Professionalism in medical education, an American perspective: from evidence to accountability

CONTEXT: Professionalism is central to sustaining the public's trust in the medical profession; it is the essence of the doctor-patient relationship. Evidence exists that public trust is waning and that doctors are facing powerful contemporary threats to their professional values. The role of medical education is paramount in preparing future doctors to recognise and overcome these threats; to do so will require substantial change in the culture and environment of medical education. OBJECTIVES: The aims of this paper are to provide a definition and framework for professionalism in the context of medical education, describe current threats to medical professionalism, and detail the role medical schools and academic medical centres can play in preparing tomorrow's doctors to recognise and resist these threats. Additionally, the paper reviews established and potential methods for measuring professionalism and thus assuring public accountability. Finally, specific recommendations are offered for medical schools and teaching hospitals to nurture and sustain professionalism. DISCUSSION: The progressive intrusion of commercialism into the realm of medicine is threatening to replace the ethics of professionalism with the irreconcilable ethics of the marketplace. Academic medicine must assume greater responsibility and accountability for strengthening the resolve of future doctors to sustain their commitment to the ethics of professionalism. It can do so by improving the medical school admission process, enhancing both formal and experiential teaching of professionalism, and purging the educational environment of unprofessional practices. Ten approaches that academic medicine might adopt to achieve these goals are provided.