Virtue-based Professionalism A recent paper in Academic Medicine 1 considered three frameworks for developing professionalism in medical educa7on. The oldest framework is virtue-based and focuses on the inner habits of the heart, the development of moral character and reasoning, plus humanis7c quali7es of caring and compassion: The good physician is a person of character. The second framework is behaviour-based, which emphasises milestones, competencies, and measurement of observable behaviours: The good physician is a person who consistently demonstrates competence in performing pa7ent-care tasks. The third framework is iden7ty forma7on, with a focus on iden7ty development and socialisa7on into a community of prac7ce: The good physician integrates into his or her iden7ty a set of values and disposi7ons consonant (consistent?) with the physician community and aspires to a professional iden7ty reflected in the very best physicians. The authors say, ‘Although each professionalism framework is useful and valid, the field of medical educa7on is currently engaged in several different discourses resul7ng in misunderstanding and differing recommenda7ons for strategies to facilitate professionalism. By examining each discourse in detail, underlying commonali7es and differences can be highlighted to assist educators in more effec7vely crea7ng professionalism curricula, pedagogy, and assessment.’ PRIME is firmly commiOed to teaching and modelling professionalism as defined by the first (and oldest) framework above (whilst acknowledging that the others have some useful features). The first framework is virtue-based professionalism with a focus on the moral character, reasoning and humanitarianism of the healthcare professional. Appropriate professional ac7ons are the result of internalising the right values (what PRIME would call ‘God’s values’) and ethical principles un7l habits are created. The strength of this approach is that it places internal values and mo7va7on first and makes moral reasoning rou7ne. It is taught by seeking to get students to internalise and gain commitment to a core set of values and ac7ons that are guided by moral reasoning. In this way, habits of the heart such as caring and compassion become part of the health-care professional’s character and are not dependent on environment, role-models or the demonstra7on of observable behaviours to pass exams. PRIME’s vision is to see all health-care professionals taught and prac7sing a virtue-based professionalism, so that health-care around the world is provided by people who truly care for their pa7ents and consistently demonstrate compassion. This does not depend on a par7cular context or

Virtue-based Professionalism

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"In this way, habits of the heart such as caring and compassion become part of the health-care professional’s character and are not dependent on environment, role-models or the demonstration of observable behaviours to pass exams. PRIME’s vision is to see all health-care professionals taught and practising a virtue-based professionalism, so that health-care around the world is provided by people who truly care for their patients and consistently demonstrate compassion."

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Virtue-basedProfessionalismArecentpaperinAcademicMedicine1consideredthreeframeworksfordevelopingprofessionalisminmedicaleduca7on.

Theoldestframeworkisvirtue-basedandfocusesontheinnerhabitsoftheheart,thedevelopmentofmoralcharacterandreasoning,plushumanis7cquali7esofcaringandcompassion:Thegoodphysicianisapersonofcharacter.

Thesecondframeworkisbehaviour-based,whichemphasisesmilestones,competencies,andmeasurementofobservablebehaviours:Thegoodphysicianisapersonwhoconsistentlydemonstratescompetenceinperformingpa7ent-caretasks.

Thethirdframeworkisiden7tyforma7on,withafocusoniden7tydevelopmentandsocialisa7onintoacommunityofprac7ce:Thegoodphysicianintegratesintohisorheriden7tyasetofvaluesanddisposi7onsconsonant(consistent?)withthephysiciancommunityandaspirestoaprofessionaliden7tyreflectedintheverybestphysicians.

Theauthorssay,‘Althougheachprofessionalismframeworkisusefulandvalid,thefieldofmedicaleduca7oniscurrentlyengagedinseveraldifferentdiscoursesresul7nginmisunderstandinganddifferingrecommenda7onsforstrategiestofacilitateprofessionalism.Byexaminingeachdiscourseindetail,underlyingcommonali7esanddifferencescanbehighlightedtoassisteducatorsinmoreeffec7velycrea7ngprofessionalismcurricula,pedagogy,andassessment.’

PRIMEisfirmlycommiOedtoteachingandmodellingprofessionalismasdefinedbythefirst(andoldest)frameworkabove(whilstacknowledgingthattheothershavesomeusefulfeatures).Thefirstframeworkisvirtue-basedprofessionalismwithafocusonthemoralcharacter,reasoningandhumanitarianismofthehealthcareprofessional.Appropriateprofessionalac7onsaretheresultofinternalisingtherightvalues(whatPRIMEwouldcall‘God’svalues’)andethicalprinciplesun7lhabitsarecreated.

Thestrengthofthisapproachisthatitplacesinternalvaluesandmo7va7onfirstandmakesmoralreasoningrou7ne.Itistaughtbyseekingtogetstudentstointernaliseandgaincommitmenttoacoresetofvaluesandac7onsthatareguidedbymoralreasoning.Inthisway,habitsoftheheartsuchascaringandcompassionbecomepartofthehealth-careprofessional’scharacterandarenotdependentonenvironment,role-modelsorthedemonstra7onofobservablebehaviourstopassexams.PRIME’svisionistoseeallhealth-careprofessionalstaughtandprac7singavirtue-basedprofessionalism,sothathealth-carearoundtheworldisprovidedbypeoplewhotrulycarefortheirpa7entsandconsistentlydemonstratecompassion.Thisdoesnotdependonapar7cularcontextor