Teaching professionalism in medical education: A Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 25

Figures & data

Table

Practice points

There is still no unifying theoretical or practical model to use as a format to integrate the teaching of professionalism in to the medical curriculum. Professionalism is learned most effectively through the influence on students of clinicians they encounter in the course of their education (role models). Situated learning theory is the best theoretical basis with which to develop a teaching program for professionalism. While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.

Figure 1. Logic framework: teaching professionalism in medical education.

Table 1  Search strings used

Medline 7/09/2010.

Topic: medical professionalism not restricted to medical education (and including humanism)

Date limits: 1999–2009

1. (humanist or humanism).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

2. exp Ethics, Medical/

3. exp Ethics/

4. Social Values/

5. exp Professional Impairment/

6. professionalism.mp.

7. ((behav* or act or acts or action* or values) adj3 (ethic* or professional or professionally)).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

8. professional role.mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8

10. (doctor* or gp or “general practition*” or “medical professional*” or surgeon* or specialist* or registrar*).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

11. exp Physicians/

12. students, medical/or students, premedical/

13. (medic* adj2 graduate*).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

14. 10 or 11 or 12 or 13

15. 9 and 14

16. limit 15 to yr = "1999–2009"

Pre-Medline 25/8/10.

1. (medic* adj3 professionalism).mp. [mp=title, original title, abstract, name of substance word, subject heading word, unique identifier]

2. (humanis* adj3 (medic* or doctor* or physician* or “health profession*” or surgeon or registrar or resident or GP or “general practitioner*”)).mp. [mp = title, original title, abstract, name of substance word, subject heading word, unique identifier]

3. 1 or 2

4. limit 3 to yr = "1999–2009"

Embase 11/09/10.

'humanism'/de OR humanist:ti OR humanism:ti OR humanist:ab OR humanism:ab OR ‘medical ethics'/exp OR ‘ethics'/de OR ‘bioethics'/de OR ‘conflict of interest'/exp OR ‘complicity'/exp OR ‘casuistry'/exp OR ‘social psychology'/exp OR ‘morality'/exp OR ‘malpractice'/exp OR ‘professional misconduct'/de OR ‘professionalism'/de OR professionalism:ti OR professionalism:ab OR ‘professional standard'/de OR ‘professional role' OR behav* NEAR/3 ethic* OR behav* NEAR/3 professional OR behav* NEAR/3 professionally OR act NEAR/3 ethic* OR act NEAR/3 professional OR act NEAR/3 professionally OR acts NEAR/3 ethic* OR acts NEAR/3 professional OR acts NEAR/3 professionally OR action* NEAR/3 ethic* OR action* NEAR/3 professional OR action* NEAR/3 professionally OR values NEAR/3 ethic* OR values NEAR/3 professional OR values NEAR/3 professionally

AND

(‘physician'/exp OR ‘medical specialist'/exp OR doctor* OR gp OR ‘medical professional' OR ‘medical professionals' OR surgeon* OR registrar* OR ‘general practitioner':ti OR ‘general practitioners':ti OR ‘general practitioner':ab OR ‘general practitioners':ab OR specialist*:ti OR specialists:ab OR ‘medical student'/exp OR medic* NEAR/2 graduate*)

AND

[embase]/lim AND [medline]/lim

AND

[1999–2009]/py

Philosophers Index 25/8/10.

1. (medic* adj3 professionalism).mp. [mp = abstract, title, heading word]

2. Medicine.sh.

3. Professionalism.sh.

4. 2 and 3

5. 1 or 4

Legaltrac 25/8/10.

(tx (medic* w3 professionalism))

Informit 25/8/10.

(kw(medic* %3 professionalism))

Capital Monitor Results not included in library

12 refs found to various parliamentary docs

Table 2.  BEME Teaching Professionalism. Quality rating sheet Score each paper from 1 to 5 based on criteria below

Score	1	2	3	4	5
Relevance	Barely relevant	One or two interesting ideas, not well developed	Relevant with a few interesting ideas	Contains new, interesting ideas	Preeminent. Ground breaking paper
Conceptual basis	Trivial or incidental (letter, introductory editorial) Local experience Redundant	Ideas covered in more recent publications	A viewpoint, well expressed	A closely reasoned deductive approach without empirical data	A closely reasoned deductive approach to teaching professionalism with empirical data
Journal	Obscure journal	Fairly unknown journal	Journal with focus far removed from medical education	Good journal	Prestigious journal
Citation count	Not cited			Well cited (>10)	Highly cited
Inclusion?	Best not to include	Will not be missed	Maybe include	Definitely include	Seminal paper

Source: Adapted from Mitton C, Adair CE, et al. 2007. Milbank Q 85(4):729–768.

Figure 2. Teaching professionalism. BEME review flow diagram.

Table 3  Best evidence on teaching professionalism by study type. (n = 49)

Type of study	Count
Qualitative	17
Quantitative	9
Viewpoint	20
Case report	9
Book	6

Mixed methods result in multiple counts.

Table 4  Papers on teaching professionalism with more than 50 citations

First author	Year	Citations
Novack	1999	137
Lempp	2004	133
Inui	2003	119
Swick	1999	109
Hicks	2001	106
Coulehan	2001	93
Branch	2000	92
Branch	2001	91
Haidet	2006	82
Suchman	2004	71
Steinert	2005	70
Wear	2000	67
Kenny	2003	59
Ginsburg	2002	58
Brownell	2001	58
Klein	2003	55
Wright	2002	51
Markakais	2000	51

Citations counts as by SCA Web of Science as at September 2010.

Table 5  Books on teaching medical professionalism

Cruess RL, Cruess SR, Steinert Y. editors. 2008. Teaching medical professionalism. New York: Cambridge University Press.

Eckenfels EJ. 2008. Doctors serving people: Restoring humanism to medicine through student community service. Piscataway, NJ: Rutgers University Press.

Egan EA. 2006. Living professionalism: Reflections on the practice of medicine. Lanham, MD: Rowman & Littlefield Publishers, Inc.

Halpern J. 2001. From detached concern to empathy: Humanizing medical practice. New York: Oxford University Press.

Kao A. 2001. Professing medicine: strengthening the ethics and professionalism of tomorrow's physicians. Chicago: American Medical Association.

Kasar J, Clark EN. editors. 2000. Developing professional behaviors. Thorofare, NJ: SLACK Inc.

Mills A, et al. 2005. Professionalism in tomorrow's healthcare system: Towards fulfilling the ACGME requirements for systems-based practice and professionalism. Hagerstown, MD: University Publishing Group.

Parsi K, Sheehan M. editors. 2006. Healing as vocation: A medical professionalism primer. Lanham, MD: Rowman & Littlefield Publishers.

Spandorfer J, et al. editors. 2009. Professionalism in medicine: A case-based guide for medical students. New York: Cambridge University Press.

Thistlethwaite J, Spencer J. 2008. Professionalism in medicine. Milton Keynes, UK: Radcliffe Medical PR.

Wear D, Bickel J. editors. 2008. Educating for professionalism: Creating a culture of humanism in medical education. Iowa: University of Iowa Press.

Table 6  Best evidence teaching papers by country. (n = 49)

Country	Number of papers
USA	34
UK	6
Canada	6
Australia	2
The Netherlands	1

Mitton C, Adair CE, Mckenzie E, Patten SB, Waye Perry B. Knowledge transfer and exchange: Review and synthesis of the literature. Milbank Q 2007; 85: 729–768

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