Professionalism is a fundamental component in the practice of medicine. However, learning to exhibit professional behavior and developing a professional identity are ongoing challenges for physicians. Lynn Monrouxe and Charlotte Rees are social scientists who have collaborated for more than a decade, seeking to understand how individuals become professionals. Their research has culminated in Healthcare Professionalism: Improving Practice Through Reflections on Workplace Dilemmas, a 272-page textbook for health care students, trainees, and educators, which imparts a reflective approach to teaching professionalism by examining day-to-day professional dilemmas experienced by students in a variety of health care professions. The authors hope that this book will help “raise professionalism standards in health care, to benefit learners, qualified practitioners, and patients.”
The book is based on multiple personal narratives collected from >4000 students in medicine, nursing, dentistry, pharmacy, and physical therapy at universities in the United Kingdom, Taiwan, Australia, and Sri Lanka. Thirteen chapters have been organized into 3 parts. Part I gives an overview of professionalism education, including the foundation, curricula, and assessment of professionalism. Part II focuses on common professionalism dilemmas experienced by health care learners that are related to the themes of identity, consent, patient safety, patient dignity, abuse, and e-professionalism. Part III concentrates on cross-cultural and hierarchical differences involved in professional dilemmas, such as variations among countries, cultural groups, and interprofessional groups. The chapters are structured consistently, beginning with learning outcomes and key terms and concluding with a summary, discussion points, learning activities, supplemental reading, and references. The core of each chapter focuses on a discussion related to individual narratives with interludes of directed, thought-provoking activities drawing on personal and professional experiences. Most narratives, activities, and terminology are formatted in boxes that are separate from the main text body. Several helpful tables that compare issues across the various health care professions and an index are included. A digital version of the book is available, with no variations from the original text.
The key strength of this book is that it continually links the theory of professionalism to the reality of day-to-day practice, or as the authors describe, “the gap between what you are taught and what you see.” The uncertainty and angst felt in the descriptions by the medical students of their predicaments are familiar to physicians and are a reminder of how one’s own professional identity can change and become jaded over the course of a career. Additionally, the authors do an excellent job of exposing the commonalities and differences in the perspectives of the various health care professions. Recognizing ordinary situational difficulties from another health care provider’s point of view can help one better relate to colleagues. The discussion of inter- and intraprofessional power relationships and hierarchy in 2 chapters, “Professional Dilemmas Across Professional Cultures” and “Conclusions,” contains important concepts for physicians who work in a team environment, such as the anesthesia care team model, to comprehend. For anesthesiologists, the sections on consent- and patient safety–related professional dilemmas are noteworthy. The chapter titled “E-professionalism-related Dilemmas” is particularly important in today’s technology-based society, where the line between personal and professional can be easily blurred. The suggested supplemental reading at the end of each chapter is useful for those readers who wish to gain in-depth knowledge on specific professional dilemmas.
It would have been helpful if the authors had included some more positive professional dilemmas, as well as narratives from nonstudents, such as trainees, attendings, or licensed practitioners. A few narratives do not focus on the failures of professionals in leadership roles, and it can be disheartening for a nonstudent to read. The addition of a few patient and family accounts of professionalism seen in the variety of practitioners they encounter might provide an interesting viewpoint as well. In terms of the structure, the text references multiple boxes containing the narratives, which requires the reader to jump back and forth between discussion and narrative. This often interrupts the flow of the manuscript and can cause the reader to lose his or her place. Other difficulties when using this textbook, specifically for an American audience, include a lack of frame of reference regarding the cultural and national practices the authors discuss from the 4 countries out of which their research is based and the British English vocabulary.
Overall, this book examines professionalism, how to teach and assess professionalism, and how to support professional identity formation, which are essential communication issues in medicine. It highlights the complex situations encountered on a day-to-day basis and the resulting emotional distress experienced during the training of health care professionals. This reasonably priced textbook is perhaps best suited for educators and students, but the information is applicable to all health care professionals.
Elizabeth B. Malinzak, MD
Department of Anesthesiology
Durham, North Carolina