When Joel Bervell thought about professionalism as a student, “Grey’s Anatomy” came to mind. Specifically, he thought about what was expected of the show’s residents, even though it often wasn’t: punctual, prepared for their cases, and respectful of everyone around them.
“That was the only measure I had of what it meant to be a doctor – especially someone like me who doesn’t come from a family of doctors,” Mr Bervell said. 28, a fourth-year medical student at Washington State University. Mr. Bervell, a Ghanaian American, is one of the first black medical students at the medical school, which opened in 2017.
From the moment students enter medical school, they are instilled with the concept of medical professionalism: their sacred responsibility to behave in accordance with the values of a profession that is automatically trusted by society. “It’s the first thing they tell you: You’re literally a medical professional now,” Mr. Bervell said.
The same metric can be used to determine whether or not a medical student will even become a doctor.
Mr. Bervell learned that he and his classmates would be regularly assessed on their performance starting in their third year professional behavior, along with other attributes such as communication skills. Faculty, staff, and other students may also express specific concerns about an individual’s professionalism, which could result in written records, the contents of which could be appended to their permanent records and follow them like scarlet letters.
The problem, as many medical students have also learned, is that “professional” is still vague, while “unprofessional” is even more unclear. Depending on who makes the call, it could be unprofessional behavior embrace Your program director, who a Bra strap showcarry braidsPutting on one swimsuit over the weekend or wearing one “Black lives matter” sweatshirt In the emergency room
As a result, professionalism exists on two levels: both as a high standard of behavior and as (sometimes literally) List of do’s and don’ts that mix ethics and appearance. This second meaning can prove particularly damaging for residents of color, Dr. Adaira Landry, a consultant at Harvard Medical School and co-author of a Current magazine article about the “over-policing” of black residents.
The article was published in the New England Journal of Medicine, adds to the growing literature documenting the ways in which residents of color live disciplined or pushed out of medicine. In the year 2015–16 20 percent of the trainees discharged from their residency were black, even though black students make up only 5 percent of residents, according to unpublished data from the Accreditation Council for Graduate Medical Education (ACGME).
For students who did not grow up in the culture of medicine or who do not conform to an outdated idea of what a doctor should look like (white, male, elite), these opaque rules can be a minefield. “The environment limits what is allowed in such a way that if you behave, look or speak differently, it seems unprofessional,” said Dr. Landry.
Among the minority students with whom Dr. Landry and those facing probation or release, she has found a common denominator. “I have never had a student tell me they were being kicked out because of an academic grade,” she said. “The overwhelming theme is that it is interpersonal conflicts that are labeled as professional challenges.”
From the code of ethics to the dress code
The high ideals Mr. Bervell encountered on his first day are more consistent with the original notion of professionalism, said Dr. David C. Leach, who served as executive director of the ACGME from 1997 to 2007.
At this time, medicine was at a crossroads. Huge companies took over individual practices and turned them into for-profit businesses. Doctors saw their time with patients decrease and the quality of patient care decrease.
“There was a growing public perception that doctors were like everyone else: they just wanted to make money,” said Dr. Matthew Wynia, a medical ethicist who worked on the ethics of managed care during this time. “The fear was that our sense of professionalism would be lost.”
In response, the Council set out to establish a set of general competencies: measurable results that a resident had to provide proof before they could go to the doctor.
Of the six competencies the Council ultimately established, professionalism came closest to the core of what it means to be a doctor. “It is a series of promises about the trustworthiness of both the profession as a whole and the people within it.” Dr. Leach wrote in 2014. Many believed that professionalism was the key to helping medicine restore its values as an ethics-based, altruistic profession – one committed to patients, not the bottom line.
Professionalism was also the vaguest competence on the list. The 1999 definition characterized professionalism as a “commitment to assuming professional responsibility, adhering to ethical principles and being sensitive to a diverse group of patients.” Doctors were also expected to demonstrate an array of attributes in every interaction, including compassion, respect, humility, integrity and responsibility.
Home leaders complained that professionalism was poor and difficult to measure compared to things like patient care and medical knowledge. The concern boiled down to the question, “I’m a very busy program director, so what the hell should I do?” recalled Dr. Leah.
The problem of vagueness never went away, said Dr. Deborah Powell, a former dean of the University of Kansas School of Medicine who sat on the ACGME board at the time. In the 2000s, discussions about what constitutes professionalism often focused on the way doctors should dress. “You shouldn’t have beards, you shouldn’t have long hair, women should wear skirts,” said Dr. Powell. “It was crazy. We overdid it.”
These conversations are still taking place today. Dr. Londyn Robinson, now a resident at Duke University, learned the second definition of professionalism in 2020. When she was looking for tips on applying for an internship, she came across this an article in the journal Vascular Surgery entitled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons.”
The authors scoured the social media accounts of 500 aspiring surgeons and rated them on their professionalism without their knowledge. By the authors’ definition, potentially unprofessional content included photos of residents holding alcoholic beverages, wearing Halloween costumes, or “posing provocatively in bikinis/swimwear.”
For Dr. Robinson, the first in her family to earn a doctorate, revealed the work revealed that for some, professionalism has been reduced to superficial qualities rather than ethical behavior towards patients. “Basically they said the quiet part out loud,” she said.
A new ideal
Like Dr. Robinson learned, the professionalism now radiates beyond the clinic or classroom. Mr. Bervell’s lecturers had warned him about the consequences of social media: Since medical students represented the profession at all times, they said that as a professional you had to think twice before talking about politics or current issues such as abortion online.
Mr. Bervell didn’t really heed that warning. During the Covid-19 pandemic, he began making TikTok videos pointing out racial bias in medical tools like Pulse oximeter And Pulmonary function tests. (Studies have found that both are less true for non-white patients), earning him the nickname “medical myth-buster.” His videos were included in medical school curricula and received widespread praise from the American Medical Association And earned him a seat at the White House Healthcare Leaders in Social Media Roundtable.
By his own school’s standards, Mr. Bervell said his social media activism could be viewed as unprofessional. But he added that part of his role is to change medicine – and perhaps give doctors something better than “Grey’s Anatomy” as a model for practicing medicine, he added.
The vagueness of professionalism can be challenging not only for students of color, but for anyone who does not fit the historical stereotype of a doctor. Dr. Robinson found that people judged by their swimwear in the journal Vascular Surgery were more often women than men.
In 2020, outraged by the newspaper, She posted a photo of herself in a bikini top and shorts on X, formerly known as Twitter, with the hashtag #MedBikini. “I’ll say it: I wear bikinis. “I’m going to be a doctor,” wrote Dr. Robinson. The next day, Her post had gone viraland the paper was officially withdrawn.
In an apologythe journal’s editors acknowledged that “professionalism has historically been defined by and for white, heterosexual men and does not always reflect the diversity of our workforce or our patients.”
As the face of medicine changes and platforms like TikTok and Twitter transform the way medical knowledge is shared, the original architects of professionalism still believe that the core principles of the term will remain central to medicine.
For Dr. Leach, the definition is simple. “Are you demanding and do you tell the truth? Do you put the patient’s interests ahead of your own? “And develop practical wisdom that can combine the best scientific evidence with the specifics of that particular patient to make a creative clinical decision?” he said. “If you do these three things, then you are professional.”
He added: “And a dress code is a far cry from those three things.”