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Herbert M. Swick, MD; Philip Szenas, MA; Deborah Danoff, MD; Michael E. Whitcomb, MD

JAMA. 1999;282:830-832.

Context  There is a growing consensus among medical educators that to promote the professional development of medical students, schools of medicine should provide explicit learning experiences in professionalism.

Objective  To determine whether and how schools of medicine were teaching professionalism in the 1998-1999 academic year.

Design, Setting, and Participants  A 2-stage survey was sent to 125 US medical schools in the fall of 1998. A total of 116 (92.3%) responded to the first stage of the survey. The second survey led to a qualitative analysis of curriculum materials submitted by 41 schools.

Main Outcome Measures  Presence or absence of learning experiences (didactic or experiential) in undergraduate medical curriculum explicitly intended to promote professionalism in medical students, with curriculum evaluation based on 4 attributes commonly recognized as essential to professionalism: subordination of one's self-interests, adherence to high ethical and moral standards, response to societal needs, and demonstration of evincible core humanistic values.

Results  Of the 116 responding medical schools, 104 (89.7%) reported that they offer some formal instruction related to professionalism. Fewer schools have explicit methods for assessing professional behaviors (n=64 [55.2%]) or conduct targeted faculty development programs (n=39 [33.6%]). Schools use diverse strategies to promote professionalism, ranging from an isolated white-coat ceremony or other orientation experience (n=71 [78.9%]) to an integrated sequence of courses over multiple years of the curriculum (n=25 [27.8%]). Of the 41 schools that provided curriculum materials, 27 (65.9%) addressed subordinating self-interests; 31 (75.6%), adhering to high ethical and moral standards; 17 (41.5%), responding to societal needs; and 22 (53.7%), evincing core humanistic values.

Conclusions  Our results suggest that the teaching of professionalism in undergraduate medical education varies widely. Although most medical schools in the United States now address this important topic in some manner, the strategies used to teach professionalism may not always be adequate.

Author Affiliations: Association of American Medical Colleges, Washington, DC. Dr Swick is with the Department of Neurology, University of Kansas, Kansas City. He is currently a scholar in residence with the Association of American Medical Colleges.

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