The Emergence of Professionalism
The term “professionalism” encompasses a reaffirmation of the values and behaviours of physicians.
The concept of professionalism first emerged in the early 1990’s in the United States as a response to the many challenges facing the health care system. Managed largely by independent Health Maintenance Organizations, HMOs, the provision of health care had increasingly become a business. As a result of this for-profit health care market, the very core of medicine was felt to be eroding. Evolving trends in medical care favored cost-effectiveness and efficacy and, as expected, had adversely affected certain aspects of the medical profession. The term “professionalism” arose out of the desire to reaffirm humanistic qualities, qualities such as compassion and altruism, back into the medical world. As such, professionalism developed out of the necessity to reinforce sound ethical principles within the medical community.
In the United States, the American Board of Internal Medicine (2) and the American Association of Medical Colleges (1) developed documents asserting that the values of the medical profession, including humanistic values, needed to be taught to medical students and residents in training.
By the mid 1990’s, the concept of “professionalism” began to surface in medical schools across Canada and the United States. The importance of including professionalism in the curriculum became increasingly apparent in light of the challenges facing medical education (such as the increasing diversity of the medical student population) and health care in general. Although the term “professionalism” seems to have emerged out of the dichotomy between private HMOs and the millions of uninsured Americans, the ideals of professionalism have existed for centuries.
An extensive literature has accompanied this increased emphasis on Professionalism in the United States, Canada, Great Britain, Australia and elsewhere. How to ‘teach’ and evaluate Professionalism has become a topic of extensive interest within medical education conferences.
In Canada, the Royal college of Physician and Surgeons developed the CanMEDS roles, including that of Professional. Drs. Sylvia and Richard Cruess, among others, advocated that the theme of professionalism be included in Undergraduate Medical Education (3). For over a decade, the Cruess’ have outlined standards of professional behaviour and emphasized the need for formal teaching of this subject matter in medical schools. They argue that “medicine must be aware of the history of professionalism, the literature pertaining to it, and the obligations resulting from professional status” (3). There is no question that the complexity of modern society calls for increased awareness in the ethics of how medicine is practiced.
Under the theme of medical professionalism, the attributes and behaviours required of soon-to-be physicians have been formally integrated into the undergraduate curriculum of nearly every faculty of medicine across Canada.