Skip to main content Accessibility help
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Print publication year: 2010
  • Online publication date: November 2010

Chapter 14 - Training in professionalism


This chapter addresses the question of whether professionalism can be effectively taught, by examining what it means to teach professionalism, proposed strategies to teach it, evidence of effectiveness of interventions aimed at teaching or improving professionalism and evidence of ability to identify or predict unprofessional behaviour. In one of the primary texts on professionalism education, Hafferty notes that professionalism lies in an interface between possession of specialized knowledge, and using that knowledge for the betterment of others'. Learning the professionalism of Hafferty and Smith occurs in the culture of medical school and residency, where examples, narratives and role modelling occur. To improve this learning would require changes in the culture of medical schools. In addition to the efforts to teach professionalism to all students, many schools have programmes specifically to identify, presumably for the purpose of remediation, and students with unprofessional behaviours.

Related content

Powered by UNSILO


ABIM Foundation, ACP-ASIM Foundation, EFIM (2002). Medical professionalism in the new millennium: a physician charter. Annals of Internal Medicine 136(3), 243–246.
AjzenI (1985). From intentions to action: a theory of planned behaviour. In J Kuhl, J Beckmann (eds.) Action-Control: From Cognition to Behaviour. Heidelberg: Springer, pp. 11–39.
AlbarracinD, JohnsonB T, FishbeinM, MuellerleileP A (2001). Theories of reasoned action and planned behaviour as models of condom use: a meta-analysis. Psychological Bulletin 127, 142–161.
AngM (2002). Advanced communication skills: conflict management and persuasion. Academic Medicine 77, 1166.
ArcherR, ElderW, HusteddeC, MilamA, JoyceJ (2008). The theory of planned behaviour in medical education: a model for integrating professionalism training. Medical Education 42, 771–777.
ArnoldL (2002). Assessing professional behaviour: yesterday, today and tomorrow. Academic Medicine 77, 502–515.
BaldwinD C, Jr, BunchW H (2000). Moral reasoning, professionalism, and the teaching of ethics to orthopaedic surgeons. Clinical Orthopaedics and Related Research 378, 97–103.
BanduraA, AdamsN E, BeyerJ (1977). Cognitive processes mediating behavioural change. Journal of Personality and Social Psychology 35, 125–139.
BerR, AlroyG (2002). Teaching professionalism with the aid of trigger films. Medical Teacher 24, 528–531.
BickelJ (1991). Medical students’ professional ethics: defining the problems and developing resources. Academic Medicine 66, 726–729.
BilletS (2002). Guided learning at work. In D Boud, J Garrick (eds.) Understanding Learning at Work. New York: Routledge, pp. 151–164.
BoeninkA D, de JongeP, SmalK, OderwaldA, van TilburgW (2005). The effects of teaching medical professionalism by means of vignettes: an exploratory study. Medical Teacher 27(5), 429–432.
BoonK, TurnerJ (2004). Ethical and professional conduct of medical students: review of current assessment measures and controversies. Journal of Medical Ethics 30, 221–226.
BrowneA, CarpenterC, CooledgeC, et al. (1995). Bridging the professions: an integrated and interdisciplinary approach to teaching health care ethics. Academic Medicine 70(11), 1002–1005.
Centre for Innovation in Professional Health Education and Research (CIPHER) (2007). Review of Work-Based Assessment Methods. Sydney: University of Sydney.
ConnerM, KirkS F L, CadeJ E, BarrettJ H (2001). Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use. Social Science and Medicine 52, 621–633.
ConnerM, SparksP (2005). Theory of planned behaviour and health behaviour. In M Conner, P Norman (eds.) Predicting Health Behaviour. Milton Keynes: Open University Press, pp. 170–222.
CruessR L, CruessS R, SteinertY (2009). Teaching Medical Professionalism. New York: Cambridge University Press.
EcclesM, GrimshawJ, WalkerA, JohnstonM, PittsN (2005). Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. Journal of Clinical Epidemiology 58, 107–112.
