unprofessional when you act, look or speak differently,” Dr. Landry said.
Among the minority students Dr. Landry works with who face probation or expulsion, she sees a common thread. “I’ve never had a student contact me saying they were expelled because of their academic performance,” she said. “The overwhelming theme was interpersonal conflict, known as professional challenges.”
From ethics to dress codes
Dr. David C. Leach, executive director of the ACGME from 1997 to 2007, said the lofty ideals Mr. Bervell encountered on his first day were more in line with the original conception of professionalism.
At the time, medicine was at a crossroads. Large corporations are snapping up individual practices and turning them into for-profit businesses. Physicians see their time with patients reduced, and patients see the quality of their care decline.
“There was a growing public perception that doctors were just like everyone else: They were just there to make money,” said Dr. Matthew Wynia, a medical ethicist who studied the ethics of managed care during this period. “The worry is that our sense of professionalism is disappearing.”
In response, the Council set out to define a set of general competencies: measurable results Residents need to demonstrate this before becoming a physician.
Of the six competencies ultimately established by the committee, professionalism is closest to the core of what it means to be a doctor. “It’s a set of commitments about the credibility of the profession as a whole and the individuals who work in it,” Dr. Leach writes Year 2014. Professionalism, many believe, is key to helping medicine reassert its values as an altruistic profession based on ethics—dedicated to patients, not the bottom line.
Professionalism is also the vaguest competency on the list. 1999 definition characterized by professionalism “Commitment to professional responsibility, ethical principles and sensitivity to diverse patient populations.” Physicians are also expected to demonstrate attribute array Include compassion, respect, humility, integrity, and accountability in every interaction.
Residency directors complain that professionalism is fragile and difficult to measure compared with things like patient care and medical knowledge. These concerns boiled down to: “I’m a very busy program director, so what on earth am I going to do?” Dr. Leach recalls.
The problem of ambiguity never goes away, said Dr. Deborah Powell, former executive dean of the University of Kansas School of Medicine and then an ACGME board member. In the 2000s, discussions about what professionalism was often shifted to how doctors should dress. “You shouldn’t have a beard, you shouldn’t have long hair, women should wear skirts,” Dr. Powell said. “This is crazy. We’ve gone too far.”
These conversations are still happening today. Dr. Londyn Robinson, now a resident at Duke University, learned a second definition of professionalism in 2020.While looking for tips on applying to residency, she stumbled upon an article Published in the journal Vascular Surgery as “The prevalence of unprofessional social media content among young vascular surgeons.”
The authors searched the social media accounts of 500 surgical trainees and rated their professionalism without their knowledge. Potentially unprofessional content, as defined by the authors, includes photos of residents holding alcoholic beverages, wearing Halloween costumes or “posing provocatively in bikinis/swimsuits.”
Dr. Robinson is the first in her family to earn an MD degree, and the paper reveals that for some, professionalism has been reduced to a superficial attribute rather than ethical behavior toward patients. “Basically, they say the quiet parts out loud,” she said.
new ideal
As Dr. Robinson learned, professionalism now extends beyond the clinic or classroom. Burwell’s mentors had warned him about the consequences of social media: Because medical students represent the profession at all times, they said, being a professional meant thinking twice before talking online about politics or hot-button issues like abortion. .
Mr. Burwell did not entirely heed the warning.During the Covid-19 pandemic, he began making TikTok videos pointing out racial bias in medical tools, such as pulse oximeter and Pulmonary function tests. (Studies have found that both methods are less accurate for non-white patients), earning him the nickname “Medical MythBusters.”His videos have been added to medical school syllabuses and have been well received From the American Medical Association and won him a seat At the White House Social Media Healthcare Leaders Roundtable.
Mr Belleville said his social media activism could be considered unprofessional by his own school’s standards. But, he added, he sees challenging growing racial disparities in health care as part of his role in changing medicine — and, perhaps, giving doctors something better than “Grey’s Anatomy,” as how Be a role model for professionals.
The ambiguity of professionalism poses a challenge not only for students of color but also for anyone who does not fit the historical stereotype of a doctor. Dr. Robinson noted that more women than men were judged for their swimwear in vascular surgery papers.
In 2020, I was angered by this paper, she posted a photo She was pictured wearing a bikini top and shorts on X (formerly Twitter) with the hashtag #MediBikini. “I would say: I wear a bikini. I’m going to be a doctor,” Dr. Robinson wrote. On the second day, Her post went viralthe paper was officially withdrawn.
in apologyThe magazine’s editors acknowledged that “professionalism has historically been defined by white, heterosexual men and has not always represented the diversity of our workforce or patients.”
As the face of medicine changes and platforms like TikTok and Twitter change the way medical knowledge is shared, professionalism’s original architects remain convinced that the term’s core principles will remain at the heart of medicine.
For Dr. Leach, the definition is simple. “Are you insightful and telling the truth? Are you putting the patient’s interests ahead of your own? Are you developing the practical wisdom to combine the best science with the specific circumstances of that particular patient to propose a Creative clinical decision-making?” he said. “If you do these three things, you’re a professional.”
He added: “The dress code is far from those three things.”
