Physicians' professionalism and humanism have become central foci of the efforts of medical educators as the public, various accrediting and licensing agencies, and the profession itself have expressed concerns about the apparent erosion of physicians' competency in these aspects of the art, rather than the science, of medicine. Of the many obstacles to enhancing trainees' skills in these domains, one of the most significant is the difficulty in assessing competency in physicians' professionalism and humanism. The author suggests that the assessment of these aspects of the art of medicine has more in common with the approaches used in criticism of the arts than with the quantitative assessment tools appropriate to the scientific method and the medical model. Quantitative and semi-quantitative tools, so effective in elucidating the etiology, pathophysiology, and treatment of disease, are often in-appropriate and invalid when applied to evaluation of professional and humanistic competencies. The author proposes that humanism connoisseurs be employed to qualitatively evaluate medical trainees' professionalism and humanism. Such connoisseurs would possess expert knowledge, training, and experience in the interpersonal aspects of the art of medicine, allowing them to deconstruct concepts such as empathy, compassion, integrity, and respect into their respective key elements while evaluating physicians' behaviors as an integrated, cohesive whole. Through the use of a rich descriptive vocabulary, humanism connoisseurs would provide valid formative and summative feedback regarding competency in medical professionalism and humanism. In the process, they would serve to counteract the relative marginalization of professionalism and humanism in the informal and lived curricula of medical trainees.
Professionalism,1 integrity, humanism, compassion, empathy, respect, altruism-these terms can be found throughout the medical literature, often accompanied by elegies for their disappearance in the modern physician. While the biomedical and technical aspects-the science-of medical practice continue to progress at an astonishing rate, it is the human part of medical practice-in particular physicians' humanism and professionalism-that seems endangered in proportion to the explosion of biomedical knowledge and rapid structural changes in the American health care system. If it is true, as succinctly stated by Francis Peabody,2 that the secret of the care of the patient is in caring for the patient, then the diminution of such caring cannot be ignored.
The public has regularly decried the apparent replacement of physicians' humanism with technologic sophistication, but patients and their advocates are not alone in their concerns. Physicians and medical educators themselves3,4,5,6,7,8,9,10,11,12,13,14,15 have expressed similar misgivings about the modern physician, just as various medical accrediting agencies such as the Liaison Committee for Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) (the latter through its Outcomes Project) have underscored their expectation that medical students, residents, and fellows be trained and formally assessed for professionalism and humanistic knowledge, attitudes, and skills. The call has been taken up as well by various medical specialty boards, with the American Board of Internal Medicine (ABIM)16, 17 being in the vanguard of this effort. Likewise, state licensing agencies have begun to demand that trainees' professional and humanistic competency be certified by appropriate assessment measures; the failure to do so may result in denial of medical licensure or board certification. Thus, a broad coalition, composed of individuals and entities from inside and outside the medical profession, has demanded the return of the professional, humanistic, caring physician.