The environment in which the training and education of medical professionals takes place serves in many ways as the incubator of professionalism. Standards for professional and ethical conduct are beginning to be addressed within the formal curriculum of medical schools but must be re-enforced by example of the faculty and staff. Factors which aid and obstruct professionalism coexist to a greater degree in this environment.
Positive factors - The profession of medicine, and academic medicine in particular, is recognized by society for its service to societal goals, its commitment to healing the sick and the advancement of knowledge. Professionalism is enhanced by the high standards of the educational environment and its dedication to collegiality, support of formal mentoring programs, and formal recognition of faculty, housestaff and student role models.
Negative factors - The increasing expectations in the face of decreasing resources confronting medical professionals, particularly in the academic environment, can threaten professionalism. The list of challenges to professionalism is extensive, but most prominent are stress and overwork; chronic fatigue and sleep deprivation; lack of confidence, self-esteem and experience due to inadequate supervision; tension with other professionals; arrogant and demeaning behavior; exposure to health risks; decreasing revenues despite increasing workloads, and not least family obligations. The academic environment may never be able to eliminate all of these barriers, but by their recognition, efforts may be successful in circumventing them and their potential damage.
Medical professionals, by definition, are expected to demonstrate professionalism. Recognizing that the focus of the Professionalism Initiative document is to define professionalism, the following descriptors serve only as a baseline to identify behavior which is unacceptable for meeting the standards of professionalism inherent in being a medical professional.
Unmet professional responsibility - This includes requiring continual reminders about responsibilities to patients, to the institution and to other health care professionals; unreliability in completing tasks, misrepresenting or falsifying actions and/or information. Accepting but not fulfilling responsibilities on committees, teaching, and mentoring are common examples.
Lack of effort toward self-improvement and adaptability - Medicine and academic science demand continuous personal growth and improvement. Resistance or defensiveness in accepting criticism, remaining unaware of one's own inadequacies, resisting changes, not accepting responsibility for errors or failure, being overly critical, being verbally abusive during times of stress and displaying arrogance are reflections of a poor professional attitude.
Poor interactions with patients and families - A lack of empathy, insensitivity to patients' needs, feelings and wishes or to those of the family, lacking rapport with patients and families, inadequate commitment to honoring the wishes of the patient are symptoms of poor professionalism, not mitigated by skills and good outcomes.
Inappropriate relationships with health care professionals - The inability to function within a team, lacking sensitivity to the needs, feelings and wishes of colleagues, harassment and discrimination are major hindrances to creating a healthy and satisfying professional environment.