The Meaning and Direction of Citizenship Education in Medical Education: A Civic Professionalism Perspective

Medical professionalism rests on a social contract: society grants a monopoly over the use of medical knowledge, autonomy, status, and self-regulation in exchange for competence, altruistic service, integrity, and attention to societal concerns. Medical education has addressed this contract through social accountability, professional identity formation, and, more recently, competencies for improving health systems. Distinct from social responsibility and responsiveness, social accountability commits medical schools to addressing health needs jointly identified by governments, health organizations, health professionals, and the public. Yet joint identification of needs in areas such as resource allocation and workforce size leaves reasonable disagreements to be resolved through public deliberation. Physicians’ participation requires distinct language to describe both the capacity in which they contribute and their duty to justify their positions publicly. This review argues that citizenship provides this language and examines its relationship to becoming a physician, the content of citizenship education, and approaches to its implementation. Following Sullivan, the review treats civic professionalism as an interpretive framework that makes professionalism’s social and public dimension explicit, rather than as a replacement for conventional professionalism. The two differ in the locus and scope of responsibility, responses to social problems, and justification. Professionalism is therefore compatible with citizenship and represents a form of citizenship institutionalized within a profession. Six domains drawn from Korean citizenship education research serve as a starting point, rather than a validated competency model, for examining the issues each raises for medical education and the directions for curriculum, teaching, assessment, and the educational environment. Curriculum development and validation, together with the development and validation of assessment tools, remain tasks for future work.