Misch Donald A
Center for Educational Excellence, Medical College of Georgia, Augusta 30912-4773, USA.
Acad Med. 2002 Jun;77(6):489-95. doi: 10.1097/00001888-200206000-00004.
Physicians' professionalism and humanism have become central foci of the efforts of medical educators as the public, various accrediting and licensing agencies, and the profession itself have expressed concerns about the apparent erosion of physicians' competency in these aspects of the art, rather than the science, of medicine. Of the many obstacles to enhancing trainees' skills in these domains, one of the most significant is the difficulty in assessing competency in physicians' professionalism and humanism. The author suggests that the assessment of these aspects of the art of medicine has more in common with the approaches used in criticism of the arts than with the quantitative assessment tools appropriate to the scientific method and the medical model. Quantitative and semi-quantitative tools, so effective in elucidating the etiology, pathophysiology, and treatment of disease, are often in-appropriate and invalid when applied to evaluation of professional and humanistic competencies. The author proposes that humanism "connoisseurs" be employed to qualitatively evaluate medical trainees' professionalism and humanism. Such connoisseurs would possess expert knowledge, training, and experience in the interpersonal aspects of the art of medicine, allowing them to deconstruct concepts such as empathy, compassion, integrity, and respect into their respective key elements while evaluating physicians' behaviors as an integrated, cohesive whole. Through the use of a rich descriptive vocabulary, humanism connoisseurs would provide valid formative and summative feedback regarding competency in medical professionalism and humanism. In the process, they would serve to counteract the relative marginalization of professionalism and humanism in the informal and lived curricula of medical trainees.
随着公众、各种认证和许可机构以及医学行业自身对医生在医学艺术而非科学方面这些能力的明显下降表示担忧，医生的专业精神和人文主义已成为医学教育工作者努力的核心焦点。在提高学员在这些领域技能的众多障碍中，最显著的障碍之一是难以评估医生的专业精神和人文主义能力。作者认为，对医学艺术这些方面的评估与艺术批评中使用的方法有更多共同之处，而不是与适用于科学方法和医学模式的定量评估工具。定量和半定量工具在阐明疾病的病因、病理生理学和治疗方面非常有效，但在应用于评估专业和人文能力时往往不合适且无效。作者提议聘请人文主义“鉴赏家”对医学实习生的专业精神和人文主义进行定性评估。这样的鉴赏家将在医学艺术的人际方面拥有专业知识、培训和经验，使他们在将医生的行为作为一个整体进行评估时，能够将同理心、同情心、正直和尊重等概念解构为各自的关键要素。通过使用丰富的描述性词汇，人文主义鉴赏家将提供关于医学专业精神和人文主义能力的有效形成性和总结性反馈。在此过程中，他们将有助于抵消医学实习生非正式和实际课程中专业精神和人文主义相对边缘化的情况。
