Although assessing professionalism poses many challenges, gauging and detecting changes in professionalism is impossible without measurement. This paper is a review of techniques used to assess professionalism during the past 20 years. The authors searched five electronic databases and reference lists from 1982 to 2002. Eighty-eight assessments were retained and organized into content area addressed (i.e. ethics, personal characteristics, comprehensive professionalism, diversity) and type of outcome examined (i.e. affective, cognitive, behavioral, environmental). Instead of creating new professionalism assessments, existing assessments should be improved. Also, more studies on the predictive validity of assessments and their use as part of formative evaluation systems are recommended. Based on the review, suggestions are presented for assessing medical students, resident physicians and practicing physicians.

Stimulus control technology was applied to the instruction of fraction ratio (e.g., /5) and decimal (e.g., 0.20) relations, with 7 students who demonstrated difficulty in fraction and decimal tasks. The students were trained to match pictorial representations of fractions (B comparison stimuli) to printed counterpart fraction ratios (A sample stimuli), and to match printed decimals (C comparison stimuli) to pictorial representations of counterpart quantities (B sample stimuli). Posttest performance by all participants indicated the emergence of equivalence relations between fractions represented as ratios, decimals, and pictures. Limited generalization of fraction-decimal relations was observed.

Six normally capable adults first learned three conditional relations in each of two prospective equivalence classes via match-to-sample training with figures as conditional (sample) and discriminative (comparison) stimuli. Then one trained conditional relation in each prospective class was brought under the control of contextual stimuli, two dictated nonsense syllables. Test performances indicated the emergence of untrained conditional relations, and therefore two equivalence classes, that were conditional on the contextual stimuli. These tests involved untrained combinations of contextual stimuli and stimuli in conditional relations, suggesting that the contextual stimuli functioned independently to control conditional relations rather than forming compound stimuli with samples and comparisons in training. Next, two novel figures were made equivalent to each of the original dictated contextual stimuli by match-to-sample training and testing. On subsequent tests, all subjects demonstrated transfer of conditional control of untrained conditional relations from the original auditory contextual stimuli to equivalent visual stimuli. These outcomes further supported the conclusion that the contextual stimuli exerted true conditional control over conditional relations in the equivalence classes and were not merely elements of compound stimuli.

Portfolios may be the most useful approach to assess residents' PBLI abilities. Active participation in peer-driven performance improvement initiatives may be a valuable approach to confirm practicing physician involvement in PBLI.

The RHSP is meeting some interim objectives conducive to its long-term goal of developing physicians who will practice primary care medicine in rural, underserved areas of North Carolina.