A recent paper in Academic Medicine1 considered three frameworks for developing professionalism in medical education.
The oldest framework is virtue-based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanistic qualities of caring and compassion: The good physician is a person of character.
The second framework is behaviour-based, which emphasises milestones, competencies, and measurement of observable behaviours: The good physician is a person who consistently demonstrates competence in performing patient-care tasks.
The third framework is identity formation, with a focus on identity development and socialisation into a community of practice: The good physician integrates into his or her identity a set of values and dispositions consonant (consistent?) with the physician community and aspires to a professional identity reflected in the very best physicians.
The authors say, ‘Although each professionalism framework is useful and valid, the field of medical education is currently engaged in several different discourses resulting in misunderstanding and differing recommendations for strategies to facilitate professionalism. By examining each discourse in detail, underlying commonalities and differences can be highlighted to assist educators in more effectively creating professionalism curricula, pedagogy, and assessment.’
PRIME is firmly committed to teaching and modelling professionalism as defined by the first (and oldest) framework above (whilst acknowledging that the others have some useful features).
The first framework is virtue-based professionalism with a focus on the moral character, reasoning and humanitarianism of the healthcare professional. Appropriate professional actions are the result of internalising the right values (what PRIME would call ‘God’s values’) and ethical principles until habits are created.
The strength of this approach is that it places internal values and motivation first and makes moral reasoning routine. It is taught by seeking to get students to internalise and gain commitment to a core set of values and actions that are guided by moral reasoning. In this way, habits of the heart such as caring and compassion become part of the health-care professional’s character and are not dependent on environment, role-models or the demonstration of observable behaviours to pass exams. PRIME’s vision is to see all health-care professionals taught and practising a virtue-based professionalism, so that health-care around the world is provided by people who truly care for their patients and consistently demonstrate compassion. This does not depend on a particular context or require expensive resources, since it arises from the heart of each doctor, nurse or paramedic themselves, and is effective in any situation.
Do you teach your students virtue based professionalism? PRIME has tutors and materials to help you.