Professionalism: an ideal to be sustained

doi:10.1016/S0140-6736(00)02458-2

The Lancet

Volume 356, Issue 9224, 8 July 2000, Pages 156-159

https://doi.org/10.1016/S0140-6736(00)02458-2 Get rights and content

Introduction

A gulf has developed between the medical profession and the society it serves. As one observer noted, “A better informed community is asking for accountability, transparency, and sound professional standards”, whereas medicine feels that “the professional's autonomy is severely restricted by budgets, bureaucracy, guidelines, and peer review”.¹ The concept of professionalism bridges the interests of physicians and society2, 3, 4 as society's need for the healer and its belief in the inherent virtue and morality of professionalism have served as the basis of modern medicine.5, 6 They are the source of the rights and privileges granted to the medical profession and of the values that physicians feel contribute to what is noble and good in their calling. Recently, a series of highly publicised events has encouraged the view that the medical profession fails to meet many of the obligations required to sustain its professionalism. In all countries, irrespective of the structure of the health-care system, threats to the values of professionalism are seen.¹ As physicians and society try to bridge the gap widened by the perceived lapses in professional standards, a redefinition of expectations and roles is taking place. To prevent medicine from becoming a commodity in a market-oriented world, physicians must participate in shaping the profession's future and understand the principles and obligations associated with being a member of a profession.

Section snippets

Role of professionalism

Society has used the concept of the profession to organise and deliver many of the complex services it requires, with the rationale that the expertise necessary to the practice of certain vocations is not easily comprehensible to the average citizen.2, 3, 5, 6

Traditional professionalism came to apply to knowledge-based activities requiring long periods of education and training and entailing service for the common good. In medicine, it was the services of the healer, whose roots can be traced

Nature of professionalism

The core elements of a profession are possession of a specialised body of knowledge and commitment to service.⁹ The Oxford English Dictionary defines a “profession” as, “The occupation which one professes to be skilled in and to follow. a) a vocation in which professed knowledge of some department of learning or science is used in its application to the affairs of others or in the practice of an art founded upon it, b) in a wider sense any calling or occupation by which a person habitually

Evolution of professionalism

The fundamental principles of professionalism have not been analysed extensively by the medical community. Most contributions have come from the social sciences and bioethics.

The early literature was largely favourable. There was faith in the virtue, morality, and service commitment of professionals, 15, 16, 17, 18 although the tension between selfinterest and altruism was identified. The collegial nature of the profession was believed to encourage and foster altruistic behaviour.8, 9, 17, 18

Taking professionalism into the future

As the contract between society and the professions is being redefined, both the public and the profession may, at times, be dissatisfied or disillusioned. Concerns expressed by the public as recorded in the lay press and social science literature relate to the integrity of medicine's knowledge base, imperfect self-regulation with unsatisfactory assurance of quality, less than altruistic behaviour on the part of some physicians and professional associations, and dissatisfaction with the

Conclusions

The ideal of the professional spans three centuries, originating in the 19th century. During the 20th century, some of the values and obligations of the profession were neglected and serious questions were posed as to whether professionalism constituted a proper basis for the organisation of the delivery of health care. As we enter the 21st century, the concept seems not only to have survived but also to be once more endorsed, albeit in renewed form. This renewal should build on the morality

First page preview

Click to open first page preview

View PDF

References (34)

AJ Dunning
Status of the doctor–present and future
Lancet
(1999)
D Irvine
The performance of doctors: the new professionalism
Lancet
(1999)
P Starr
The social transformation of American medicine
(1984)
E Freidson
Professional dominance: the social structure of medical care
(1970)
J Kultgen
Ethics and professionalism
(1988)
R Cruess et al.
Teaching medicine as a profession in the service of healing
Acad Med
(1997)
R Cruess et al.
Renewing professionalism: an opportunity for medicine
Acad Med
(1999)
P Sohl et al.
Codes of medical ethics: traditional foundations and contemporary practice
Soc Sci Med
(1980)
W Sullivan
Work and integrity: the crisis and promise of professionalism in North America
(1995)
W Goode
The theoretical limits of professionalism

Oxford English Dictionary.

(1989)

E Freidson

Professionalism reborn

(1994)

CK Ihara

Collegiality as a professional virtue

H Perkin

The third revolution: professional elite in the modern world

(1996)

D Mechanic

Changing medical organization and the erosion of trust

Milbank Q

(1996)

S Webb et al.

