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Teaching Professionalism: A Tale of Three Schools

HOLLY HUMPHREY, M.D.1

JEFFREY ANDERSON2

NIRAV SHAH, J.D.3

Meno: Can you tell me, Socrates, whether virtue is acquired by teaching or by

practice; or if neither by teaching nor practice, then whether it comes to man by

nature, or in what other way?

Socrates: I confess with shame that I know literally nothing about virtue.

Meno: Are you in earnest, Socrates, in saying that you do not know what virtue is?

Socrates: Not only that, but you may say further that I have never known of any one

else who did, in my judgment.

I. INTRODUCTION

Were Socrates with us today, he would no doubt be just as perplexed by the

debate surrounding issues of professionalism, regardless of the discipline. From

business to medicine and to law, the topic of professionalism has received much

press – both popular and academic. Yet despite this volume of coverage, no

multi-disciplinary analysis of professionalism across different fields has been

done. Moreover, little has been written comparing the ways in which

professionalism is conceived of and taught in various professional fields.

This Article surveys the landscape of professionalism across three disciplines:

medicine, business, and law. In particular, it asks how graduate schools in each

of those fields conceive of professionalism and, by extension, how they teach it to

their students. It focuses on the historical roots of each field’s educational

mandate and how that history and culture inform different ideas of how

professionalism should be taught. In doing so, it attempts to find a definition of

professionalism within each field (or, at the very least, identify the common

ideals that each field hopes to inspire in its students). The Article then proceeds

to compare professionalism education across the three schools as a way of

1 Dean of Medical Education, The University of Chicago Pritzker School of Medicine. 2 Associate Dean of Leadership Development, The University of Chicago Graduate School of Business. 3 4th Year Medical Student, The University of Chicago Pritzker School of Medicine.

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gleaning insight into how its each discipline might improve its own educational

modules.

Part II of the Article asks the baseline question of how professionalism is

conceived in each field. Notably, professionalism’s “object” (that is, the target of

the educational process itself) differs in each field. Part III surveys how

professionalism is taught in each school and how these approaches vary from

one another. In keeping with the Meno, it examines how difference conceptions

of professionalism influence each school’s approach to pedagogy. Part IV

discusses the possible challenges to professional education based on the

experience of schools of medicine, law, and business. By corollary, it offers

insight into how professionalism education might actually achieve its goal of

fostering a professional ethic and engendering professional behavior within a

field. Part V concludes ends with thoughts about whether and to what extent

professionalism can be taught at all? Do our current professional school

curricula actually make any impact on students? If not, then what do such

courses achieve? If professionalism can not actually be taught, then does it, as

Meno postulated, “come to man by nature”? Or is there something deeper

behind the notion of professionalism that goes beyond mere rules?

II. WHAT IS PROFESSIONALISM?

Not surprisingly, there are as many definitions of professionalism as there

are definers. As a result, there are no commonly agreed upon definitions of

“professionalism.” Yet in the main, most commentators agree that

professionalism invokes a sense of duty, certainly to others in the field (the guild

aspect) and often to the public as a whole (the social contract element).

Some define professionalism ostensively and through its consequences.

For example, a group at Vanderbilt University Medical Center suggests that a

large component of professionalism is patient satisfaction. The group tracks the

number of complaints lodged against each doctor and offers those results to the

individual physician in the hopes of spurring more “professional behavior.”

Similarly, the legal profession, through state bar associations, tracks complaints

filed against individual attorneys and makes those complaints available to the

public. Indeed, it should come as no surprise that most professional societies

both monitor and censure their members as complaints come in.

A. The Concept of a “Profession.”

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The middle ages saw the emergence of the concept of a “profession.”

Historically, medicine, law and the clergy were the three classical “professions.”

They earned this status partly because of their organization into self-regulating

guilds, but also because they, unlike merchants, dedicated themselves to

“something other than self-interest while providing their services.”4 In essence,

their espousal of altruism allowed these three fields to meet the original

sociological criteria for a “profession.” The fields were set apart from all others

because, in order to join their ranks, one had to “profess” publicly a devotion to

others apart from one’s own self. As a result, their pursuits had both a private

and a public dimension – an ethic that remains persists to this day.5

Today, the notion of a profession is that of a discrete group of

practicitioners that possess a specialized body of knowledge that allows them to

engage in a narrow field of work. Sociologists have identified other prerequisites

before a field can reasonably be called a profession: an identified social need, an

internal ethical framework, a degree of internal standards for admission into the

field, and, in some cases, a social mandate allowing the field to set these

admissions standards.6 Given these various criteria, it is not surprising that

several fields lay claim to being “professions” today. Yet only a subset of those

fields have a well-developed concept of “professionalism.”

