Professionalism in Medicine: Critical Perspectives

Professionalism in Medicine: Critical Perspectives casts a careful, and at times wary, eye on a dominant force in contemporary academic medicine that appears to have been accepted as an absolute good. Calls for developing, increasing, or maintaining professionalism¿not to mention the current obsession with evaluating or assessing it¿appear with regularity in medical journals and conference programs of all stripes. The resultant literature has defined, organized, contained, and made seemingly immutable a group of attitudes and behaviors subsumed under the label "professional" or ''professionalism" (Wear & Kuczewski, 2004). Moreover, the fixation with assessment has become a new steering mechanism that is reductionistic when it shapes the total range of possible and thinkable dimensions of professionalism. The richness, complexity, and contradictions of professionalism in medicine are being flattened into categorical attitudes or behaviors that evaluators (whose professionalism is rarely assessed) can check. As Mark Kuczewski, one of the contributors to this volume, observes, "Valuing and evaluating professionalism seem to have become equated. " This preoccupation with assessment is not indigenous to medical education. It is arising and taking hold of many institutions as new principles¿indeed, mandates¿of scrutiny and examination become acceptable, if not desirable, cultural practices. In their incisive work on audit cultures in higher education. Shore and Wright (2000) argue that coercive practices of accountability sometimes sound eerily like moves toward "exhibiting" professionalism whereby "every individual is made acutely aware that [his] conduct and performance is under constant scrutiny" (p. 77).