Defining professionalism from the perspective of patients, physicians, and nurses

Although professionalism has always been a core value in medicine, it has received increasingly explicit attention over the past several years. Unfortunately, the terms used to explain this competency have been rather abstract. This study was designed to identify and prioritize behaviorally based signs of medical professionalism that are relevant to patients, physicians, and nurses.

The qualitative portion of this project began in 2004 with a series of 22 focus groups held to explore behavioral signs of professionalism in medicine. Separate groups were held with patients, inpatient nurses, outpatient nurses, resident physicians, and attending physicians from different specialties, generating a total of 68 behaviorally based items. In 2004-2006, quantitative data were collected through national patient (n = 415) and physician leader (n = 214) surveys and a statewide nurse (n = 237) survey that gauged the importance these groups attach to the behaviors as signs of professionalism and determined whether they are in a position to observe these behaviors in the clinical setting.

The surveys of patients, physician leaders, and nurses provided different perspectives on the importance and visibility of behavioral signs of professionalism. Most of the behaviors were deemed very important signs of professionalism by at least 75% of patients, physicians, and/or nurses; far fewer were considered observable in the clinical setting.

This study demonstrates that it is possible and instructive to define professionalism in terms of tangible behaviors. Focusing on behaviors rather than attributes may facilitate discussion, assessment, and modeling of professionalism in both medical education and clinical care.