Professional associations

New Statesman

(1917)

A Flexner

Is social work a profession?

School Soc

(1915)

Cited by (113)

Pro Bono Services in 4 Health Care Professions: A Discussion of Exemplars
2020, Journal of Chiropractic Humanities
Citation Excerpt :
The foundational ethics of health care are congruent with the intent and application of pro bono and charity efforts in all aspects of health care. An individual in need of care is deserving of such, irrespective of their ability to afford it.24 Health, liberty and quality of life are considered the highest ideals, paramount in any advanced society.
The purpose of this article is to discuss exemplars of pro bono and charity activities in health care professions.
We searched PubMed and Google Scholar from inception to August 2019 using search terms “pro bono healthcare,” “medical volunteerism,” “pro bono clinics OR free clinics OR organizations,” “pro bono curriculum OR education,” “underserved OR uninsured OR underinsured OR disadvantaged OR poor populations.” Inclusion criteria were that practitioners, students, or volunteers be involved in pro bono care or education and in any discipline, including medicine, physical therapy, chiropractic, or dentistry.
We selected 5 exemplars to review, and determined that students can benefit from participation in pro bono or charity health care such as through a student administered clinic model. Academic curricula can play a role in building confidence and create positive attitudes and behaviors regarding pro bono and charity activities, and nonprofit organizations can help build sustainable models.
We conclude that the implementation and delivery of health care pro bono or charity services can fill a health care gap and can be applied successfully in the health professions.
Trust as an analytical concept for the study of welfare programs to reduce child health disparities: The case of a Swedish postnatal home visiting programme
2020, Children and Youth Services Review
Citation Excerpt :
The management practices of the professionals’ organisations can be significant for the professionals’ attitudes and practices towards the parents. The trend in the management of healthcare and welfare organisations with a focus on evidence-based national guidelines, quality indicators and performance monitoring have been described as a departure from the traditional trust in a profession’s autonomy to set its standards (Cruess, Cruess & Johnston, 2000) and power to decide how to use its expertise in the treatment of the individual patient (Freidson, 1994). In contrast, management practices that are more based on trust will permit professional discretion and the opportunity to involve clients in the problem-solving process in accordance with a client-centred approach (Gilson, 2003).
The aim of this article is to outline a theoretical framework for how the concept of trust can be used as analytical tool for a study of the aim, design, output and societal legitimacy of a Swedish welfare programme conducted to reduce disparities in health and social inequities and to give newborn a positive start in life. This programme, labelled Grow Safely, implies that home visits will be conducted at six occasions at first-time parents by different professionals: child health care nurses, midwifes, dental hygienists and counsellors from the social services. Prior to when the intervention is carried out, the involved professionals in the programme will be participating in training in order to increase the possibility that the home visits will be carried out in similar ways and be followed the same manual throughout the programme.
The welfare programme will be based on relationships on different levels: between professionals and parents, between different professionals, between professionals and managers, and between organisations. Trust is believed to be of significance for the development of relationships as well as for the social legitimacy of the implantation of welfare programmes. Therefore, our ambition is to embrace a broad perspective on trust, combining insights from a variety of research traditions and analyses on macro, meso and micro levels in the outline a model for how the concept of trust can be used as an analytical tool for studying welfare programmes like Grow Safely. We argue for that the model can capture the significance of trust at different levels: individual, professional, organisational and societal levels as well as interplays between these levels, and consequently be useful in to analyse implementations of welfare programmes.
Adaptation, psychometric properties and feasibility of the Professionalism Scale Germany
2016, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen
