Hafferty Frederic W
University of Minnesota Medical School, Duluth, MN 55812-2487, USA.
Clin Orthop Relat Res. 2006 Aug;449:193-204. doi: 10.1097/01.blo.0000229273.20829.d0.
This paper examines issues of medical professionalism using definitions and meanings as its analytic lens. It explores similarities, differences, and changes in meaning and interpretation over time and across three primary literatures of professionalism: sociology, medicine, and education. In compiling these literatures, three stages in the evolution of medical professionalism emerged: the first (1980s-early 1990s) was dominated by the polemics of professionalism and commercialism; a second (1900s) was dominated by calls to define medical professionalism as a concept and as a competency; the third (late 1990s-current) quickly superseded calls to define by highlighting the need to develop measures and metrics. Across these three stages, two sets of "authoritative voices" emerged in the medical literature with certain medical organizations and journal articles beginning to dominate, and in certain cases dictate, agendas and debates. The paper closes with an extended discussion of the largely US based and sociologically focused "new professionalism" literature, and contrasts this with a parallel UK medically based literature. The paper closes with a set of six conclusions covering the lessons learned in compiling this literature.
本文以定义和意义为分析视角,探讨医学职业精神的相关问题。它探究了不同时间以及横跨专业精神的三个主要文献领域(社会学、医学和教育)在意义及阐释方面的异同与变化。在编纂这些文献时,医学职业精神的演变呈现出三个阶段:第一阶段(20世纪80年代至90年代初)以职业精神与商业主义的论战为主导;第二阶段(21世纪初)以将医学职业精神界定为一种概念和能力的呼声为主导;第三阶段(20世纪90年代末至今)迅速取代了界定的呼声,转而强调制定措施和指标的必要性。在这三个阶段中,医学文献中出现了两组“权威声音”,某些医学组织和期刊文章开始主导,在某些情况下还左右着议程和辩论。本文结尾对主要基于美国且聚焦于社会学的“新职业精神”文献进行了深入讨论,并将其与英国基于医学的平行文献进行了对比。本文结尾给出了六点结论,涵盖了编纂此文献过程中的经验教训。