Medical professionalism: what the study of literature can contribute to the conversation

Philosophy, Ethics, and Humanities in Medicine

David J. Doukas⁴  Stephen E. Wear³  Lois L. Nixon²  Johanna Shapiro¹ 

[1] Family Medicine and Director of the Program in Medical Humanities & Arts, University of California-Irvine, School of Medicine, 101 City Dr. South, Rte 81, Bldg 200, Ste 835, Orange 92868, CA, USA;Internal Medicine, Division of Ethics and Humanities, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd, Tampa 33612, FL, USA;Center for Clinical Ethics and Humanities in Healthcare, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo SUNY School of Medicine, Buffalo, NY, USA;William Ray Moore Endowed Chair of Family Medicine and Medical Humanism, and Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, 2301S 3rd St, Louisville 40292, KY, USA

关键词: Medical humanities;    Health humanities;    Literature;    Professional identity formation;    Medical professionalism;   

Others  :  1221128
DOI  :  10.1186/s13010-015-0030-0

 received in 2014-09-10, accepted in 2015-06-23,  发布年份 2015

【 摘 要 】

Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.

【 授权许可】

   
2015 Shapiro et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Holmgren L, Fuks A, Bourdreau D, Sparks T, Kreiswirth M. Terminology and praxis: clarifying the scope of narrative in medicine. Lit Med. 2012; 29(2):246-273.
• [2]Bishop JP. Rejecting medical humanism: Medical humanities and the metaphysics of medicine. J Med Humanit. 2008; 29:15-25.
• [3]Doukas DJ, McCullough LB, Wear S. Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med. 2012; 87:334-341.
• [4]Doukas DJ, McCullough LB, Wear S et al.. Perspective: The challenge of promoting professionalism through medical ethics and humanities education. Acad Med. 2013; 88:1624-1629.
• [5]Available at: http://academy-professionalism.org. Accessed July 22, 2014.
• [6]Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136(3):243-246.
• [7]Little JM. Humanistic medicine or values-based medicine…what's in a name? Med J Aust. 2002; 177:319-321.
• [8]Giordano J. Quo vadis? Philosophy, ethics, and humanities in medicine: preserving the humanistic character of medicine in a biotechnological future. Philos Ethics Humanit Med. 2009; 14(4):12. BioMed Central Full Text
• [9]Markakis KM, Beckman HB, Suchman AL, Frankel RM. The path to professionalism: cultivating humanistic values and attitudes in residency training. Acad Med. 2000; 75:141-150.
• [10]Doukas DJ. Where is the virtue in professionalism? Camb Q Healthc Ethics. 2003; 12(2):147-154.
• [11]Holden M, Buck E, Clark M, Szauter K, Trumble J. Professional identity formation in medical education: the convergence of multiple domains. HEC Forum. 2012; 24:245-255.
• [12]Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: Pedagogical challenges to medical education. Teach Learn Med. 2013; 25:369-373.
• [13]Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med. 2015; 90(6):753-60.
• [14]Doukas DJ, Kirch DG, Brigham TP, Barzansky BM, Wear S, Carrese JA, Fins JJ, Lederer SE. Transforming educational accountability in medical ethics and humanities education toward professionalism. Acad Med. 2015; 90(6):738-743.
• [15]Kumagai AK. From competencies to human interests: ways of knowing and understanding in medical education. Acad Med. 2014; 89(7):978-983.
• [16]Long DM. Competency-based residency training: The next advance in graduate medical education. Acad Med. 2000; 75(12):1178-1183.
• [17]Kirk LM. Professionalism in medicine: definitions and considerations for teaching. Proc (Bayl Univ Med Cent). 2007; 20(1):13-16.
• [18]The core competencies as described by the Outcome Project. Chicago, IL: Accreditation Council for Graduate Medical Education; updated 2001 [cited 2004 Jun 11]. Available from:. www. acgme.org/acgmeweb webcite
• [19]Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff (Millwood). 2002; 21(5):103-111.
