Defining Professionalism From the Perspective of Patients, Physicians, and Nurses

TLDR

Professionalism has long been a core value in medicine, yet its terminology remains abstract and has attracted explicit attention in recent years. The study aimed to identify and prioritize behaviorally based signs of medical professionalism relevant to patients, physicians, and nurses. Qualitative focus groups (22) across patients, nurses, and physicians generated 68 behavioral items, which were then evaluated in quantitative surveys of 415 patients, 214 physician leaders, and 237 nurses to assess importance and observability. Most behaviors were rated as very important by at least 75% of participants, though fewer were considered observable, showing that professionalism can be defined by tangible behaviors and that this focus may facilitate discussion, assessment, and modeling.

Abstract

Although professionalism has always been a core value in medicine, it has received increasingly explicit attention over the past several years. Unfortunately, the terms used to explain this competency have been rather abstract. This study was designed to identify and prioritize behaviorally based signs of medical professionalism that are relevant to patients, physicians, and nurses.The qualitative portion of this project began in 2004 with a series of 22 focus groups held to explore behavioral signs of professionalism in medicine. Separate groups were held with patients, inpatient nurses, outpatient nurses, resident physicians, and attending physicians from different specialties, generating a total of 68 behaviorally based items. In 2004-2006, quantitative data were collected through national patient (n = 415) and physician leader (n = 214) surveys and a statewide nurse (n = 237) survey that gauged the importance these groups attach to the behaviors as signs of professionalism and determined whether they are in a position to observe these behaviors in the clinical setting.The surveys of patients, physician leaders, and nurses provided different perspectives on the importance and visibility of behavioral signs of professionalism. Most of the behaviors were deemed very important signs of professionalism by at least 75% of patients, physicians, and/or nurses; far fewer were considered observable in the clinical setting.This study demonstrates that it is possible and instructive to define professionalism in terms of tangible behaviors. Focusing on behaviors rather than attributes may facilitate discussion, assessment, and modeling of professionalism in both medical education and clinical care.