Virtues and Vices in Medical Education: A Critical Analysis of Allopathic Medical School Professionalism Policies

Abstract

The notion of professionalism is paramount to physicians and physicians-in-training alike, constituting a fundamental component of medical education. The Accreditation Council for Graduate Medical Education reinforces the importance of professionalism, mandating the integration of professionalism as a core competency in residency programs. Moreover, individual medical schools attempt to identify and teach professionals through two overarching policy frameworks: behavior-based or virtue-based. Thus, we report on results from the Insight Into Professionalism Initiative, which has attempted to characterize professionalism in undergraduate medical education through examining institutional policies of allopathic medical schools across the United States. Policies were categorized as behavior-based, virtue-based, or a combination thereof, with the predominant type being behavioral. For instance, the professionalism policies of Morehouse School of Medicine and Mercer School of Medicine focus on delineating professional and unprofessional behaviors. These policies centered on behaviors are potentially limited in their ability to comprehensively address the myriad of encouraged and discouraged actions. Conversely, institutions such as Michigan State University and Loma Linda University guide students toward professionalism by elucidating virtues to be cultivated through deliberate conversations, introspection, and practical application. Policies concentrating on the cultivation of virtues acknowledge the symbiotic relationship of virtues and behaviors: the interplay between virtues (e.g. altruism, respect, honesty) and congruent actions establish a mutually reinforcing dynamic. In light of our findings, we suggest that medical education should prioritize cultivating virtues for professional development, especially to diminish occurrences of malpractice, mistreatment, and misconduct in healthcare. This entails a paradigm shift toward holistic student development through clear, informative professionalism policies that explicitly define virtues and offer examples of behaviors that embody them. This approach seeks to foster a medical culture rooted in the intrinsic values of virtuous professionalism, thus contributing to the formation of ethical, compassionate, and competent physicians.