Kinghorn Warren A
DurhamVA Medical Center, Duke Divinity School, Durham, NC 27705,USA.
Perspect Biol Med. 2010 Winter;53(1):87-105. doi: 10.1353/pbm.0.0145.
The medical professionalism movement, bolstered by many influential medical organizations and institutions, has in the last decade produced a number of conceptual definitions of professionalism and a number of concrete proposals for its measurement and teaching. These projects, however laudable, are misguided when they treat professionalism as a unitary descriptive concept rather than as a contested and therefore primarily evaluative one; when they conceive professionalism as a domain of medical practice separable in principle from other domains; and when they treat professionalism as, in principle, a specifiable goal or product of sufficiently well designed educational curricula. The logic of professionalism-as-product corresponds to the logic of techne (art or practical skill) in Aristotle's Nicomachean Ethics. Aristotle provides a cogent argument, however, that the moral excellences denoted by "professionalism" cannot be "produced" or even prespecified in the concrete; rather, they must be acquired through long practice under the careful concrete guidance of teachers who themselves embody these moral excellences. Phronesis (practical wisdom) rather than techne must therefore be the guiding logic of educational initiatives in medical professional formation, with particular emphasis on close mentorship and on the moral character both of students and of those who teach them.
在许多有影响力的医学组织和机构的推动下，医学专业主义运动在过去十年中产生了一些关于专业主义的概念定义，以及一些关于其衡量和教学的具体建议。然而，这些项目虽然值得称赞，但如果将专业主义视为一个统一的描述性概念，而不是一个有争议的、因此主要是评价性的概念；如果将专业主义设想为医学实践中一个原则上可与其他领域分离的领域；如果将专业主义原则上视为精心设计的教育课程的一个可明确规定的目标或产物，那么这些项目就被误导了。作为产物的专业主义的逻辑与亚里士多德《尼各马可伦理学》中技艺（艺术或实践技能）的逻辑相对应。然而，亚里士多德提出了一个有说服力的论点，即“专业主义”所指的道德卓越不能在具体中“产生”甚至预先确定；相反，它们必须通过在自身体现这些道德卓越的教师的仔细具体指导下的长期实践来获得。因此，实践智慧而非技艺必须成为医学专业形成中教育举措的指导逻辑，特别强调密切的指导以及学生和教师的道德品质。