B. From Profession to Professionalism.

Starting in the 20th century, “professionalism” became a watchword for a

concept of a standardized, normative ethic within a field coupled with a degree

of self-regulation necessary to enforce those norms. Various definitions have

been offered, but the essence of professionalism remains: self-regulation plus an

aspirational ethic. Over the years, field like medicine and law cultivated their

own sense of professionalism. Both evolved in response to societal demands

alongside the demands of their own members. The struggle between those

groups has, sadly, often seen the needs of the public relegated to the self-interest

of the profession.7

4 Pellegrino, E. “Professionalism, Profession and the Virtues of the Good Physician.” Mount Sinai Journal of Medicine, 69; 6:378-384 (2002). Pellegrino also suggests that other early fields, such as the military, encompassed a notion of both profession and professionalism based on their desire to serve others. Yet the notion of merchants as an entirely self-interested group is not universally accepted. See, e.g., Greif A, Milgrom P, and Weingast B. “Coordination, Commitment, and Enforcement: The Case of the Merchant Guild.” J Political Economy. 102;4J:745-776 (1994). 5 Id. 6 Freidson, E. Professionalism: The Third Logic. University of Chicago Press (2001). 7 See Starr, P. For example, many scholars see the American Medical Association’s vehement fight against national health care in the 1960s as a triumph of self-interest over professionalism.

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Recognizing the need to balance these two forces, medical and law schools

began responding to calls for more professionalism within their ranks. Medical

professionalism and education, in particular, have undergone several notable

shifts in the past two centuries.8 At the beginning of the 20th century, medical

education was fragmented and still followed the guild-based apprenticeship

model of the prior four hundred years. Medicine was, by all accounts, still a

“trade” and its education followed that model closely: admissions requirements

were low and an instruction emphasized practice and experience over theory

and inquiry.9

Abraham Flexner’s landmark report on medical education radically

altered this landscape.10 Medical schools across the country instituted strict

admissions requirements and substandard medical shuttered their doors.

Consonant with these changes was the emergence of medicine as a “profession”

as opposed to a “trade.”11 Flexner’s report advocated for an alliance between

medical schools and state regulators, with the aim of creating a cohesive

regulatory body that would address the needs of the public through alterations

in the medical education system. Finally, Flexner recognized that physicians are

“social instruments” whose training comes at great cost to the state and thus

requires them to function in a “social and preventive” role.

These changes, then, ushered in the first wave of “medical

professionalism” and charged medical schools with educating young physicians

in these norms.

III. TEACHING PROFESSIONALISM: GRADUATE SCHOOLS COMPARED

A. Medical Professionalism

Although Hippocrates is credited with advancing the first notion of

medical professionalism, the concept wasn’t properly recognized until the British

historian Thomas Percival codified the subject and promulgated his own code

that “professionalism” took on its own meaning.12 Percival argued that

8 For a corresponding history of the evolution of legal professional education, see Gerber, R. Lawyers, Courts, and Professionalism: An Agenda for Reform. Greenwood Press (1989). 9 Flexner, A. “Medical Education in the United States and Canada.” Carnegie Foundation for Higher Education, 1910. Available online at http://www.carnegiefoundation.org/publications/pub.asp?key=43&subkey=977 (visited November 11, 2007). 10 Hyatt, MD and Stockton, CG. “The Impact of the Flexner Report on the Fate of Medical Schools in North America after 1909.” Available online at http://www.jpands.org/vol8no2/hiattext.pdf (last visited November 11, 2007). 11 Starr, Paul. The Social Transformation of American Medicine. Basic Books, 1982. 12 Percival, T. Medical Ethics; or, a Code of Institutes and Precepts Adapted to the Professional Conduct

of Physicians and Surgeons. (1803).

