What medical students know about professionalism.

Three different sources of data are used to explore how medical students think about the physician as a professional. The data include exercises employed by the University of Minnesota-School of Medicine to foster professionalism among its medical students, such as the skills of peer review and self reflection, a 20-hour course for first-year medical students in which approximately two-thirds of the course focuses directly (e.g., topic-specific readings and class exercises) and indirectly (e.g., medical training and socialization) on the topic of professionalism, and a set of questions asked during admissions interviews which highlight issues of professionalism. Although the data are neither definitive nor generalizable, they do suggest that medical school applicants approach the admissions process well versed in academic and related (e.g., service activities) requirements, but without having given much thought to what it means to be a physician, particularly in terms of professional values. Once in medical school, students express great enthusiasm for being service oriented and doing good but are not necessarily receptive to the notion that they are obliged in these respects. Instead, students express a variety of utilitarian views on things like codes of ethics and medical oaths to support their stance on nonobligation (sometimes directly and sometimes indirectly). Furthermore, students do not draw distinctions among the values commonly associated with professionalism. In particular, they foresee numerous problems associated with integrating the values of altruism and dutifulness into their future practice of medicine.