Professionalism: a framework to guide medical education.

CONTEXT: Despite considerable advances in the incorporation of professionalism into the formal curriculum, medical students and residents are too often presented with a mechanical, unreflective version of the topic that fails to convey deeper ethical and humanistic aspirations. Some misunderstandings of professionalism are exacerbated by commonly used assessment tools that focus only on superficially observable behaviour and not on moral values and attitudes.
METHODS: Following a selective literature review, we engaged in philosophical ethical analysis to identify the key precepts associated with professionalism that could best guide the development of an appropriately reflective curriculum.
RESULTS: The key precepts needed for a robust presentation of professionalism can be grouped under two headings: 'Professionalism as a trust-generating promise' (representing commitment to patients' interests, more than a mere business, a social contract, a public and collective promise, and hard work), and 'Professionalism as application of virtue to practice' (based on virtue, deeper attitudes rather than mere behaviour, and requiring of practical wisdom).
CONCLUSIONS: These key precepts help students to avoid many common, unreflective misunderstandings of professionalism, and guide faculty staff and students jointly to address the deeper issues required for successful professional identity formation.