Medical Professionalism: Conflicting Values for Tomorrow's Doctors
Open accessAbstract
Background New values and practices associated with medical professionalism have created an increased interest in the concept. In the United Kingdom, it is a current concern in medical education and in the development of doctor appraisal and revalidation.Objective To investigate how final year medical students experience and interpret new values of professionalism as they emerge in relation to confronting dying patients and as they potentially conflict with older values that emerge through hidden dimensions of the curriculum.Methods Qualitative study using interpretative discourse analysis of anonymized student reflective portfolios. One hundred twenty-three final year undergraduate medical students (64 male and 59 female) from the University of Cambridge School of Clinical Medicine supplied 116 portfolios from general practice and 118 from hospital settings about patients receiving palliative or end of life care.Results Professional values were prevalent in all the portfolios. Students emphasised patient-centered, holistic care, synonymous with a more contemporary idea of professionalism, in conjunction with values associated with the 'old' model of professionalism that had not be directly taught to them. Integrating 'new' professional values was at times problematic. Three main areas of potential conflict were identified: ethical considerations, doctor-patient interaction and subjective boundaries. Students explicitly and implicitly discussed several tensions and described strategies to resolve them.Conclusions The conflicts outlined arise from the mix of values associated with different models of professionalism. Analysis indicates that 'new' models are not simply replacing existing elements. Whilst this analysis is of accounts from students within one UK medical school, the experience of conflict between different notions of professionalism and the three broad domains in which this conflict arises are relevant in other areas of medicine and in different national contexts.
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- Authors
- Borgstrom, E., Cohn, S., & Barclay, S.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Borgstrom, Erica
- Venue
- Journal of General Internal Medicine
- Published
- 2010-08-26
- Volume
- 25
- Issue
- 12
- Pages
- 1330-1336
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2988149
- OpenAlex
- W2063493163
- Cited by
- 71
- References
- 56
- Citations by year
- 2026: 3 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 4 · 2013: 10 · 2012: 6
- FWCI
- 5.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Open Research Online (The Open University) (acceptedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Macmillan Cancer Support
- University of Cambridge
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- medical professionalism, professional values, value conflicts, palliative care, end-of-life care, dying patients, medical students, hidden curriculum, physician-patient relationship, ethical considerations, patient-centered care
- MeSH terms
- Clinical Competence, Female, Forecasting, Humans, Male, Physician-Patient Relations, Physicians, Social Values
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