Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Teaching medical professionalism through literature

Susan Stagno, MD and Michael Blackie, PhD
Education
March 17, 2019
Share
Tweet
Share

A excerpt from From Reading to Healing: Teaching Medical Professionalism through Literature (Literature and Medicine).

There are several traditional ways to teach about professionalism. Some training programs have didactic lectures on this issue. These typically focus on principle-based ethics and “rules” about professionalism. “Do this. Don’t do that.” Most educators and students will agree that lecturing about this topic has some (but limited) value. Applying concrete, principle-based concepts in an ambiguous, sometimes abstract world is difficult.

Another, more useful approach, is recognizing and remediating professionalism lapses in medical students, residents or other trainees, understanding that we must see such events as a developmental and educational opportunity. Students, residents, or other trainees – anyone involved in the care of patients – can come up against a situation or dilemma that taxes one’s limits, creates a scenario that exposes one’s vulnerabilities, or simply presents a circumstance in which the individual does not or cannot respond appropriately. When these situations occur, particularly in training, it becomes a “teachable moment” – deconstructing what happened, why it happened, and how to prevent it from happening in the future. Critical to this process is developing a sense of ownership of what happened and learning and growing from it – not being judged for it (unless, of course, it is so egregious as to be untenable and must result, either for legal or moral reasons, in some definitive sanction). The drawback with this teaching option is that, in the course of training as a student or resident, issues that a given trainee might benefit from learning more about may not arise, resulting in a missed opportunity to learn from and about important professionalism concepts during a time when they can be addressed or remediated.

Another is use of role models – “good” and “bad” – but this approach is inherently risky. While it is easy to applaud doctors with great skills in the patient-physician relationship and who are adept at handling ethically challenging situations, translating these skills and traits we see in such doctors to our learners is challenging. And it’s fairly common for learners to describe behaviors seen in the clinical or other learning environments that they regard as representing “unprofessional” behaviors. But calling these out, processing them and learning from them is not always practical. People in training simply are not going to directly challenge what they perceive as unprofessional behavior with those who are in the position of assessing or grading them, or those who are in authority. Having a safe space to talk about these incidents is one option for teaching, and a useful one, but once again, is limited because we generally hear about the situation or behavior from a singular perspective and do not have the benefit of hearing from the person who is identified as demonstrating the unprofessional behavior, nor from the others in the clinical or learning space – the patient, the family, other members of the health care team. It may well have been that the person who the learner felt displayed unprofessional behavior had a good reason for doing or saying what they did, and the limitations of the learning situation do not allow the issue to be put in context.

In his essay, “Written Role Models in Professionalism Education,” Jack Coulehan addresses these concerns when he writes, “the current emphasis on teaching and evaluating professionalism in clinical education risks failure because of the large gap between explicit professional ideals and today’s culture of medical education. For professionalism curricula to be successful, they must be narrative-based, rather than rule-based.” For Coulehan, and for many of the educators whose pedagogical pieces appear in this volume, an exploration of narrative, especially in literature, offers better preparation for the demands of maintaining standards of professionalism than approaches that rely solely on rules and checklists. Checklists certainly have a place in medicine. Atul Gwande’s The Checklist Manifesto: How to Get Things Right provides a persuasive model for using them effectively in the practical applications of medical science in order to ensure patient safety. But the abstract concepts most often associated with professionalism – altruism, duty, truthfulness, and empathy, to name a few – do not lend themselves to single, observable actions to be checked off as achieved. Rather, these concepts speak to ways of being – of professing – in the practice of medicine, especially when faced with situations rife with ambiguity. For example, educators have noted an association between an intolerance of ambiguity and declines in medical students’ attitudes toward underserved, geriatric, alcoholic, and chronic pain patients. Such intolerance for ambiguity challenges professionalism at its core. Providing students opportunities to engage with ambiguity in literary representations during their education prepares them for its appearance in clinical and other health care settings.

Susan Stagno and Michael Blackie is are editors, From Reading to Healing: Teaching Medical Professionalism through Literature (Literature and Medicine).

Image credit: Shutterstock.com

Prev

The tide is turning: a pro-vaccine Facebook thread

March 17, 2019 Kevin 4
…
Next

Is the physician financial independence community preaching to the choir?

March 17, 2019 Kevin 0
…

Tagged as: Medical school, Psychiatry

Post navigation

< Previous Post
The tide is turning: a pro-vaccine Facebook thread
Next Post >
Is the physician financial independence community preaching to the choir?

ADVERTISEMENT

Related Posts

  • Teaching residents to teach will improve medical education

    Kristin Puhl, MD
  • Professionalism or depersonalization in medical school?

    Anonymous
  • #MedBikini and medical professionalism [PODCAST]

    The Podcast by KevinMD
  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • The medical education system hates families

    Anonymous
  • America’s inadequate LGBTQ medical education

    Haidn Foster

More in Education

  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Why medical student debt is killing primary care in America

    Alexander Camp
  • Why the pre-med path is pushing future doctors to the brink

    Jordan Williamson, MEd
  • Graduating from medical school without family: a story of strength and survival

    Anonymous
  • 2 hours to decide my future: Why the NRMP’s SOAP process is broken

    Nicolette V. S. Sewall, MD, MPH
  • What led me from nurse practitioner to medical school

    Sarah White, APRN
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Who will train the next generation of primary care clinicians without physician mentorship? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • The CDC’s restructuring: Where is the voice of health care in the room?

      Tarek Khrisat, MD | Policy
    • Choosing between care and country: a dual citizen’s Independence Day reflection

      Kathleen Muldoon, PhD | Policy
    • What Elon Musk and Diddy reveal about the price of power

      Osmund Agbo, MD | Conditions
    • 3 tips for using AI medical scribes to save time charting

      Erica Dorn, FNP | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...