To the Editor:
Medical schools need to do more to help students in the transition from being laypersons to being members of the medical profession, a process so eloquently described by Kanter1 in his September editorial. Below are some possible ways that medical schools could better foster the transition:
First, if medical schools are expecting their new students to become medical professionals, professionalism in the medical curriculum should be taught through day-to-day experiences, not just with lectures or small-group activities.2 These experiences could, for example, include students' reflections on challenging, real-life situations they encountered in the learning environment, what they did about them, and how they think their fellow students view such situations. Such an approach would reinforce a student's belief that he or she is becoming a member of the medical profession.
Second, medical schools should change assessment to focus much more on a student's attitudes and personal development as a professional, not just on his or her knowledge of medicine. Something like “What would you do if you were in this situation?” could allow a student to assess circumstances, apply knowledge learned, and make his or her own decisions. The student might also offer a justification for his or her actions. This component, together with reflective journals and 360-degree evaluations, could provide a better measurement of a student's professional development as a member of the medical profession.3
Third, medical schools should encourage the development of an “ecology of professionalism” because medical professionalism is an institutional responsibility. Everyone involved—residents, staff, teachers, administrators, and the older medical students—is accountable for creating an institutional culture that allows professional behaviors to flourish.4
We wonder whether Dr. Kanter plans to write another open letter, this one to medical schools, to encourage them in their efforts to foster such a culture.
Samy A. Azer, MD, PhD, MPH
Professor of medical education and head, Curriculum Development Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia; firstname.lastname@example.org.
Sami Al-Nassar, MD, FRCSC
Assistant professor of surgery and chairman, Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia.