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      Medical professionalism: what the study of literature can contribute to the conversation

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          Abstract

          Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of “professionalism” itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.

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          Competency is not enough: integrating identity formation into the medical education discourse.

          Despite the widespread implementation of competency-based medical education, there are growing concerns that generally focus on the translation of physician roles into "measurable competencies." By breaking medical training into small, discrete, measurable tasks, it is argued, the medical education community may have emphasized too heavily questions of assessment, thereby missing the underlying meaning and interconnectedness of how physician roles shape future physicians. To address these concerns, the authors argue that an expanded approach be taken that includes a focus on professional identity development. The authors provide a conceptual analysis of the issues and language related to a broader focus on understanding the relationship between the development of competency and the formation of identities during medical training. Including identity alongside competency allows a reframing of approaches to medical education away from an exclusive focus on "doing the work of a physician" toward a broader focus that also includes "being a physician." The authors consider the salient literature on identity that can inform this expanded perspective about medical education and training.
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            Beyond cultural competence: critical consciousness, social justice, and multicultural education.

            In response to the Liaison Committee on Medical Education mandate that medical education must address both the needs of an increasingly diverse society and disparities in health care, medical schools have implemented a wide variety of programs in cultural competency. The authors critically analyze the concept of cultural competency and propose that multicultural education must go beyond the traditional notions of "competency" (i.e., knowledge, skills, and attitudes). It must involve the fostering of a critical awareness--a critical consciousness--of the self, others, and the world and a commitment to addressing issues of societal relevance in health care. They describe critical consciousness and posit that it is different from, albeit complementary to, critical thinking, and suggest that both are essential in the training of physicians. The authors also propose that the object of knowledge involved in critical consciousness and in learning about areas of medicine with social relevance--multicultural education, professionalism, medical ethics, etc.--is fundamentally different from that acquired in the biomedical sciences. They discuss how aspects of multicultural education are addressed at the University of Michigan Medical School. Central to the fostering of critical consciousness are engaging dialogue in a safe environment, a change in the traditional relationship between teachers and students, faculty development, and critical assessment of individual development and programmatic goals. Such an orientation will lead to the training of physicians equally skilled in the biomedical aspects of medicine and in the role medicine plays in ensuring social justice and meeting human needs.
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              Medical professionalism in the new millennium: a physician charter.

              , , (2015)
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                Author and article information

                Contributors
                714-456-5171 , jfshapir@uci.edu
                lnixon@health.usf.edu
                wear@buffalo.edu
                david.doukas@louisville.edu
                Journal
                Philos Ethics Humanit Med
                Philos Ethics Humanit Med
                Philosophy, Ethics, and Humanities in Medicine : PEHM
                BioMed Central (London )
                1747-5341
                27 June 2015
                27 June 2015
                2015
                : 10
                : 10
                Affiliations
                [ ]Family Medicine and Director of the Program in Medical Humanities & Arts, University of California-Irvine, School of Medicine, 101 City Dr. South, Rte 81, Bldg 200, Ste 835, Orange, CA 92868 USA
                [ ]Internal Medicine, Division of Ethics and Humanities, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
                [ ]Center for Clinical Ethics and Humanities in Healthcare, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo SUNY School of Medicine, Buffalo, NY USA
                [ ]William Ray Moore Endowed Chair of Family Medicine and Medical Humanism, and Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, 2301S 3rd St, Louisville, KY 40292 USA
                Article
                30
                10.1186/s13010-015-0030-0
                4484639
                26122270
                551e300c-a134-425c-a31b-13747bfe6135
                © Shapiro et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 September 2014
                : 23 June 2015
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                © The Author(s) 2015

                Philosophy of science
                medical professionalism,professional identity formation,literature,health humanities,medical humanities

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