Department of Surgery and the Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
Acad Med. 2010 Jan;85(1):134-9. doi: 10.1097/ACM.0b013e3181c47b25.
To explore perceptions of how professionalism is learned in the current academic environment. Professionalism is a core competency in surgery (as in all of medical practice), and its presence or absence affects all aspects of clinical education and practice, but the ways in which professional values and attitudes are best transmitted to developing generations of surgeons have not been well defined.
The authors conducted 34 semistructured interviews of individual surgery residents and faculty members at two academic institutions from 2004 to 2006. Interviews consisted of open-ended questions on how the participants learned professionalism and what they perceived as challenges to learning professionalism. Two researchers analyzed the interview transcripts for emergent themes by using a grounded-theory approach.
Faculty members' and residents' perceptions of how they learned professionalism reflected four major themes: (1) personal values and upbringing, including premedical education experiences, (2) learning by example from professional role models, (3) the structure of the surgery residency, and (4) formal instruction on professionalism. Of these, role modeling was the dominant theme: Participants identified observation, reflection, and reinforcement as playing key roles in their learning from role models and in distinguishing the sometimes blurred boundary between positive and negative role models.
The theoretical framework generated out of this study proposes a focus on specific activities to improve professional education, including an active approach to role modeling through the intentional and explicit demonstration of professional behavior during the course of everyday work; structured, reflective self-examination; and timely and meaningful evaluation and feedback for reinforcement.
探讨当前学术环境中如何学习专业精神的看法。专业精神是外科（如同所有医疗实践）的核心能力，其存在与否会影响临床教育和实践的各个方面，但尚未明确将专业价值观和态度最佳传递给外科医生的方法。
作者于 2004 年至 2006 年在两所学术机构对 34 名外科住院医师和教员进行了半结构式访谈。访谈内容包括参与者如何学习专业精神以及他们认为学习专业精神的挑战等开放性问题。两名研究人员采用扎根理论方法分析访谈记录中的新兴主题。
教员和住院医师对他们学习专业精神的看法反映出四个主要主题：（1）个人价值观和成长背景，包括医学预科教育经历；（2）从专业榜样身上学习，（3）外科住院医师培训的结构；（4）专业精神的正式指导。其中，榜样示范是主要主题：参与者认为观察、反思和强化在从榜样学习以及在区分积极和消极榜样之间有时模糊的界限方面起着关键作用。
本研究提出的理论框架建议将重点放在改善专业教育的具体活动上，包括通过在日常工作中有意和明确地展示专业行为、进行结构化的反思性自我检查以及及时、有意义的强化评估和反馈，积极开展榜样示范。
