Professionalism:

Defining and Measuring Professionalism

 Defining and Measuring Professionalism

• What is (and is not) “professionalism”

• How can we measure something as

“subjective” as professionalism?

• 4 measures of professionalism
 What is a Profession?

• An occupation for which the

necessary preliminary training is
intellectual in character . . .
• . . . Pursued largely for others and
not merely for one’s self
• . . . In which the amount of financial
return is not the accepted measure
of success.

Louis Brandeis, Brown University Commencement, 1912

 What is a Professional?

• A professional has command of a

special body of knowledge and
skills.
• A professional is given specific
rights not generally provided to the
public.
• A professional has specific
responsibilities or duties not
generally expected of the public.
 Professionals have
specialized knowledge and skills

• Physicians: Therapies, surgical

procedures
• Lawyers: Details of the content and
process of the law (local, state, and
federal)
• Clergy: Religious ritual and
scriptural interpretation
 Professionals have
specific rights

• Physicians: Asking private

questions, prescribing narcotics,
performing operations
• Lawyers: Lawyer-Client privilege
• Clergy: Participation, leadership,
and access to certain religious
rituals
 Common Elements

• Excellence
• Humanism
• Accountability
• Altruism

Arnold L. Acad Med, May 2002.

 Excellence

• A commitment to competence
• Lifelong learning
• Continuous quality improvement
• Promotion of scientific
knowledge
 Humanism

• Caring, compassion, empathy

• Honor and integrity
• Respect for patients and their
families
 Humanism

“Humanism is the passion that

animates authentic professionalism.
Humanism is a way of being. It
comprises a set of deep-seated
personal convictions about one’s
obligations to others, especially
others in need.”

Jordan Cohen, Acad Med 2007

 Accountability
• “procedures and processes by which
one party justifies and takes
responsibility for its activities”
• Responsibility to: patients, families,
society
• Accountability for: quality care,
upholding principles, managing
conflicts of interest
• Self and professional regulation
 Altruism

• The interests of patients should

guide behavior more than the
interests of the individual physician.
• Can be part of excellence,
humanism, or accountability
 Professionalism

Accountability
Humanism
Excellence

Altruism
Ethical and Legal Understanding

Communication Skills

Clinical Competence (Knowledge of Medicine)

Arnold
Arnold and Stern,
and Stern, 20062006
 . . . and wise application . . .

The ultimate measure of a man is not

where he stands in moments of
comfort and convenience, but where
he stands at times of challenge and
controversy.

Martin Luther King Jr. Strength to Love, 1963

Three Ways to Promote Professionalism

• Expectations
• Experiences
• Evaluation

Stern and Papadakis, 2006

 Defining and Measuring Professionalism

• What is (and is not) “professionalism”

• How can we measure something as

“subjective” as professionalism?

• 4 measures of professionalism
How to Measure the “Subjective”

• Connoisseurship
• Criticism
• Choice
 Connoisseurship

A means through which the

complexities of situations can be
noticed; it is a way of seeing what
is subtle and significant.

Elliot Eisner
 Criticism

The reeducation of perception. It is

intended to illuminate through
commentary or narrative what is
subtle but significant in a situation
so that those less sophisticated in a
particular domain can come to see
what they had not.

Elliot Eisner
 Purpose of Measurement

To provide the tools with which

you can convert connoisseurship
into criticism in a formal and
consistent manner.
 Choice:
For What Purpose are you Measuring?

• To select (summative)
 Allows the comparison of students
 Provides information for feedback
 Could identify residents not fit to practice
• To improve (formative)
 Does not allow for comparisons
 Intended purpose is for feedback
 More likely to be honest and critical
 Defining and Measuring Professionalism

• What is (and is not) “professionalism”

• How can we measure something as

“subjective” as professionalism?

• 4 measures of professionalism