Frederick W. Hafferty and Brian Castellani
It is well worth reading this important and interesting paper in the February edition of Academic Medicine written by two leading sociologists interested in medical education and complexity theory. Writing in the Flexner centenary edition, Hafferty and Castellani show how 100 years ago Flexner saw professionalism as a multifaceted concept and took a systems-approach to treating professionalism as an evolving and dynamic force. He also perceived differences in the nature of professionalism of the ‘physician-clinician’ and the full-time academic ‘physician-scientist’, a role which has now evolved into the medical educator and researcher of today. Flexner also saw tensions between the altruistic nature of vocational professionalism and the increasingly pervasive commercialism, with its inherent conflicts of interest. Today these tensions retain their crucial importance today, especially in the USA, but also elsewhere.
The authors then build on their earlier work (1) proposing seven, often competing, types of professionalism, and offer the concept of professionalism as a complex adaptive system, seen as consisting of three levels (macro, meso and micro) layered in a fractal pattern. The three-level concept might also offer different ways to approach professionalism from a research viewpoint, and they go on to suggest that a complexity perspective might imply new tools such as network theory and analysis to explore professionalism, including such concepts as the informal and hidden curricula (2), known to be important in the professionalisation of both students and doctors. Importantly the suggestion is made that : ‘professionalism must be treated as a complex system if [it] is to function as a positive force for change in 21st-century medicine’.
The following are also available in MedEdWorld:
1. Castellani B, Hafferty FW. The Complexities of Professionalism: a Preliminary Investigation. In: Wear D, Aultman JM, editors. Professionalism in Medicine: Critical Perspectives. New York: Springer; 2006. p. 3-23
2. Hafferty FW. In Search of a Lost Cord: Professionalism and Medical Education's Hidden Curriculum. In: Wear D, Bickel J, editors. Educating for Professionalism: Creating a Culture of Humanism in Medical Education. Iowa Iowa: University of Iowa Press; 2000.
SUBMITTED BY: Jim Price