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physicians occupied a position of “public trust” and, as a result, had obligations

to society that transcended those of typical workers. Despite a chilly reception to

this early social contractarian approach in Britain, his ideas gained credence in

the United States and were to become the basis for the American Medical

Association’s first code of medical ethics in 1847. Percival’s ideas were

revolutionary at the time: gone was the concept of medicine as a cloistered guild

whose primary aim was to protect fellow physicians. Percival advocated a

public-goods approach to medicine, arguing that the public trust it inspires sets it

apart from all other fields. To this day, that code forms the basis for much of the

current thinking on medical professionalism.

Professional education in U.S. medical schools has existed, in some form

or another, almost as long as medical schools have. But the modern, social

contract-based concept of medical professionalism has only been taught since the

early 20th century. This model holds that physicians owe a debt to society in

exchange for the training they receive and the intimate details they learn about

their patients. Many physicians and educations feel that this level of intimacy is

what makes medicine unique.13 Medicine, to a large degree, conceives of itself as

“different” from other professions.14 The presence of an implied social contract

has meant that physicians have strived to hold themselves to a higher standard

of professionalism than other fields.

The teaching of medical professionalism, too, is different from both law

and medicine. As with much of medicine, professionalism is taught partly

through aspirational lectures, but mainly through example and mentorship.

Indeed, the aspirational quality of medical professionalism is truly unique

within graduate education. In medicine, as contrasted with law, what is

considered “ethical” behavior is not necessarily what is legal whereas in law, the

two are synonymous.15

B. The Teaching of Legal Professionalism

13 Starr. Though many have questioned the notion of medical exceptionalism and have argued that it leads

to a protectionism and union-like behavior. 14 See Starr, Paul. The Social Transformation of American Medicine.

15 This is perhaps best illustrated by considered the thorny problem of disclosure of error to a patient or family. Some physician-ethicists argue in favor of disclosure even where the error was without consequence. Malpractice law, however, compels no such disclosure in this case. See generally, Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. “Patients’ and Physicians’ Attitudes Regarding the Disclosure of Medical Errors.” JAMA. 2003;289:1001-1007; Rosner F, Berger JT, Kark P, Potash J, Bennett AJ; for the Committee on Bioethical Issues of the Medical Society of the State of New York. “Disclosure and Prevention of Medical Errors.” Arch Intern Med. 2000;160:2089-2092.

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The American Bar Association is charged with accrediting the nation’s law

schools. It does so based on various curricular requirements – one of which is

legal professionalism. The Association’s “Standards for Approval of Law

Schools” give guidance to law schools on what elements of professionalism

should be included in their curricula and the extent to which the topic should

figure into a legal education.16 Standard 302(a) addresses curricular issues in

particular and notes that “A law school shall require that each student receive

substantial instruction in. . . (4) other professional skills generally regarded as

necessary for effective and responsible participation in the legal profession; and

(5) the history, goals, structure, values, rules and responsibilities of the legal

profession and its members.”17 This vague language is clarified later in the

publication, for Interpretation 302-9 states that Standard 302(a)(5)’s mandate

“includes instruction in matters such as the law of lawyering and the Model

Rules of Professional Conduct of the ABA.”18

Law schools typically instantiate this requirement by offering a required

course on “The Legal Profession.” Such courses teaches to the ABA’s concept of

professionalism by discussing issues like the creation of an attorney-client

relationship, the attorney-client privilege, the notion of zealous representation,

and conflicts of interests between clients. Though the class is often called an

“ethics” class, the notion of a “legal ethic” is typically not to be found. The

course focuses on the ABA’s “Model Rules of Professional Responsibility,”

various analogous state codes, and the court opinions interpreting them.

