Hero or has-been: Is there a future for altruism in medical education?

Abstract

The term 'altruism' is often used without definition, leading to contradictions in what we expect from medical students. In this reflection paper, we critique the concept of 'altruism' from the perspective of moral philosophy and social psychology and challenge its unquestioned usage within the medical education literature, especially that emerging from the USA. We will argue that 'altruism' is a social construction with a particular history, stemming from Kantian philosophy and perpetuated within newer disciplines such as social psychology. As it currently stands, 'altruism' seems to mean utter self-sacrifice--a position contradictory to recent recommendations by regulatory bodies in the UK, which suggest that graduates should look after the 'self' and achieve a work-life balance. In this article, we argue that it is undesirable to have 'altruism' as a learning outcome for medical students and we also argue that 'altruism' is not an observable behavior that can be measured. Instead, we suggest that medical educators should employ a more balanced term, borrowed from the social psychology literature i.e. pro-social behavior. We argue that whilst 'pro-social behavior' focuses on actions that benefit others, it does not do so at the expense of the self. In addition, it focuses on students' observable behaviors rather than their inner motivations, so is measurable. We conclude our article by discussing the formation of physicians based upon a virtue ethics, where society and the profession are in dialogue about the telos of medicine and its virtues, and where the character of the young physician is formed within the crucible of that dialogue. Thus, central to this pro-social behavior is the concept of phronesis or prudence, including the balancing of self-interest such as self-care, and the interests of the other.

Climate for career choices: survey of medical students' motivation for studying, career preferences and perception of their teachers as role models

“…However, it should be kept in mind that medical students' decision to pursue an academic career is probably infl uenced by other factors, including role-models, mentoring [25] and even geographic origin [26]. An educational climate that instills the values of obedience, competitiveness, ambition and punctuality may not be conducive for developing pro-social behavior important for good medical practice in both academic and non-academic settings [27]. Fostering pro-social behavior may require less frontal and more interactive teaching, with greater personal interaction between students and teachers.…”

Resilience among doctors who work in challenging areas: a qualitative study

“…[21][22][23] The doctors in this study actively distanced themselves from the notions of selfless service and sacrifice implicit in most discussions of altruism in practice. 24 It may be more useful to understand their approach to their work and its sustainability using the notion of prosociality.…”

“…should be taught in medical schools. 24 Doctors who are experienced in providing prosocial patient care are well placed to be role models and teachers to students. Some of the doctors interviewed hold academic positions and others are involved in teaching at both undergraduate and postgraduate levels.…”

Dependence and caring in clinical communication: The relevance of attachment and other theories

“…Moreover, the face validity of the current culturally prevalent view of practitioners as altruistic may be weakening as generational changes shift practitioners’ concern to their own well-being [118]. Bishop and Rees [119] suggest that claims to altruism are generally best understood as social construction to mask the reality of financial reward for care. Moreover, Glannon and Ross [120] argued that clinical practice is no more altruistic than other types of work that involve obligations to others; altruism arises only where a practitioner goes beyond the role prescribed by their fiduciary relationship with patients.…”