Department of Behavioral Sciences, University of Minnesota Medical School-Duluth, Duluth, Minnesota 55812, USA.
Acad Med. 2010 Feb;85(2):288-301. doi: 10.1097/ACM.0b013e3181c85b43.
Organized medicine's modern-day professionalism movement has reached the quarter-century mark. In this article, the authors travel to an earlier time to examine the concept of profession within the work of Abraham Flexner. Although Flexner used the concept sparingly, it is clear that much of his writing on reforming medical education is grounded in his views on physicians as professionals and medicine as a profession. In the first half, the authors explore Flexner's views of profession, which were (1) empirically (as opposed to philosophically) grounded, (2) case based and comparatively framed, (3) sociological in orientation, and (4) systems based, with professionalism conceptualized as dynamic, evolving, and multidimensional. In the second half, the authors build on Flexner's systems perspective to introduce a complexity science understanding of professionalism. They define professionalism as a complex system, introduce a seven-part typology of professionalism, and explore how the organization of physician work and various flash points within medicine today reveal not one but several competing forms of professionalism at work. The authors then develop a tripartite model of professionalism with analysis at the micro, meso, and macro levels. They conclude with observations on how best to frame professionalism as a force for change in 21st-century medical education. Flexner's reforms were grounded in his vision of two particular types of professional-the physician clinician and the full-time academic physician-scientist. The authors propose reform grounded in professionalism as a complex system composed of competing types.
标题：论 Flexner 作品中的医学职业观
摘要：本文旨在回顾 Flexner 作品中蕴含的职业观，其改革医学教育的观点亦根植于此。尽管 Flexner 对“职业”的使用频率不高，但他的许多关于医学教育改革的论述，均是基于他对医师作为专业人士和医学作为一种职业的看法。文中首先分析了 Flexner 的职业观，包括（1）基于经验而非哲学，（2）基于案例和比较框架，（3）倾向于社会学，以及（4）基于系统，将专业主义概念化为动态、不断发展和多维的。在第二部分，作者基于 Flexner 的系统观，引入了复杂性科学视角下的专业主义理解。他们将专业主义定义为一个复杂系统，引入了一个由七个部分组成的专业主义分类法，并探讨了医师工作的组织以及当今医学领域的各种热点问题如何揭示了多种而非单一的专业主义形式。随后，作者构建了一个专业主义的三分模型，在微观、中观和宏观层面进行分析。最后，作者就如何在 21 世纪的医学教育中最好地将专业主义作为变革的力量进行了讨论。Flexner 的改革根植于他对两种特定类型的专业人士的愿景：临床医师和全职学术医师科学家。作者提出了基于专业主义作为一个由竞争类型组成的复杂系统的改革建议。