Nowhere is concept of legal professionalism situated against larger ethical or

philosophical backdrop. As a result, there are no “ethical” dilemmas – only legal

ones that require the afflicted lawyer to research the law on point and follow

precedent just as he or she would for any other legal issue. For a practicing

attorney faced with a quandary, the ethical path is, in the main, identical to the

legal one.19 Unlike in medicine, where physicians attempt to hold themselves to

a higher standard than merely “what the law allows,” lawyers are focused

primarily on the body of opinion, created by judges, that circumscribes the limits

16 Available online at http://www.abanet.org/legaled/standards/standards.html 17 See http://www.abanet.org/legaled/standards/20072008StandardsWebContent/Chapter%203.pdf 18 Standards for Approval of Law Schools, Interpretation 302-9 available at http://www.abanet.org/legaled/standards/20072008StandardsWebContent/Chapter%203.pdf 19 This devotion to what is “legal” as opposed to what might be “ethical” also stems from the fact that

attorneys can be quickly disbarred for even the slightest ethical transgression. Physicians, however, cannot

have their license revoked for unethical behavior unless it coincides with gross negligence or is otherwise

flagrant. Thus, when deciding a course of action, an attorney is more likely to follow a path already

approved of by a judge.

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of their actions. To many physicians and attorneys, then, “law often represents

the lowest acceptable measure of morality.”20

This disconnect between the ethical path and the legal one has

consequences. As a result of its focus on rules and legal opinions, the enterprise

of “legal professionalism” is focused on protecting the attorney from censure as

opposed to uniformly putting the needs of the client first. Attorneys faced with a

professional dilemma are concerned chiefly with protecting themselves from

liability exposure. Judging by the rhetoric and aims of medical professionalism,

however, physicians aim for a higher standard: to do whatever is best for the

patient regardless of its consequences for the physician. To be sure, this “patient-

centric” approach may not always be followed by practicing physicians, but

what’s notable here is that, at least insofar as medical professionalism is

addressed in medical school, the aim is that they should aspire to a higher

standard, whereas in law, no such aspirational goal is even introduced in the first

place.

In a sense, the legal field takes professionalism more seriously than both

business and medicine. To pass the bar exam in any state, for example, an

applicant must pass a standardized, nationwide professional responsibility exam

that covers issues of conflict, communication, duties to a client, and

confidentiality of information.21 While the value of instilling professionalism

through a multiple-choice exam is debatable, the process does ensure that all

recently minted attorneys have some passing familiarity with the “law of

lawyering.”

Legal professionalism is hardly aspirational in the way that a medical

student might recognize from his or her “ethics” class. That is to say, the focus of

the class is not about choosing the most appropriate ethical choice of action is in

any particular legal quandary. Rather, legal ethics is about finding the most

appropriate legal path to a legal dilemma. If this is so, then how do lawyers

conceive of the legal profession? Judge Richard Posner has offered several

ideas.22

Finally, law stands in stark contrast to medicine with respect to the

“object” of its professionalism. Indeed, the American Board of Internal

Medicine’s “Physician Charter” on medical professionalism in the new

millennium begins by underscoring professionalism as the basis for medicine’s

20 Sokol DK. “Letter to a New Medical Student.” Lancet Nov. 27, 2007 21 This test, called the Multistate Professional Responsibility Exam, is administered as part of the overall

bar examination process. It consists of multiple-choice questions designed to test applications on the

nuances between the various conflicts that can arise in the course of legal practice. For more information,

see XXXX. 22 See Posner, The Problematics of Legal and Ethical Theory

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social contract.23 The very next sentence continues that “[professionalism]

demands placing the interests of patients above those of the physician . . . .”24 In

medicine, it seems, the beneficiary of the professional ethic should always be the

patient. Law, by contrast, does not necessarily elevate the interests of the client

above those of the attorney. In a sense, the object of legal professionalism is

manifold: in some cases, it is the client. Yet in others, professionalism demands

that the attorney’s interests take precedence. And in other situations still, some

courts have held it is interests of the legal system as a whole that should trump.

Thus, there is no consistent beneficiary or object of legal professionalism.

This absence of object has consequences. From a public-relations

standpoint, it means that lawyers are often conceived of as solely out for

themselves with no greater social aim in mind. Moreover, the lack of a consistent

beneficiary often leaves attorneys confused as to whom their primary “client”

actually is.25 Finally, some critics have suggested that the failure to place the

needs of the client above all else itself is a failure of legal professionalism.

C. The Business (School) Case for Professionalism Education

The concept of “business professionalism” is, in many ways, more

difficult to define than it is for either medicine or law. To a large degree, this

stems from the fact that business schools do not teach professionalism in the

sense recognized by physicians or lawyers. “Business” is not a traditional guild-

based profession, charged with its own self-regulation. Rather, business school

graduates go into fields as diverse as the students themselves. As such, there is

no monolithic, agreed-upon concept of business professionalism.

