The Importance of Professionalism in Medicine

Professionalism is the current buzzword in medical education, yet most medical schools lack a formal professionalism curriculum. Numerous educators have addressed the problem of professionalism in medicine, with an eye toward developing curricula to address challenges. Since 2014, National University of Natural Medicine (NUNM) in Portland, Oregon, has followed the lead of far-sighted deans at Case Western Reserve University’s School of Medicine in building a formal naturopathic professionalism curriculum

Professional behavior has recognizable attributes, but professionalism itself is difficult to define. Professionalism has been described as the ability to maintain equanimity no matter how difficult the problem or challenge facing an individual, but this is much easier to state than it is to manifest consistently throughout practice. It is equally difficult to measure. Interpersonal skills vary from individual to individual, and the inability to resolve problems that arise between doctor and patient can have adverse effects. In a profession such as medicine, where the therapeutic relationship is built essentially on a healthy interpersonal relationship, patient outcomes may suffer if a provider lacks interpersonal skills.

Furthermore, data demonstrate that medical students who experience the greatest challenges in professional behaviors during school are also the most likely to be sued for malpractice after they graduate, so it behooves medical schools to address the issue of professionalism.

Preparing Professional Doctors at National University of Naturopathic Medicine

NUNM begins this work with matriculating naturopathic medical students during new student orientation, in an exercise to help the students develop a personal understanding about what professional behavior means to them. The purpose of the exercise is to introduce the concept of professionalism as an integral and measurable part of their education and development as clinicians.

Before the exercise, the students are assigned several medical journal articles that discuss the concepts of professionalism, complex adaptive challenges and change. The exercise brings students together into small groups with faculty and staff facilitators to discuss their values. The exercise continues with a series of guided reflective exercises to identify complex adaptive challenges the students may face, and the interpersonal and professional skills required to address these types of challenges, including coping with change and loss.

Each of the groups creates a definition of professionalism based on their personal values and posts their draft version on the wall in a large lecture hall. The students then perform a “Gallery Walk” to select the best draft version. The groups coalesce, and with the help of facilitators, they merge all the versions together. By the end of the exercise, they reach a consensus on the professional behaviors they intend as a class to manifest and develop throughout their medical careers, beginning with their behaviors as student doctors.

At the conclusion of the exercise, the students wordsmith the NUNM Oath of Professionalism, based on their shared commitment of values. NUNM administrators and faculty weave the Oath into the four-year naturopathic curriculum through expected program outcomes and competencies by which the students will be measured. The new students formally pledge the oath at the NUNM White Coat Ceremony, which concludes their orientation week and launches them into their medical education.

It gives me great pleasure to share the 2017-18 NUNM Oath of Professionalism, developed by the first-year naturopathic medicine students: “We vow to courageously and mindfully serve with integrity, humility and empathy by cultivating equity, adaptability, awareness, positive growth, learning, and open communication.”

Thanks to this early and ongoing focus on professional behaviors, NUNM knows that its graduates begin their careers well trained as clinical professionals, ready to diagnose and treat illness, as well as deliver compassionate care to all patients, ethically, equitably and altruistically. The NUNM Oath of Professionalism is the first step in that process.

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