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Teaching and Evaluating Students' Professionalism in US Medical Schools, 2002-2003
To the Editor: In recent decades, medicine's expanded ability to diagnose and treat diseases, coupled with dramatic changes in the financing and delivery of health care, have created many new ethical and professional dilemmas for physicians. Related problems, including financial conflicts of interest, end-of-life decisions, and disclosure of medical errors, are now frequently discussed in both the medical and popular press. In response, there have been growing demands for greater curricular creativity and educational accountability in professionalism education. Herein we report on a survey of US medical schools and their current educational practices and needs in teaching and evaluating professionalism of medical students.
Methods
Associate deans responsible for curriculum at the 125 medical schools accredited by the Liaison Committee on Medical Education (LCME) were sent a survey in September 2002. The survey was based on items from the study by Swick and colleagues.1 The survey asked whether and how medical schools taught and evaluated students' professionalism, and if there were explicit goals/objectives and syllabus materials. Items inquiring about the types of assistance the school believed would be most helpful in the enhancement of professionalism education were also part of the survey. No specific definition of professionalism was provided to the respondents. Frequencies and percentages were calculated for each survey item using SPSS 10.0 (SPSS Inc, Chicago, Ill).
Results
Of the 125 LCME-accredited medical schools, 111 returned the survey (89% response rate). Response frequencies of survey items are reported in Table 1.
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Table. Assessment of Professionalism Education in LCME-Accredited US Medical Schools (N = 125)
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Comment
Nearly all US medical schools include content related to professionalism in their formal curriculum, and most schools have established explicit goals and objectives for their professionalism courses. Only a minority of schools report needing help to justify adding professionalism courses to their curriculum.
Even though almost all medical schools have incorporated some level of professionalism education in their formal curriculum, most still report needing assistance with developing teaching materials or "model" programs, and especially faculty development material. In our experience, there is widespread agreement among medical educators that the informal curriculum is as important, if not more so, than formal professionalism coursework in shaping the professional development of medical students. Studies show that medical students often receive conflicting messages between what they learn in the classroom and what they observe in the clinical setting about important values to uphold and appropriate behaviors to demonstrate.2-4
Although the teaching of professionalism-related topics has become prevalent in US medical schools, many continue to express uncertainty about how to evaluate their students' professional attributes and behaviors.5 Despite greater demands that physicians possess professionalism competencies, the number of schools that report having an explicit and rigorous process by which medical educators can effectively evaluate students' acquisition and development of professional behavior has not increased as compared with 1998 in the study by Swick et al.1 We acknowledge that we did not provide a definition of professionalism to respondents, and thus our results may be affected by some response variability.
Nonetheless, nearly all medical schools report that they have incorporated professionalism content into the formal curriculum, but that they still lack valid and reliable means for teaching and evaluating professionalism in their students.
Audiey Kao, MD, PhD;
Michelle Lim, BA;
Jeremy Spevick, BA
Ethics Standards Group
Barbara Barzansky, PhD
Council on Medical Education
American Medical Association
Chicago, Ill
1. Swick HM, Szenas P, Danoff D, et al. Teaching professionalism in undergraduate medical education. JAMA. 1999;282:830-832.
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2. Inui TS. A Flag in the Wind: Educating for Professionalism in Medicine. Washington, DC: Association of American Medical Colleges; 2003.
3. Hafferty FW, Franks W. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994;69:861-871.
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4. Reynolds PP. Reaffirming professionalism through education in the community. Ann Intern Med. 1994;120:609-614.
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5. Arnold L. Assessing professional behavior: yesterday, today, and tomorrow. Acad Med. 2002;77:502-515.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2003;290:1151-1152.
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