Yet business schools do have analog courses in fields such as leadership,

social responsibility, and nonprofit management – each of which embraces a

notion similar to that of “professionalism.” Namely, that business school

students are part of a larger social framework and, as a result, should conform to

certain standards of behavior with corollary obligations to the greater public.

Yet business schools do not conceive of themselves in vacuum. For

decades, the business community and business schools have embraced the

concept of “corporate social responsibility.” Often criticized for its vagueness,

corporate social responsibility suggests that corporations should [voluntarily

23 American Board of Internal Medicine in partnership with the American College of Physicians and the

European Federation of Internal Medicine. “Medical Professionalism in the New Millennium: A Physician

Charter.” Annals of Internal Medicine. 136;3:243-46 (2002). 24 Id. at 244. 25 See, e.g., Upjohn case.

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undertake to assess the social, economic, and environmental impacts of its

business operations]// should take the broader interests of society (and not just

shareholders) into consideration when charting a particular course of action.26

This ethic is, in many ways, the analog to the “altruism” model taught in medical

schools and the pro bono spirit espoused in many law schools. Indeed, data

from Christensen, et. al., shows that the majority of top business schools in the

United States teach some form of ethics or corporate social responsibility in their

curricula.27 Of the world’s top 50 business schools, a full 84% require students to

take at least one course addressing either ethics or corporate social

responsibility.28 And if the definition of an “ethics” course or CSR course is

expanded to include topics such as sustainability and corporate leadership, every

one of the top 50 schools requires at least one such course.29 The authors also

note that much of the drive for inclusion of such courses into the mandatory

curriculum comes from students themselves,30 perhaps spurred in part by recent

corporate accounting scandals.31

Business leaders, too, must grapple with serious ethical challenges in their

professional lives. These quandaries are in many cases no different from those

experienced by physicians and attorneys. A case from the University of

Chicago’s Graduate School of Business’s LEAD program highlights these

difficult decisions:

You are the CEO of a corporation making baby cribs. The media has reported that

several babies have been trapped and died while in their cribs because of a defect in the

side railing. To date, three such tragic events have occurred even though your company

has sold over 15,000 units. You can issue a recall of all cribs, a move that will cost your

company millions of dollars and likely force layoffs. Or you can do nothing, in which

case more babies may die. Do you issue a recall of all cribs?32

Discussion on this point varied:

26 A corporation accounting for “the interests of society” in its calculus stands in stark contrast to the views of many lawyers and economists, who argue that the only interests that should be taken into account are those of the shareholders. That is, the only duty of a corporate board of directors is to generate profits for shareholders. Thus, any action that increases shareholder profits is desirable regardless of its effect on society. For more on this debate, see Friedman, Milton. “The Social Responsibility of Business is to Increase Its Profits.” The New York Times Magazine, Sept. 13, 1970. 27 Christensen LJ, Peirce E, Hartman LP, Hoffman WM, Carrier J. “Ethics, CSR, and Sustainability Education in the Financial Times Top 50 Global Business Schools: Baseline Data and Future Research Directions.” J Business Ethics 73:347-68 (2007). 28 Id. at Table 1 (353) 29 Id. 30 Id. at 347. 31 Adler PS, “Corporate Scandals: It’s Time for a Reflection in Business Schools.” Academy of Management Executive 16; 148-49 (2002). 32 Adapted from The University of Chicago Graduate School of Business’s LEAD Program materials.

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V. CONCLUSION

Socrates himself would probably not be surprised with the state of

professionalism education in America’s graduate schools. Each discipline exists

in a changing world with a rapidly-evolving definition of what constitutes

“professional” behavior. Indeed, the medical education model of

professionalism is ever-expanding with hopes to include instruction and

evaluation in behavior, mannerisms, and integrity.33 The University of Chicago

itself has announced a new “roadmap” to professionalism that hopes to integrate

efforts to foster professionalism from starting from day one of medical school

and extending through residency.34

Sadly, debates about professionalism fail to ask the anterior question of

why professionalism matters at all. Failure to produce a cogent, well-argued

answer to this basic question leads critics of the enterprise to claim that it is,

variously, either an unfruitful endeavor or, worse, rooted in hypocrisy.35 But

experience from the accounting profession demonstrates what can happen when

self-regulated fields fail to scrutinize their own internal practices. In the wake of

the Enron corporate accounting scandals, the accounting profession came under

heavy fire from the public and, ultimately, Congress for failing to police itself.