Pre- and postgraduate education is meant to be competency-based. Over the last two decades various competency frameworks have been published. An important aspect of competency is professionalism, being discussed widely in the literature while a clear-cut definition is still lacking. The purpose of this study was to translate the Nijmegen Professionalism Scale into the German language, to adapt the scale to the German setting and to examine the psychometric properties, test-retest reliability and feasibility of the culturally adapted instrument designed to assess professionalism in general practice, in addition to the validity of the concept of professionalism and to testify the transfer across linguistic, cultural and societal differences.
After translating the Nijmegen Professional Scale into German, we conducted its cultural adaptation, the German Professionalism Scale (Pro-D). Its psychometric properties were assessed using Cronbach's α, descriptive statistics, and test-retest reliability. The validation of the construct was analysed by confirmatory factor analysis. Feasibility was confirmed in interviews with GP trainees and their trainers.
A total of 133 trainees completed the Pro-D. The Pro-D showed high internal consistency (Cronbach's α 0.93) and good test-retest reliability (Spearman's rank correlation and Wilcoxon's matched-pairs test) for the different domains. Confirmatory factor analysis was unable to establish construct validity. Change in sensitivity of the instrument was good. Statements of interviews confirmed the feasibility of the new instrument.
We found good psychometric properties for the Pro-D. This might indicate transferability of the concept across linguistic, cultural and societal differences although the concept of professionalism was not replicated in a confirmatory factor analysis.
Die medizinische Ausbildung wird zunehmend kompetenzbasiert. In den letzten beiden Jahrzehnten wurden daher unterschiedliche Kompetenzmodelle veröffentlicht. Ein Kompetenzfeld ist das der Professionalität, wobei bisher noch keine einheitliche Definition für dieses Kompetenzfeld gefunden wurde. Ziel der hier berichteten Studie war die Übersetzung und Adaptation der „Nijmegen Professionalism Scale“, ein Instrument zur Beurteilung von Professionalität, auf die deutsche Weiterbildungssituation sowie die Überprüfung der psychometrischen Eigenschaften, der Test-Retest-Reliabilität und Anwendbarkeit des neuen Instruments in der Weiterbildung. Zusätzlich sollte die Validität des theoretischen Konstrukts des Instruments überprüft werden. Damit sollte ein Beispiel für den Transfer von Instrumenten zur Überprüfung des Kompetenzfelds über sprachliche und kulturelle Grenzen hinweg gezeigt werden.
Es wurde eine Übersetzung und kulturelle Adaptation der „Nijmegen Professional Scale“ in die deutsche Sprache (Professionalitäts-Skala Deutschland, Pro-D) durchgeführt. Die psychometrischen Eigenschaften wurden mittels Cronbachs α, deskriptiver Statistik und der Betrachtung der Test-Retest-Reliabilität geprüft. Zur Validierung des theoretischen Konstrukts des Instruments wurde eine konfirmatorische Faktorenanalyse durchgeführt. Die Anwendbarkeit auf die deutsche Weiterbildungssitutation wurde in Gruppeninterviews mit Ärzten in Weiterbildung und deren Weiterbildern evaluiert.
Insgesamt 133 Ärzte in Weiterbildung füllten das neue Instrument Pro-D aus. Die Ergebnisse zeigten eine hohes Maß an interner Konsistenz (Cronbach α 0,93) und eine gute Test-Retest-Reliabilität (Spearmans Rangsummen-Korrelation und der Wilcoxon-Vorzeichen-Rang-Test) für das neue Instrument an. Eine konfirmatorische Faktorenanalyse konnte das theoretische Konstrukt nicht bestätigen. Das Instrument zeigte eine gute Veränderungssensitivität. Die durchgeführten Interviews bestätigten die Anwendbarkeit in der deutschen Weiterbildung.
Die Pro-D weist gute psychometrische Eigenschaften auf. Die Bestätigung des theoretischen Konstrukts in der konfirmatorischen Faktorenanalyse schlug fehl. Dennoch kann diese Studie als Hinweis für den Transfer eines Instruments zur Überprüfung des Kompetenzfeldes über sprachliche und kulturelle Grenzen hinweg angesehen werden.
Translating Professional Obligations to Care for Patients with Ebola Virus Disease into Practice in Nonepidemic Settings
2015, Disaster Medicine and Public Health Preparedness
Mindfulness training in healthcare professions: A scoping review of systematic reviews
2024, Medical Education
Workplace support for newly qualified doctors and secondary school teachers: A comparative analysis
2023, British Educational Research Journal

View all citing articles on Scopus

View full text

ViewpointProfessionalism: an ideal to be sustained

Introduction

Section snippets

Role of professionalism

Nature of professionalism

Evolution of professionalism

Taking professionalism into the future

Conclusions

First page preview

Lancet

Lancet

The social transformation of American medicine

Professional dominance: the social structure of medical care

Ethics and professionalism

Teaching medicine as a profession in the service of healing

Acad Med

Renewing professionalism: an opportunity for medicine

Acad Med

Codes of medical ethics: traditional foundations and contemporary practice

Soc Sci Med

Work and integrity: the crisis and promise of professionalism in North America

The theoretical limits of professionalism