The Primacy of Professionalism: A Selective Review of Medical Education, Practice, and Research

From the 12th Century, when the word referred to taking religious vows, to its present meaning as a constellation of organized practices requiring special training, legal liability, and covenants with individual patients and society, professionalism has played an important role in the practice of medicine. Until relatively recently, the concepts of professionalism and professional behavior were rooted in timeless ideals that individual physicians were expected to achieve in training and practice. As an ideal type, professionalism was seen as a quality or characteristic residing in the individual physician. By the same measure, the period of rapid technological and social change that marked the early to mid-20th Century made clear that timelessness, as it applied to professionalism, had its limitations. Where once sharing bad or sad news with patients was viewed as harmful, the right to know one's diagnosis is now enshrined in law and taken for granted in education and practice. Moreover, research shows that knowing one's diagnosis is often beneficial, not harmful, to individuals and families. In response to changing norms and technological advances, medical educators have introduced new models of professionalism that stress the role of social context and relationships in training and practice. One innovative approach is based on the concept of professional identity formation, the moment-by-moment process of becoming and being a physician. Identity formation occurs primarily through story-telling and other forms of self-expression in the context of a community of peers who learn to practice medicine with technical proficiency, kindness, and self-awareness together. [.