Professionalism: hard to measure but you know it when you see it

Professionalism: hard to measure but you know it when you see it I n 1992, the American Board of Internal Medicine (ABIM) convened a committee, which produced a white paper entitled Project Professionalism (1). chaired the committee. The paper emphasized values and ethics standards that would be required for board certification (2). It also pointed out that suboptimal professional behavior negatively impacted patient care. In 2002, the ABIM combined with the American College of Physicians (ACP) and the European Federation of Internal Medicine to put forth a charter on professionalism for a new millennium (3). With the dawn of the Accreditation Council for Graduate Medical Education (ACGME) new accreditation process in 2013, there has been an increased emphasis on the documentation and proof of satisfactory professionalism for all residents in approved training programs in the United States (4). For internal medicine program directors and teaching faculty, measuring and judging degrees of professionalism creates challenges in many ways more difficult and more subjective than assessing medical knowledge or procedural skills. Professionalism, or, acting like a professional, is at the heart of being a physician. Although other professions may claim professionalism as equally important, I do not believe there are any with higher standards than in medicine. Since Hippocrates (and no doubt before), it has been an unambiguous standard. So why should it be necessary to focus and work so hard for definitions and for it even to be a milestone? This is in part because of public demand, forcing medical educators to set specific standards. What words describe medical professionalism? Words that come to mind include accountability, empathy, and responsibility. The health profession has a moral compass led by decency and altruism. It includes professional appearance when working; an indication of respect for the patient and their loved ones. In my observations at the bedside, professional appearance is usually more important to the family since they are likely feeling much better than the patient who has other issues. A sense of duty is the encompassing rubric. Professionalism means always trying to do the right thing, particularly when you are on your own making decisions in the middle of the night. In this issue of the journal, Malakoff et al. have developed a novel approach to the challenges of assessing professionalism in residents in training (5). They commented that 'medical professionalism is complicated. .. and measurement is even more complex'. They developed …