Does a Narrow Definition of Medical Professionalism lead to Systemic Bias and Differential Outcomes?

Abstract

The concept of medical professionalism is enshrined in the principles of Good Medical Practice (GMP), upheld by the General Medical Council (GMC), and is applicable to all doctors as well as undergraduate students in the United Kingdom. The principles were conceived, developed and implemented to ensure that the highest standards of medical practice are adhered to for the safety of the public and to retain trust in the medical profession. The GMC has a statutory duty to ensure that professional standards are maintained. Approximately 1% of doctors on the medical register are subject to investigation by the GMC, based on referrals made by employing organisations or the public.
 While appropriate GMC investigation is essential to maintain standards, patient safety and public confidence, there are inherent inequalities in the process resulting in widely different outcomes for certain groups of students or doctors based on Black and minority ethnicity, male gender and non-UK primary medical qualification often leading to devastating consequences.
 This narrative review considers the contributors to differential attainment (DA) and the impact on the health service, patients and individual wellbeing. It explores the tenets of a current narrow definition of professionalism which, while representing the unidimensional White majority view, ignores the huge diversity of the workforce and the public, thus exposing significant tensions for groups of professionals. The Covid-19 pandemic has exposed the inherent systemic bias in the health service for both professionals and the public. This review recommends root and branch reform of the definition of professionalism, by engagement with the public and the workforce, to incorporate principles of equality, diversity and inclusion, which the authors believe will create the environment for a just and equitable professional experience. 1

The do’s, don’ts and don’t knows of redressing differential attainment related to race/ethnicity in medical schools

“…However, diversity of ethnic backgrounds is often under-represented in faculty, especially in senior positions, giving rise to a paucity of role models for medical students [ 98 , 116 – 120 ]. We suspect, but do not know, that the lack of representation and role models within the broader learning environment may impact on the learning and performance of minoritized students [ 78 , 121 , 122 ].…”

“…If these reflect only the norms of the privileged group, this can result in biased assessments that lack cultural validity and may contribute to differential attainment. In particular, the assessment of professionalism in examinations is likely to reflect culturally embedded values about the practice of medicine [ 121 ]. For example, medical educators may have a white Eurocentric view of what clinical communication looks like or how empathy is expressed [ 116 ].…”

Learning from the Arora case: the GMC must prioritise early intervention and prevention

“…The pattern, however, still seems to be a reactive rather than a proactive approach of early intervention and prevention. The work by the British Association of Physicians of Indian Origin has some useful recommendations in this regard to help change the culture 23…”