What is Professionalism?
Can you capture it with a checklist?
One of my charges as a medical educator is to try to teach budding doctors how to be professional.
What exactly is professionalism?
The word likely brings to mind ideas like sharp grooming, snappy attire, articulate speech, confident presence, keen expertise, and so forth. We know it when we see it. And we can easily recognize when something is unprofessional.
But if we’re trying to teach medical students what professionalism is—and also grade them on it and remediate the students who seem to be lacking professionalism—somehow we have to get a more clear and precise definition of professionalism.
How, then, do we better understand a concept like professionalism? We turn to our good old trusted tool of reductionism: break the complex whole down into its constituent parts, study the parts in isolation until they are well-understood, and thereby understand the whole.
So put yourself into my shoes. If you had to reduce the concept of professionalism to a checklist of observable, measurable aspects of a medical student, what would you include?
Grab a paper and a pen, or a notes app or something, and write a few things down. Seriously. Think about it. Make a checklist.
What observable aspects of the students’ dress, communication, behavior, etc. would you use to grade the students on their professionalism during a medical encounter with a standardized “actor” patient?
Ok. Did you write something down? What did you include? Does it look something like this?
Professionalism Assessment:
Professionally dressed
Respectful language
Washed hands
Didn’t interrupt the patient
Maintained poise
Organized and systematic
Knowledgeable about the medical problem
Check, check, and check! You have a professional student! Now, let’s see if your checklist works.
Student number one is being seen by the standardized patient. He meets every single item on our Professionalism Assessment perfectly except for the fact that he openly, blatantly picks his nose in the middle of the encounter, disgusting the patient and the staff watching.
Clearly, picking one’s nose is not professional. But it wasn’t on my checklist. Did your checklist capture it? If not, this student is considered 100% professional.
Recognizing the limitation in our checklist, we revamp it—this time adding the bullet point “Did not pick the nose or touch the face in a distracting way.”
Round two for our student. He knows the updated checklist well, and he follows every checklist item, including the new no-nose-picking expectation. Everything is going well until he suddenly passes gas loudly in front of the patient. Ugh. But none of our checklist items captured it, so this student is, once again, counted as professional, despite the fact that he is clearly not.
And here’s where we get back to our core philosophical conundrum: is the whole truly more than the sum of its parts? Is it even possible to capture what professionalism is by breaking it down into its observable parts? Or is there something to professionalism that can never be adequately captured by understanding its parts—even if our checklist included 1,000 accurate aspects of professionalism?
From my experience with teaching and assessing medical students, I would say professionalism cannot be adequately reduced. No matter how refined our checklist becomes, it will never adequately capture what professionalism is.
But isn’t our checklist close enough?
Maybe. And it has some utility.
If we try to grade our students by simply asking the faculty grader whether the student was professional, we risk getting a wide range of what different faculty members consider professional. So we tend to lean on checklists that, albeit imperfect, give some standardization to our faculty assessments of student professionalism.
But in our effort to standardize do we lose some of the big picture of professionalism? Would we be better off just sticking with something like “Was the student professional? If no, why not?” and assume most people can grasp professionalism as a whole without any accompanying checklist?
I tend to think so.
In that case, I would consider myself a holist when it comes to professionalism—I believe that the whole of professionalism is more than the sum of its parts and can’t be reduced without losing something of the essence of professionalism.
The checklist never quite captures the whole of professionalism. And that causes problems. Especially when real world decisions are based on how we decide to measure, or checklist, big-picture concepts like professionalism in students, employees, or others.
In fact, I think we will next explore some of the problems that often arise in business when we rely too much on reductionism in assessing the performance of our employees.
Please invite your friends to join our exploration!