Amending Miller's Pyramid to Include Professional Identity Formation

Area of Science:

• Medical Education
• Professionalism Assessment

Background:

• George Miller's 1990 article introduced a four-level pyramid (Knows, Knows How, Shows How, Does) for assessing clinical competence.
• This model has guided medical education assessment and professionalism evaluation for decades.
• Current focus on professional identity formation questions 'Does' as the ultimate aspiration.

Purpose of the Study:

• To propose an enhancement to Miller's pyramid for assessing medical professionals.
• To introduce a fifth level, "Is," representing professional identity formation.
• To align assessment methods with the evolving understanding of physician development.

Main Methods:

• Conceptual framework development based on existing literature.
• Analysis of the limitations of the original four-level Miller's pyramid.
• Proposal of a fifth level, "Is," integrating professional values and attitudes.

Main Results:

• The original four-level Miller's pyramid is a foundational tool but may not fully capture professional identity.
• A fifth level, "Is," is proposed to represent the internalization of professional values and attitudes.
• This new level signifies a more holistic assessment of aspiring physicians.

Conclusions:

• The proposed fifth level, "Is," enhances Miller's pyramid for assessing professional identity formation.
• Assessment methods should evolve to evaluate the integration of professional values into a physician's identity.
• This updated framework supports a more comprehensive evaluation of medical professionalism.