Frameworks for professionalism


There have been three dominant frameworks for professionalism in medical education. These are 1) virtue-based; 2) behaviour-based; and 3) identity formation. Irby and Hamstra (2016) discuss the misunderstanding and confusion created by a lack of understanding of these frameworks by health professionals. The authors trace conceptions of virtue-based professionalism where physicians demonstrate through modelling moral character and humansim to be ‘good’ doctors. This framework places internal values and motivation. Behaviour-based  professionalism focuses on competencies and goals.  Clear expectations, actions and feedback on performance are reinforced. Unprofessional behaviour is sanctioned. Professional identity formation focuses on the evolving and changing identities created through developmental paths associated with socialization. The authors argue that all frameworks have strengths and weaknesses that contribute to the notion of professionalism. Virtue-based professionalism emphasises character and honour codes; behaviour-based professionalism aggregates competencies into the development of entrustable behaviours, but has been criticized for being reductionist. Professional identity formation explores the developmental processes of being and becoming, including values and ethics. The authors discuss these frameworks in relation to curriculum, pedagogy and assessment and advocate that the frameworks need to be taken into account. Irby and Hamstra (2016) suggest that there are distinction between professionalism as a trait and a process. Becoming a good health professional requires all three frameworks.

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