• [20]https://www.acgme.org/acgmeweb/tabid/430/ProgramandInstitutionalAccreditation/NextAccreditationSystem/Milestones.aspx
• [21]Hafferty F. Measuring professionalism: a commentary. J Eval in Clin Pract. 2002; 8:281-306.
• [22]Hanna M, Fins JJ. Power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006; 81:265-270.
• [23]Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: Integrating identity formation into the medical education discourse. Acad Med. 2012; 87:1185-1190.
• [24]Cohen JJ. Linking professionalism to humanism: what it means, why it matters. Acad Med. 2007; 82:1029-1032.
• [25]Rees CE, Knight LV. The trouble with assessing students’ professionalism: theoretical insights from sociocognitive psychology. Acad Med. 2007; 82:46-50.
• [26]Lucey C, Souba W. The problem with the problem of professionalism. Acad Med. 2010; 85:1018-1024.
• [27]Branch WT. The road to professionalism: reflective practice and reflective learning. Patient Educ Couns. 2010; 80(3):327-332.
• [28]Sharpless J, Baldwin N, Cook R, Kofman A, Morley-Fletcher A, Slotkin R, Wald HS. The becoming: students' reflections on the process of professional identity formation in medical education. Acad Med. 2015; 90(6):713-717.
• [29]Brainard AH, Brislen HC. Learning professionalism: a view from the trenches. Acad Med. 2007; 82:1010-1014.
• [30]Baernstein A, Amies Oelschlager A-ME, Chang TA, Wenrich MD. Learning professionalism: perspectives of preclinical medical students. Acad Med. 2009; 84:574-581.
• [31]Cuesta-Briand B, Auret K, Johnson P, Playford D. A world of difference': a qualitative study of medical students' views on professionalism and the 'good doctor. BMC Med Educ. 2014; 14:77. BioMed Central Full Text
• [32]Humphrey HJ, Smith K, Reddy S, Scott D, Madara JL, Arora VM. Promoting an environment of professionalism: the University of Chicago “roadmap.”. Acad Med. 2007; 82:1098-1107.
• [33]Petersen A, Bleakley A, Brömer R, Marshall R. The medical humanities today: humane health care or tool of governance? J Med Humanit. 2008; 29(1):1-4.
• [34]Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ. 2014; 48(10):980-7.
• [35]Fisher D, Frey N. Text complexity and close readings. Newark DE, International Reading Association; 2012.
• [36]Kain P. How to do a close reading. Harvard University. www.fas.harvard.edu , Writing Center; 1998.
• [37]Beers K, Probst RE. Notice and note: Strategies for close reading. Heinemann, Portsmouth NH; 2012.
• [38]Paul R, Elder L. How to read a paragraph: The art of close reading. Foundation for Critical Thinking Press, Dillon Beach, CA; 2008.
• [39]Charon R. Narrative medicine: Honoring the stories of illness. Oxford University Press, Oxford; 2008.
• [40]Shapiro J: The feeling physician: Educating the emotions in medical training. European Journal of Patient-Centered Medicine 2013, 1(2)
• [41]Shapiro J. Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med. 2011; 86(3):326-332.
• [42]McEntyre MC. Getting from how to why: a pause for reflection on professional life. Acad Med. 1997; 72(12):1051-1055.
• [43]Wear D, Nixon LL. Literary inquiry and professional development in medicine: Against abstractions. Perspect Biol Med. 2002; 45(1):104-124.
• [44]Stephens GG. Family medicine as counterculture. Fam Med. 1998; 30(9):629-36.
• [45]Macnaughton J. The humanities in medical education: context, outcomes and structures. Med Humanit. 2000; 26:23-30.
• [46]Doukas DJ, McCullough LB. Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Acad Med. 2012; 87:334-341.
• [47]Kirklin D. Medical humanities and the ongoing search for reliability, authenticity and humility. Med Humanit. 2011; 37(2):67.
• [48]Dror OE. De-medicalizing the medical humanities. The European Legacy. 2011; 16:317-326.
• [49]Squier SM. Beyond nescience: The intersectional insights of health humanities. Perspect Biol Med. 2007; 50(3):334-337.
• [50]Waitzkin H. A critical theory of medical discourse: Ideology, social control, and the processing of social context in medical encounters. J Hlth Soc Behav. 1989; 30(2):220-239.
