The subject of professionalism has received much attention in recent literature, and in the United States is listed in both the Liaison Committee on Medical Education (LCME) standards
San Antonio Military Medical Center (SAMMC) and Walter Reed National Military Medical Center (WRNMMC) are the two largest graduate medical education (GME) training platforms in the United States Department of Defense. Between the two centers, a complete spectrum of surgical and medical training programs exist, offering residency and fellowship positions to over 1100 military trainees. Both hospitals are designated teaching hospitals for the Uniformed Services University of the Health Sciences (USUHS) F. Edward Hebert School of Medicine. This medical school exclusively trains physicians for service on active duty in the United States Army, Navy, Air Force and Public Health Service. The University begins professionalism training early in medical school, with small group discussions and dedicated didactics. Medical students in the second through fourth years spend the vast majority of their educational experience at military hospitals, including SAMMC and WRNNMC, and almost all will continue with residency training in military medical training centers. Similarly, large proportions (20%) of residents at these two institutions matriculate from USUHS. Therefore, it is important to understand perspectives on professionalism from this spectrum of learners who are fully immersed in the military culture.
Defining professionalism from the learner’s viewpoint
Following Institutional Review Board approval, we emailed an anonymous survey to all residents and fellows at our two training centers asking the learners to free-text the three essential characteristics of a professional. Approximately one-third of the trainees responded. The characteristics of patient-centered and life-long learning were by far the most frequently cited as a defining feature of professionalism. Over half of the respondents from any year group incorporated one or both of those themes. These results were similar to 4th-year medical students in a similar survey of USUHS medical students, but dissimilar to 1st through 3rd-year medical students.
Some educators suggest that professionalism, at its core, cannot be taught, implying if a fundamental understanding is not present at the beginning of training, it will never be fully embraced. This is somewhat supported by data which reveals many residents are facing professionalism lapses in training also suffered similar lapses in medical school, and are at risk to face further negative professional actions following completion of training.
It is likely that the military environment in which they train impacted the residents’ perspective. The military in and of itself is an organization predicated on public service; therefore the concept of patient-centered care--placing the patient’s needs and desires first--is very much in keeping with military culture. Life-long learning is also clearly part of this culture, as military advancement is contingent on obtaining the professional education at all levels of one’s career, as well as fulfilling a broad spectrum of clinical, academic, leadership and administrative roles. Physicians who do not embrace this continuum of change, challenge and education are not promoted and do not advance.
We found that trainees in two large US military teaching hospitals largely define the concept of professionalism as patient-centered care and lifelong learning. These characteristics begin to come into focus for 4th-year medical students and are important to residents in every year and every specialty. They are not necessarily innate in early learners but are acquired late in medical school and likely impacted by observing behaviors in senior residents and faculty. The military environment likely influences this perspective of professionalism, and understanding this point of view is necessary for faculty training these residents. As faculty, if we fully embrace and demonstrate these concepts to our residents, we will increase our impact and credibility as educators in any teaching or learning circumstance. By framing resident education through the context of these two elements, we can improve understanding and resident buy-in of professionalism, the critically important, but often undefined aspect of the complete physician.
The opinions expressed herein are those of the authors and do not represent the official position of the San Antonio Military Medical Center, The Uniformed Services University of the Health Sciences, the United States Army, The United States Navy, the United States Air Force or the United States Department of Defense.
The authors declare that they have no conflict of interest.