EcclesM P, GrimshawJ M, JohnstonM, et al. (2007). Applying psychological theories to evidence-based clinical practice: identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implementation Science 2, 26.
FawcettJ (1989). Conceptual Models and Theories: Analysis and Evaluation of Conceptual Models of Nursing. Philadelphia, PA: F.A. Davis Company.
FincherR E (2001). A longitudinal approach to teaching and assessing professional attitudes and behaviours in medical school. Academic Medicine 76, 505–506.
GaiserR R (2009). The teaching of professionalism during residency: why it is failing and a suggestion to improve its success. Anesthesia & Analgesia 108, 948–954.
General Medical Council (2001). Good Medical Practice. London: GMC.
General Medical Council (2002). Tomorrow's Doctors: Recommendations on Undergraduate Medical Education. London: GMC.
GibsonD D, ColdwellL L, KiewittS F (2000). Creating a culture of professionalism: an integrated approach. Academic Medicine 75, 509.
GinsburgS, RegehrG, HatalaR, et al. (2000). Context, conflict and resolution: a new conceptual framework for evaluating professionalism. Academic Medicine 75(10 Suppl), S6–S11.
GlanzK, LewisF, RimerB (1997). Theory, research and practice in health behavior and health education. In K Glanz, F Lewis, B Rimer (eds.) Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass, pp. 22–40.
GodinG, Belanger-GravelA, EcclesM, GrimshawJ (2008). Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implementation Science 3, 36.
GoldieJ (2008). Integrating professionalism teaching into undergraduate medical education in the UK setting. Medical Teacher 30, 513–527.
GoldieJ, SchwartzL, McConnachieA, MorrisonJ (2002). The impact of three years’ ethics teaching in an integrated medical curriculum, on students’ proposed behaviour on meeting ethical dilemmas. Medical Education 36, 489–497.
GoldieJ, SchwartzL, McConnachieA, MorrisonJ (2003). Students’ attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum. Medical Education 37, 368–375.
GoldsteinE A, MaestasR R, Fryer-EdwardsK, et al. (2006). Professionalism in medical education: an institutional challenge. Academic Medicine 81, 871–876.
GordonG (2003). Fostering students’ personal and professional development in medicine: a new framework for PPD. Medical Education 37, 341–349.
GrimshawJ M, EcclesM P, WalkerA E, ThomasR E (2002). Changing physicians’ behavior: what works and thoughts on getting more things to work. Journal of Continuing Education in the Health Professions 22, 237–243.
HaffertyF W (2002). What medical students know about professionalism. The Mount Sinai Journal of Medicine 69, 385–397.
HiltonS R, SlotnickH B (2005). Protoprofes-sionalism: how professionalisation occurs across the continuum of medical education. Medical Education 39, 58–65.
HoltmanM C (2008). A theoretical sketch of medical professionalism as a normative complex. Advances in Health Science Education 13, 233–245.
HoweA (2002). Professional development in undergraduate medical education. Medical Education 34, 353–359.
JacksonP (1966). The students’ world. The Elementary School Journal 66, 353.
JhaV, BekkerH L, DuffyS R G, RobertsT E (2005). Perceptions of professionalism in medicine: a qualitative study. Medical Education 40, 1027–1036.
JhaV, BekkerH L, DuffyS R G, RobertsT E (2007a). A systematic review of studies assessing and facilitating attitudes towards professionalism in medicine. Medical Education 41, 822–829.
JhaV, BekkerH L, PellG, ConnerM, RobertsT E (2007b). Influence of attitudes and beliefs on prediction of medical students’ intentions to behave professionally. Abstracts of Association of Medical Education in Europe (AMEE) Conference, Trondheim, 134.
LaveJ, WengerE (1991). Situated Learning. Legitimate Peripheral Participation. Cambridge: Cambridge University Press.
LingardL, ReznickR, EspinS, RegehrG, DeVitoI (2002). Team communications in the operating room: talk patterns, sites of tension, and implications for novices. Academic Medicine 77, 232–237.
LoeserH, PapadakisM (2000). Promoting and assessing professionalism in the first two years of medical school. Academic Medicine 75, 509–510.
