The 'Medical Professionalism' Dilemma

                                                                  By Paige Twenter 

A murky definition of "professionalism" in healthcare confounds medical students, who are realizing the term is in the eye of the beholder.

Professionalism in medical settings is outlined in a "do's and don'ts" article and decades-old guidance from the Accreditation Council for Graduate Medical Education. A more dangerous manifestation of the metric shows up during a medical student's education: Faculty, staff and other students can report concerns about a person's professional behavior, resulting in write-ups saved to permanent records.

"Depending on who makes the call, unprofessional behavior can mean hugging your program director, letting a bra strap show, wearing braids, donning a swimsuit over the weekend or wearing a 'Black Lives Matter' sweatshirt in the E.R.,".

The power of an unclear definition also shows up to restrict diverse backgrounds and experiences. Adaira Landry, MD, an emergency medicine physician at Brigham and Women's Hospital in Boston and a professor at Harvard Medical School, recently co-authored an article on the overpolicing of Black residents.

"The environment is so restrictive of what is allowed that when you behave or look or speak differently, it feels like it's unprofessional," said Dr. Landry.

Between 2015 and 2016, 20% of trainees dismissed from their residency were Black, despite Black students accounting for only 5% of all residents, according to unpublished data.

In late 2019, an article titled, "Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons." The authors rated social media accounts of nearly 500 surgery trainees on what they defined as unprofessionalism, which included holding alcoholic drinks, wearing Halloween costumes or "provocative posing in bikinis/swimwear."

Londyn Robinson, MD, a resident at Duke University in Durham, N.C, found the article while applying for residencies in 2020. The discovery unearthed an ugly truth: Professionalism can be minimized to a person's image instead of ethical behavior with patients.

"Basically, they said the quiet part out loud," said Dr. Robinson, who is the first in her family to earn an MD.

After Dr. Robinson talked about the article in a post that went viral, the journal retracted the paper.

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