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Medical Professionalism: Conflicting Values for Tomorrow's Doctors

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Abstract

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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Acknowledgements

The authors would like to thank the students who gave their consent for their portfolios to be in this study. We are grateful to the students and other colleagues who have provided feedback on previous drafts, including Diana F. Wood, John Benson, Thelma Quince and James Brimicombe. We further thank the James Knott Family Trust for funding this research, with additional funding from the General Practice and Primary Care Research Unit at the University of Cambridge.

Conflict of Interest

None disclosed.

Ethical Approval

The study was approved by the ethical committee of the University of Cambridge Psychology Research Ethics committee. All participants signed an informed consent form.

Author information

Authors and Affiliations

  1. General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK

    Erica Borgstrom MA, Simon Cohn PhD & Stephen Barclay FRCGP, MD

Authors
  1. Erica Borgstrom MA
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  2. Simon Cohn PhD
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  3. Stephen Barclay FRCGP, MD
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Corresponding author

Correspondence to Erica Borgstrom MA.

Additional information

Contributors

SB, SC, Diana F. Wood (Clinical Dean), John Benson, Thelma Quince and James Brimicombe were involved in the initial planning and ethics application. SB obtained consent from students. James Brimicombe managed and anonymized the data. SC and SB further developed the research with EB, who then led the analysis and reporting with support from SC and SB. DFW reviewed early versions of the manuscript. All authors had full access to the data, contributed to and approve of the final version. SB is the guarantor.

Funding

This study was funded by the James Knott Family Trust. The funders had no part in the design of the study; the collection, analysis, and interpretation of the data; the writing of the report, and the decision to submit the article for publication. SB is a Trustee of the James Knott Family Trust: his work as a researcher in the University of Cambridge is independent from the funders. SB is funded by Macmillan Cancer Support as a Post-Doctoral Research Fellow, and is a member of the NIHR CLAHRC for Cambridge and Peterborough (Collaborations for Applied Health Research and Care). Additional funding was received from the General Practice and Primary Care Research Unit at the University of Cambridge.

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Borgstrom, E., Cohn, S. & Barclay, S. Medical Professionalism: Conflicting Values for Tomorrow's Doctors. J GEN INTERN MED 25, 1330–1336 (2010). https://doi.org/10.1007/s11606-010-1485-8

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  • DOI: https://doi.org/10.1007/s11606-010-1485-8

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