For many years, accounting, like medicine and law, enjoyed the privilege of self-

regulation and standard setting. Yet once the accounting profession’s complicity

with Enron’s corporate fraud emerged, Congress’s response was swift: the

Sarbanes-Oxley legislation of 2003 ushered in an onerous regulatory scheme to

replace and federalize a corporate accounting system previously entrusted to

private accountants. The accounting firm Arthur Andersen was found to be

complicit in Enron’s hijinks and was itself found guilty of obstructing justice – a

verdict that ultimately spelled the end of the once-giant firm.36 By all accounts

Arthur Andersen’s troubles were of its own making and stemmed largely from a

failure of professionalism. Individual accountants were willing to engage in

“creative accounting” in clear violation of the accounting profession’s own

33 Association of American Medical Colleges. “A Guide to the Preparation of the Medical Student Performance Evaluation.” 2002. 34 Humphrey, et al. University of Chicago Roadmap to Professionalism. Academic Medicine 35 Brainard AH and Brislen HC. Learning Professionalism: A View from the Trenches. Acad Med. 82:1010-1014 (2007). 36 Beltran L, Gering B, and Martin A. “Andersen Guilty.” Available online at http://money.cnn.com/2002/06/13/news/andersen_verdict/ (last visited October 28, 2007).

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internal standards.37 As a result of this blatant breach of professional behavior,

thousands of investors lost billions of dollars in assets and several key figures

were sentenced to jail. Yet it could be argued that it was the accounting

profession as a whole that suffered the most: Sarbanes-Oxley greatly increased

the regulatory burden on accounting and removed much of the independence

that accountants previously enjoyed.

It is not inconceivable that medicine and law could likewise lose the same

privilege of self-regulation and face an even more onerous regulatory scheme if a

scandal with the same failure of professionalism rocked either profession.

Indeed, physicians in the UK have already experienced this pressure in the wake

of the Alder Hey scandal. There, a hospital in Liverpool, England, was found to

have taken the organs of children post-mortem without the parents’ consent. A

swift investigation found abuse and, again, a failure to abide by professional

standards. The Commission conducting the investigation recommended that a

new oversight committee be established to monitor organ procurement and

retention in UK hospitals and to ensure that pathologists did not enjoy the same

degree of free-reign over organ procurement and research as they previously

did.38

More empirically, Maxine Papadakis has observed a link between

unprofessional behavior during medical school and subsequent disciplinary

complaints later in that same physicians’ career.39 Her results are hardly

surprising but call attention to the fact that the proper point of intervention is

during medical school and not after. If professionalism education can both

screen for potentially problematic students and provide them with counseling

and coaching, it could potentially save these students their careers and save

patients the agony of being treated by an unprofessional physician. In this

spirit, a collective effort at Vanderbilt University Medical Center has made

strides in identifying and addressing the unprofessional behavior of physicians.40

Their approach uses reports from staff and patients and intervenes in gradual

increments. Further, it uses social sanctions as a way to compare publicly the

37 Accountants follow the “Generally Accepted Accounting Principles.” These self-instituted rules set forth the general approach an accountant should take when preparing a financial statement. In the United States, these principles are reviewed and promulgated by the Financial Accounting Standards Board (FASB). For more information, visit http://www.gasb.org/. 38 A summary of the Redfern Report can be found at http://www.guardian.co.uk/uk_news/story/0,,431353,00.html (last visited November 2, 2007). For commentary on the scandal and its effect on the British medical community, see Hall and Lilleyman, “Reflecting on Refern: What can We Learn from the Alder Hey Story?” Arch Dis Child. 84:455-56 (2001). 39 Papadakis, M. Insert reference here 40 Hickson GB, Pichert JW, Webb LE, Gabbe SG. “A Complementary Approach to Promoting

Professionalism: Identifying, Measuring, and Addressing Unprofessional Behaviors.” Acad Med.

