Goldstein Erika A, Maestas Ramoncita R, Fryer-Edwards Kelly, Wenrich Marjorie D, Oelschlager Anne-Marie Amies, Baernstein Amy, Kimball Harry R
Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington 98195-7430, USA.
Acad Med. 2006 Oct;81(10):871-6. doi: 10.1097/01.ACM.0000238199.37217.68.
Despite considerable attention to professionalism in medical education nationwide, the majority of attention has focused on training medical students, and less on residents and faculty. Curricular formats are often didactic, removed from the clinical setting, and frequently focus on abstract concepts. As a result of a recent curricular innovation at the University of Washington School of Medicine (UWSOM) in which role-model faculty work with medical students in teaching and modeling clinical skills and professionalism, a new professionalism curriculum was developed for preclinical medical students. Through student feedback, that curriculum has changed over time, and has become more focused on the clinical encounter. This new and evolving curriculum has raised awareness of the existence of an "ecology of professionalism." In this ecological model, changes in the understanding of and attention to professionalism at one institutional level lead to changes at other levels. At the UWSOM, heightened attention to professionalism at the medical student level led to awareness of the need for increased attention to teaching and modeling professionalism among faculty, residents, and staff. This new understanding of professionalism as an institutional responsibility has helped UWSOM teachers and administrators recognize and promote mechanisms that create a "safe" environment for fostering professionalism. In such an institutional culture, students, residents, faculty, staff, and the institution itself are all held accountable for professional behavior, and improvement must be addressed at all levels.
尽管全国范围内的医学教育对专业精神给予了相当多的关注，但大部分关注都集中在医学生的培训上，而对住院医师和教师的关注较少。课程形式往往是说教式的，脱离临床环境，并且经常侧重于抽象概念。由于华盛顿大学医学院（UWSOM）最近进行了一项课程创新，即榜样教师与医学生一起教授和示范临床技能及专业精神，因此为临床前医学生开发了一门新的专业精神课程。通过学生反馈，该课程随着时间的推移而发生了变化，并且更加侧重于临床接触。这一全新且不断发展的课程提高了人们对“专业精神生态”存在的认识。在这种生态模式中，一个机构层面上对专业精神的理解和关注的变化会导致其他层面的变化。在UWSOM，对医学生层面专业精神的高度关注促使人们意识到需要更多地关注教师、住院医师和工作人员中专业精神的教学和示范。这种将专业精神视为机构责任的新理解帮助UWSOM的教师和管理人员认识并推广了为培养专业精神创造“安全”环境的机制。在这样一种机构文化中，学生、住院医师、教师、工作人员以及机构本身都要对专业行为负责，并且必须在各个层面解决改进问题。
