We thank Dr. Freed and Dr. Franks for their compliments and constructive comments. We agree with them that it is of the utmost importance for trainees to learn how to cope with novel professional and ethical dilemmas in their professional lives as independent doctors. However, we believe that role modeling is essential in this process, and in this letter we examine how it can be used to effectively prepare trainees to address these dilemmas.
Freed and colleagues1 have stated that role modeling typifies the “do as I do” approach. Therefore, they defined the need for critical thinking skills, like the SOAP (Subjective, Objective, Assessment, and Plan) method, for professional and ethical decision making in clinical situations. Previous studies2,3 assessed whether role modeling contributes to teaching and learning by “just relying on” the apprenticeship model. These studies agreed that role modeling is a combination of unconscious and conscious activities, and both agreed that negative role modeling, without the step of apperception, will result in nonprofessional behavior of the trainee.
Paice et al2 confirmed that passing on the correct strategy for managing moral dilemmas requires the use of explicit teaching methods, not just role modeling while busy doing other things. Cruess et al3 concluded that awareness of being a role model in the formal, informal, and hidden curricula is the first step that makes it possible to protect time for teaching. To achieve this, they advised being explicit about what is being modeled whenever possible.
Heightened awareness may lead the trainer to seek the opportunity to demonstrate behavior, comment on what was done, and explain what was done to make the implicit explicit.4 By following this pattern when confronting professional and ethical dilemmas, trainers can thereby model a process trainees can apply to novel dilemmas in the future.
The attributes found in our systematic review confirm that this extra dimension is recognized as positive role modeling. This kind of role modeling transcends the “rely on me and do as I do” role of the trainer and allows the trainer to use, model, and teach tools such as the SOAP method. Thus, role modeling remains an essential part of teaching powerful strategies to overcome novel professional and ethical dilemmas, no matter what those strategies may be.
H.G.A. Ria Jochemsen-van der Leeuw, MD
PhD student and general practitioner, Department of General Practice/Family Medicine, Academic
Medical Center, Amsterdam, the Netherlands;
Nynke van Dijk, MD, PhD
Assistent professor, Department of General Practice/
Family Medicine, Academic Medical Center,
Amsterdam, the Netherlands.
Margreet Wieringa-de Waard, MD, PhD
Professor, Department of General Practice/Family
Medicine, Academic Medical Center, Amsterdam,
1. Freed CR, Bonnici DM, Craddock LN, Franks RD. Professional and ethical decision-making among health science students: A call to action about critical thinking. Med Sci Educ. 2012;22:33–36
2. Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ. 2002;325:707–710
3. Cruess SR, Cruess RL, Steinert Y. Role modelling—Making the most of a powerful teaching strategy. BMJ. 2008;336:718–721
4. Wright SM, Carrese JA. Excellence in role modelling: Insight and perspectives from the pros. CMAJ. 2002;167:638–643