82(11):1040-48 (2007).

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number of reports lodged against any particular physician with his or her cohort.

The group’s early results suggest that physicians – even chronic offenders – can

and do change their behavior when presented with the proper mix of carrots and

sticks.

The real question, then, is whether professionalism education can make

any difference. That is to ask, have students changed their notion of what

constitutes acceptable and professional behavior within their chosen field? And

if so, is there any evidence to suggest that their actual behavior has changed as a

result? If the answer to this question is anything but an unequivocal “yes” then

curricular changes should be instituted across the board in an attempt to

engender such a response. Moreover, further research is needed to shed light on

what pedagogical methods can actually induce behavioral change.41 To be sure,

there will be resistance to these efforts. Critics contend that professionalism

education has suffered from “mission creep” and that its ambit has gone too far.

Indeed, some students at the University of Chicago Pritzker School of Medicine

report feeling “harassed” by the school’s emphasis on professionalism. But this

Paper demonstrates that each of the three fields can benefit from each others’

variegated experience in teaching professionalism. Both medicine and law can

benefit from business schools’ focus on leadership and social responsibility. And

the fact that professionalism education in medicine incorporates little about the

rules and regulations affecting medical care hampers physicians’ ability to act

professionally. Likewise, business schools could benefit from a codified

approach to professional ethics that both law and medicine offer.

Despite the atmosphere of optimism surrounding professionalism

education, many challenges remain. Of prime concern is a failure to educate

students on the nature and type of professional dilemmas they will actually face

in practice. Too often, professionalism education focuses on “hard cases” at the

expense of leaving basic guidance and instruction by the wayside. Misallocating

educational time and capital by focusing on dilemmas that are exceedingly rare

means that students may not learn clear answers to quandaries that are more

common. Professionalism education can falter, too, if its agenda becomes (or is

perceived to have become) politically tinged. Students will surely bristle if they

feel that their education has been co-opted by a political agenda.

Professionalism education can make itself both useful and relevant if it

instead focuses on teaching the tools that students can use to discern good

policies from bad. In the medical context, for example, that would involve

41 See, e.g., Weber J. “Measuring the Impact of Teaching Ethics to Future Managers.” J Business Ethics. 9;183-90 (1990). For a discussion of analysis of baseline professionalism criteria, see Phelan S, Obenshain S, Galey WR. “Evaluation of Non-cognitive Professional Traits of Medical Students.” Acad Med 1993;68:799-803.

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teaching students the basics of biostatistics so that they can filter good studies

from bad. In a business and legal contexts, it involves preparing students for

real-world dilemmas they are likely to solve and highlighting the ethical

tradeoffs inherent in those dilemmas. This point is crucial: professionalism

education can easily fail if, instead of teaching students how to think about

difficult issues, it merely teaches them what to think. In medical education, for

example, if students are blindly told that studies supplied by pharmaceutical

companies are unreliable (and that, therefore, relying on them is unprofessional)

rather than being taught how to parse and understand the validity of a study, the

entire goal of professionalism will be upended. It would then come as no

surprise that students bristle at professionalism education; indeed, students at

some medical schools already report “professionalism fatigue.”

Finally, professionalism educators should interact with colleagues from

other graduate schools to learn about curricular innovations across different

disciplines. At The University of Chicago, for example, the Dean of Medical

Education and co-author of this paper, Dr. Holly Humphrey, attended several

sessions of the “LEAD” program at the Graduate School of Business to learn how

that school teaches leadership skills to its students. Such cross-campus

collaboration can foster the needed dialog across different professional schools.

In the end, Socrates’ skepticism toward moral education is probably

misplaced. Evidence from a diverse array of fields suggests that professional

behavior can be engendered through a difficult balance of carrots and sticks.

But perhaps educators should strive for more than just “managing

professionalism.” Indeed, the educational model aspires to something greater. It

hopes that the individual actor him or herself will be spurred to better behavior

for the sake of the profession, not under threat of sanction. Socrates was correct,

though, in noting that virtue must be defined before it can be discussed. But the

fields of medicine, business, and law have done an admirable job on that score.

What remains is determining the best way to instill professional virtue across

disciplines– if such a thing can be taught at all.