Professionalism: the conduct, aims, or qualities that characterize a profession or a professional person.
If you ever give this answer to anyone who asks you what professionalism is, then remember to cite Merriam-Webster [http://www.merriam-webster.com/dictionary/professionalism].
One cannot literally and philosophically avoid the concept of “professional” in health professional fields. Indeed professionalism is generally used as a list of unwritten rules or “hidden curriculum” when it comes to how one should talk, behave, or practice to defend the ideals of the profession. If you break the code – no matter how innocuous you think it is – you get it etched on your “permanent record”; unlike in grade school, it really is permanent and could haunt you for the rest of your career. (Ask anyone in the cheating ring at a dental school in Indiana [ http://chronicle.com/article/46-Students-Are-Disciplined/122192 ] . You are naïve if you don’t think that that binder in the student affairs office at your professional school stays on the shelf when your dean’s letter is drafted for residency directors to review.
I was dealt the challenge of seeing if I could create a curriculum on “professionalism” for graduate students and postdocs when I was working on a set of core competencies that mirrored the ACGME core competencies. While it might be easy to create a set of learning goals and assessable metrics for courses in laboratory or personnel management, cutting edge technology, or grant-writing, professionalism was extremely elusive to carve into courses or workshops without imagining grade-school teachers who would tell you not to cheat or steal.
It was extremely difficult to discover anyone who truly documented and indexed breaches in professionalism in a way that could be easily explained through research, and there was very little that really talked about professionalism in a way that resonated with my doctoral-trained data-driven mind. No code of professionalism appeared to have exactly the same values, whether we were talking about lawyers, nurses, physicians, dentists, or engineers, and while I found a couple of papers talking theoretically about professionalism, none seemed to apply or appeal so well to my task.
My epiphany finally came with discussion with diversity officers and advocates about why they felt professional people excluded or belittled people who came from underserved backgrounds or minority communities. After participating in a lot of diversity workshops, it dawned on me that no single didactic approach or lecture series was going to make any training in professionalism work. I finally theorized that professionalism is all about the perception of identities and the social and cultural forces that change them.
In my mind, there are six domains of professionalism that are addressed all the time. The first domain is “personal”: what identities do you individually hold? So many of my advisees address themselves as premeds first, or maybe “prepharmacy but not premed”. Many others look in the mirror and see “biology major”, college student, postbac, or alumnus. Some others know themselves by age, cultural heritage, neighborhood, gender identity, musical or movie preferences.
I can tell a lot from how an advisee thinks of himself or herself from an email handle, a Facebook page, clothes worn, language spoken, and so forth. When you get older, you need to be comfortable with “pediatrician vs. surgeon (or both),” “optometrist,” “public health officer,” “professor,” “parent,” “caregiver,” “patient,” and perhaps “president” even as you move and become more “Southern” or more “affluent.”
How you view yourself and all the influences that shape your own personal identity with your professional and lifelong identity is at the heart of professionalism and for discussions about future career directions. Being able to adopt multiple identities or accept shifts in your own identity defines your own personal happiness and satisfaction with your career.
The second domain is “social”, meaning how your immediate family and non-professional friends perceive you. You already may have recognized how your perception of a friend who got into medical school changed how you and that person’s family and friends thought of him/her. Imagine how it changes when your friend tells you he/she will do “rural medicine” (because he/she grew up on a farm) or wants to get a master’s in public health.
If you told your family or significant other that you viewed yourself as a pediatric neurosurgeon and that it would take you 20 years of training, what would your family say? Would your family influence your personal domain if they saw you becoming more depressed as you were toiling at what you thought was an ideal professional identity?
Ultimately the question is, “Are your friends and family really proud of you as a member of their community?” This is one reason why it is hard for individuals who have no family members in health care to have the confidence to continue along that path without dedicated mentors.
These two domains are extremely difficult to address in large workshops as individualized reflection and confidential conversations are required. These domains are avoided in formal curriculum because until there is professional training, most are extremely uncomfortable setting a standard of “competency” in these domains. Thus, the frank discussions you will hear about work/life balance or diversity are usually scheduled extracurricularly, brought up at home, or placed as a responsibility to the student if he/she is interested.
From what I have observed in many open houses and trainee panels I have sat in on (not to mention job interviews), the best questions asked by prospective applicants and possible matriculants on interview or second-look day focus on these two domains as it pertains to their own situations and identities.
Most schools and programs are comfortable evaluating the other four domains. The third domain is “workplace”: how well an individual interacts with others in the immediate work environment. Is the individual respectful of others’ opinions and habits when working in teams or with patients? How well do you represent the best of the workplace you are part of?
The fourth domain is “institutional” where the workplace is situated. In short, this is the school or the hospital/clinic. You represent these institutions when you say you are one of their trainees, and when something goes wrong, you also stain the reputation of these institutions. Remember the “Craig’s List Killer” or the cheating scandal at the Indiana University School of Dentistry? When resumes are reviewed, expectations often are created (and often are self-deluded) based on just the institution associated with the applicant. How does the institution help influence your identity when you graduate and practice?
The fifth domain is “disciplinary” professionalism, and this can take the form of being proud to be a “veterinary student,” “pharmacist,” or a “policy fellow.” Professionals have their own communities so how you connect, interact with, and influence people from different institutions and workplaces is the focus of this domain.
The sixth domain is “universal”, or how you are perceived as a professional to the general public. When health care careers are mentioned, is the public perception of them good or bad? What does the patient or general public understand about “osteopathic medicine”?
Mentors and evaluators easily exist in these other four domains, and your comfort with these four helps significantly with determining your institutional fit (which I mentioned in a previous article is the most elusive competency metric that arguably may truly determine your acceptance to a program). Thus it is important before spending hundreds more dollars on applications to truly get this information and see how those answers appeal to your personal and social domains.