LynchD C, SurdykP M, EiserA R (2004). Assessing professionalism: a review of the literature. Medical Teacher 26, 366–373.
McMillanB, ConnerM (2003). Applying an extended version of the theory of planned behaviour to illicit drug use among students. Journal of Applied Social Psychology 33, 1662–1683.
MeetzH K, BebeauM J, ThomaS J (1988). The validity and reliability of a clinical performance rating scale. Journal of Dental Education 52(6), 290–297.
MooreG T, BlockS D, StyleC B, MitchellR (1994). The influence of the New Pathway Curriculum on Harvard medical students. Academic Medicine 69, 983–989.
MultonK D, BrownS D, LentR W (1991). Relation of self-efficacy beliefs to academic outcomes: a meta-analytic investigation. Journal of Counselling Psychology 38, 30–38.
NorciniJ J, BurchV (2007). Workplace-based assessment as an educational tool: AMEE Guide No. 31. Medical Teacher 29(9), 855–871.
PapadakisM A, OsbornE H, CookeM, HealyK (1999). A strategy for the detection and evaluation of unprofessional behaviour in medical students. Academic Medicine 74, 980–990.
PapadakisM A, HodgsonC S, TeheraniA, KohatsuN D (2004). Unprofessional behaviour in medical school is associated with subsequent disciplinary action by a State Medical Board. Academic Medicine 79(3), 244–249.
ParkerM, LukeH, ZhangJ, WilkinsonD, PetersonR, OzolinsL (2008). The ‘pyramid of professionalism’: seven years of experience with an integrated program of teaching, developing and assessing professionalism among medical students. Academic Medicine 83, 733–741.
PololiL, FrankelR M, ClayM, JobeA C (2001). One year's experience with a programme to facilitate personal and professional development in medical students using reflection groups. Education for Health 14, 36–49.
PopperK (2002). The Logic of Scientific Discovery. London: Routledge Classics.
ReesC E, KnightL V (2007). The trouble with assessing students’ professional behaviors: theoretical insights from socio-cognitive psychology. Academic Medicine 82, 46–50.
RowleyB D, BaldwinD C, Jr, BayRC, CannulaM (2000). Can professional values be taught? A look at residency training. Clinical Orthopaedics 378, 110–114.
Royal College of Physicians (2005). Doctors in Society: Medical Professionalism in a Changing World. Report of a working party of the Royal College of Physicians of London. London: RCP.
SierlesF, HendrickxI, CircleS (1980). Cheating in medical school. Journal of Medical Education 55(2), 124–125.
SteinertY (2009). Educational theory and strategies for teaching and learning professionalism. In R L Cruess, S R Cruess, Y Steinert (eds.) Teaching Medical Professionalism. New York: Cambridge University Press, pp. 31–52.
StephensonA E, AdsheadL E, HiggsR H (2006). The teaching of professional attitudes within UK medical schools: reported difficulties and good practice. Medical Education 40, 1072–1080.
SternD T (1998). In search of the informal curriculum: when and where professional values are taught. Academic Medicine 73, S28–S30.
SwickH M, SzenasP, DanoffD, WhitcombM E (1999). Teaching professionalism in undergraduate medical education. Journal of the American Medical Association 282, 830–832.
TangT S, FantoneJ C, BozynskiM E A, AdamsB S (2002). Implementation and evaluation of an undergraduate sociocultural medicine program. Academic Medicine 77, 578–585.
VeloskiJ J, FieldsS K, BoexJ R, BlankL L (2005). Measuring professionalism: a review of studies with instruments reported in the literature between 1982 and 2002. Academic Medicine 80, 366–370.
WagnerP, HendrichJ, MoseleyG, HudsonV (2007). Defining medical professionalism: a qualitative study. Medical Education 41, 288–294.
WearD (1998). On white coats and professional development: the formal and hidden curricula. Annals of Internal Medicine 129, 734–737.
WilkinsonT J, WadeW B, KnockL D (2009). A blueprint to assess professionalism: results of a systematic review. Academic Medicine 84, 551–558.
WoloschukW, HarasymP H, TempleW (2004). Attitude change during medical school: a cohort study. Medical Education 38, 522–534.
YeheskelA, BidermanA, BorkanJ M, HermanJ (2000). A course for teaching patient-centered medicine to family medicine residents. Academic Medicine 75, 494–497.