• [51]Kester GH. Conversation pieces: Community and communication in modern art. University of California Press, Berkeley; 2004.
• [52]Broderick S. Arts practices in unreasonable doubt? Reflections on understandings of arts practices in healthcare contexts. Arts Health. 2011; 3:95-109.
• [53]Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009; 84:782-787.
• [54]Wear D, Aultman JM. Creating difficulties everywhere. Perspect Biol Med. 2007; 50(3):348-362.
• [55]Belling C. Sharper instruments: on defending the humanities in undergraduate medical education. Acad Med. 2010; 85:936-994.
• [56]Kumagai AK, Wear D. "Making strange": a role for the humanities in medical education. Acad Med. 2014; 89(7):973-977.
• [57]Carson RA. Educating the moral imagination. In: Practicing the medical humanities: Engaging physicians and patients. Carson RA, Burns CR, TR Cole TR, editors. University Publishing Group, Hagerstown, MD; 2003: p.25-38.
• [58]Charon R. Narrative evidence based medicine. The Lancet. 2008; 371(9609):296-297.
• [59]Shapiro J. Walking a mile in their patients' shoes: empathy and othering in medical students' education. Philos Ethics Humanit Med. 2008; 3:10. BioMed Central Full Text
• [60]Wear D. The medical humanities: toward a renewed praxis. J Med Humanit. 2009; 30:209-220.
• [61]Coles R. The call of stories: Teaching and the moral imagination. Houghton Mifflin, New York; 1990.
• [62]Brody H. Defining the medical humanities: three conceptions and three narratives. J Med Humanit. 2011; 32(1):1-7.
• [63]Case GA, Brauner DJ. The doctor as performer: a proposal for change based on a performance studies paradigm. Acad Med. 2010; 85:159-163.
• [64]Garden R. Sympathy, disability, and the nurse: Female power in Edith Wharton’s The Fruit of the Tree. J Med Humanit. 2010; 31:223-242.
• [65]Garden R. The problem of empathy: Medicine and the humanities. New Literary History. 2007; 38:551-567.
• [66]National Board of Medical Examiners: Assuring quality of the healthcare practitioner workforce: An essential ingredient of a high quality health system. Policies of the National Board of Medical Examiners® regarding health system reform. April, 2011. http://www. nbme.org/PDF/Health-System-Reform/health-system-reform-policies.pdf webcite
• [67]Frost HD, Regehr G. “I am a doctor”: negotiating the discourses of standardization and diversity in professional identity construction. Acad Med. 2013; 88:1570-1577.
• [68]Avrahami E. Bridging the divides. The European Legacy. 2011; 16:299-306.
• [69]Krupat E, Pelletier SR, Chernicky DW. The third year in the first person: medical students report on their principle clinical year. Acad Med. 2011; 86:90-97.
• [70]Kumagai AK. Acts of interpretation: a philosophical approach to using creative arts in medical education. Acad Med. 2012; 87:1138-1144.
• [71]Chick NL: Beyond the essay: Making student thinking visible in the humanities. http://cft. vanderbilt.edu/guides-sub-pages/beyond-the-essay/ webcite
• [72]Chick NL, Haynie A, Gurung RAR, Regan AR: From generic to signature pedagogies: teaching disciplinary understandings. In Exploring signature pedagogies: Approaching disciplinary habits of mind. Edited by Gurung C, Haynie A. Sterling, WV: Stylus;2009:1–16.
• [73]Goldie J. Assessment of professionalism: a consolidation of current thinking. Med Teach. 2013; 35(2):e952-e956.
• [74]Ginsburg S, Bernabeo E, Ross KM, Holmboe ES. "It depends": results of a qualitative study investigating how practicing internists approach professional dilemmas. Acad Med. 2012; 87(12):1685-1693.
• [75]Kuper A. Literature and medicine: a problem of assessment. Acad Med. 2006; 81:S128-S137.
• [76]Charon R. At the membranes of care: stories in narrative medicine. Acad Med. 2012; 87:342-347.
• [77]Charon R. Calculating the contributions of humanities to medical practice – motives, methods, and metrics. Acad Med. 2010; 85:935-937.