“We teach good communication skills because we accept not everyone has them. But we also need to teach professionalism… We’re happier to challenge poor clinical skills, or to point out a gap in knowledge, than to have a conversation about behaviour or attitudes.”
“We expect learners to improve and progress. So, by implication, they’re not perfect professionals: they can make mistakes. It gives people permission to say, “That doesn’t look professional”.”
“We need to work on accepting constructive feedback
for unprofessional behaviours… We want a positive culture, where we teach
people to speak up to promote professionalism.”
[Sheona MacLeod, BMJ 2020;368:m768]
Easier to spot when people are being unprofessional than to teach professionalism!
Which makes me think the issue is conflicting values/priorities rather than not knowing what is “good medical practice”.
So dress codes become an issue when someone’s need to express their individuality or fit in with their peer group clashes with public perceptions of what a health care professional should look like.
Or someone complaining about their work place on social media is wanting to assert their independent spirit even as an employee, perhaps also their right to self expression and to attract “likes”.
And professionalism is clearly performative. We can swear all we want in our heads, but to swear out loud (in most cases) would be considered inappropriate. Which also potentially makes class an issue.
Expectations (of the public but also our peers) change over time. Consider suits, white coats, ties, scrubs. Consider also #medbikini twitter controversy – an article by men describes social media posts of women doctors in bikinis as potentially unprofessional.
Rosenthal 2011 – humanism and professionalism student module included blogging about clerkship experiences, debriefing after significant events, and discussing journal articles, fiction, and film. Main focus however was on empathy.
Scott Oliver and Kathleen Collins described differences in attitudes between medical school students which appeared to suggest a hidden curriculum. Students with more knowledge focus failed to identify potential issues of confidentiality, ethics or trust. Students who had not explored such issues struggled to know how to approach such issues even if they did recognise them.
Definition is probably best medical practice but also the duties and responsibilities of being an employee. High level morals/values (as in GMC good medical practice) are uncontroversial but also hard to then produce policies from (and which can then be defended in court when issues arise).
Clearly some personalities can be more playful, or disagreeable, which are not necessarily negative (cf engaging, whistleblowing) so perhaps more about defining the outer limits rather than homogenizing behaviour.
Surveillance capitalism; social dilemma documentary (mental health declines with higher use; disinformation campaigns; extremism encouraged by algorithms)
Social media is performative (Erving Goffman – the presentation of self (name of his book), life as theatre (metaphorically- although some say actual)).
MedTwitter – now X of course
Human face vs personality cult and influencers
Social media hygiene.
Modelling in absence of “official” voices.
Self curation of brand. Bordieu’s social capital.
How to teach?
Learn through active reflection on work based learning (cf how artificial PBL etc are). Think about values, how they shape communication. Modelling of democratic values. Appreciation of complexity of communication.
[ Alan Bleakley, Peninsula medical school – Homer as evidence of honour/shame/face directed behaviours, cf feminine, guilt directed behaviours etc]
“We teach good communication skills because we accept not everyone has them. But we also need to teach professionalism… We’re happier to challenge poor clinical skills, or to point out a gap in knowledge, than to have a conversation about behaviour or attitudes.”
“We expect learners to improve and progress. So, by implication, they’re not perfect professionals: they can make mistakes. It gives people permission to say, “That doesn’t look professional”.”
“We need to work on accepting constructive feedback for unprofessional behaviours… We want a positive culture, where we teach people to speak up to promote professionalism.”
[Sheona MacLeod, BMJ 2020;368:m768]