A theoretical sketch of medical professionalism as a normative complex

Abstract

Validity arguments for assessment tools intended to measure medical professionalism suffer for lack of a clear theoretical statement of what professionalism is and how it should behave. Drawing on several decades of field research addressing deviance and informal social control among physicians, a theoretical sketch of professionalism is presented that can be used to predict how individual adjustment to professional norms should co-vary with other social and psychological phenomena. Physicians may understand and value professional norms but fail to enact them in practice because of conflicting normative demands. Physicians' social networks are predicted to act as conduits of social learning and social pressure, driving the resolution of normative conflicts in specific directions. A valid assessment of professionalism requires an adequate accounting of the social reaction to an individual's professional conduct, because the reaction and the conduct itself are inseparable.

Assessment of professionalism: Recommendations from the Ottawa 2010 Conference

“…There is a need for "thick description" to "interpret the flow of meaningful events from participants' perspectives", because "social reaction and conduct are inseparable". 30,24 Finally, adding a contextual element are papers that suggest that professionalism is a set of definable and measurable behaviours that vary across cultures. For example, whereas psychometric evaluation with the P-MEX was reliable and acceptable in the Japanese context, nevertheless new items were needed and different results were obtained in Japan than in a Canadian setting.…”

The formation of professional identity in medical students: Considerations for educators

“…They also learn through listening to stories passed onto them by older members of the profession (Stern & Papadakis 2006). Experiencing structured silence (Holtman 2008) and value-laden rituals, such as anatomy labs and morbidity and mortality reviews (Bosk 1979), can help them avoid issues considered taboo by the profession. Some medical schools stage rites of passages that mark transitions in identity, e.g.…”

“…Effective integration into social networks creates opportunities for cooperation, trust and empathy with others (Granovetter 1985). It also promotes students' normative adjustment (Holtman 2008) and has the potential to promote social identity complexity in both students and existing members of the profession if relationships are based on mutuality.…”

Assessment of professionalism: A consolidation of current thinking

“…It ought to include monitoring of the learning/practice environment and doctors' interpersonal relationships, e.g. student-teacher, teacher-student, student-patient, for problematic interpersonal phenomena (Holtman 2008). In measuring professionalism symmetry, i.e.…”