The YouTube generation: implications for medical professionalism

While medical education has remained relatively constant over the past century, the rising popularity of internet-based technologies, such as applications for social networking, media sharing, or blogging, has drastically changed the way in which physicians-in-training interact with educators, peers, and the outside world. The implementation of these new technologies creates new challenges and opportunities for medical educators. Representation, the absence of established policies and legal precedents, and the perception of the lay public exemplify some of the issues that arise when considering the digital images used by trainees. While some of these issues affect higher education generally, medical schools are faced with additional challenges to ensure that graduates exemplify the ideals of medical professionalism. We present a case vignette with subsequent discussion to highlight the complexities of ensuring medical professionalism in the digital age.     

Educating for social responsibility: changing the syllabus of developmental biology

Developmental biology is deeply embedded in the social issues of our times. Such topics as cloning, stems cells, reproductive technologies, sex selection, environmental hormone mimics and gene therapy all converge on developmental biology. It is therefore critical that developmental biologists learn about the possible social consequences of their work and of the possible molding of their discipline by social forces. We present two models for integrating social issues into the developmental biology curriculum. One model seeks to place discussions of social issues into the laboratory portion of the curriculum; the other model seeks to restructure the course, such that developmental biology and its social contexts are synthesized directly.     

Beyond the physician charter: reflections on medical professionalism

The numerous challenges now facing the profession of medicine have led to an intense focus on professionalism by individual physicians and by their professional and academic organizations. In 2002, a distinguished group of leaders in internal medicine created the Physician Charter, which calls on physicians to reaffirm medical professionalism through commitment to three principles and 10 responsibilities. The Charter reflects a duty-based ethic that is chiefly concerned with physician competence. This article offers a critical analysis of the Physician Charter from the perspective of the traditional values of medicine as articulated in medical oaths and championed by leaders of past generations, exemplified by William Osler. The authors argue that medical professionalism should reflect the values of a virtue-based ethic that stresses compassion and beneficence, rather than the values of a duty-based ethic. The challenges that now confront the practice of medicine can be addressed successfully only to the extent that physicians promote virtue-ethics, act collectively in the public interest, and render service that clearly transcends their own self-interests.     

Medical professionalism: crossing a generational divide

A comprehensive discussion of professionalism in medicine must include its impact on successive generations of physicians. Fifty years ago, doctors acting professionally emphasized medicine as a calling and an ability to act as the authority for patients in crisis at home and in hospitals. Therapeutic options were limited relative to the modern era, and the laying on of hands was practiced as science and art. Today, doctors balance increasing demands on time and efficiency with the sense of primacy of patient care. Technological innovation and patients' increasing access to medical knowledge through varying media of inconsistent quality challenge physicians in novel ways. Fifty years in the future, doctors will have access to vast amounts of information through a multitude of noninvasive diagnostics. Progressively more personalized medicine should inspire doctors to become even more adept at communicating effectively with patients. Professionalism in medicine throughout these generations embodies similar fundamental behaviors, such as demonstrating compassion, respect, and humility; adhering to high ethical and moral standards; subordinating personal interest to that of others; and reflecting on actions and decisions. Despite the dynamic nature of the profession itself, the omnipresent need for such traits will define medical professionalism for decades to come.     

Food for healing: Convalescent cookery in the early modern era

Despite major theoretical shifts in early modern nutritional theory, from humoralism to chemical and mechanical systems, the form and structure of convalescent cookery remained remarkably constant throughout the era and to a large extent even down to the present. In medical texts, cookbooks and in the popular imagination convalescent food generally mirrored food for infants, being soft and bland, based on dairy and grains, as well as foods considered highly nutritious yet easy to digest like concentrated broths. This article traces the development of ideas about convalescent food and how little they change over time.     

Medical professionalism and the doctor-patient relationship

The practice of medicine increasingly poses obstacles to the cultivation of strong relationships between physicians and their patients. The current discussion of medical professionalism aims to identify some of these obstacles and to improve both the doctor-patient relationship and the quality of medical care. In this essay, we explore professionalism within the context of the relationship between physician and patient and examine the concrete actions, behaviors, and qualities that medical professionalism requires of physicians in today's challenging environment.     

Medical professionalism and the social contract

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.     

Teaching professionalism: a tale of three schools

This article compares professionalism education from the vantage points of three different disciplines: medicine, law, and business. In particular, it asks how each of these professions conceives of "professionalism," and how these different conceptions affect what is taught to graduate students. The object of professionalism education differs among these three disciplines, as do the specific challenges to professionalism and professionalism education. The article offers examples of how professionalism is taught in medicine, law, and business, and what each profession might learn from the others in developing their professionalism education and pedagogy.