Forming technically proficient, professional, and humanistic physicians for the 21st century is no easy task. Mountains of biomedical knowledge must be acquired, diagnostic competence achieved, effective communication skills developed, and a solid and applicable understanding of the practice and role of physicians in society today must be reached. The central experience for learners in this complex and challenging terrain is the modeling of and learning how to be a caregiver and health professional.
Role modeling remains one crucial area where standards are elusive and where repeated negative learning experiences may adversely impact the development of professionalism in medical students and residents. The literature is mainly descriptive, defining the attributes of good role models from both learners and practitioners' perspectives. Because physicians are not playing a role as an actor might, but embodying different types of roles, the cognitive and behavioral processes associated with successfully internalizing roles (e.g., the good doctor/medical educator) are important.
In this article, the authors identify foundational questions regarding role models and professional character formation; describe major social and historical reasons for inattention to character formation in new physicians; draw insights about this important area from ethics and education theory (philosophical inquiry, apprenticeship, situated learning, observational learning, reflective practice); and suggest the practical consequences of this work for faculty recruitment, affirmation, and development.
Forming technically proficient, professional, and humanistic physicians for the 21st century is no easy task. Mountains of biomedical knowledge must be acquired, diagnostic competence achieved, effective communication skills developed, and a solid and applicable understanding of the practice and role of physicians in society today must be reached. Central to the experience of learners in this complex and challenging terrain is the modeling of and learning how to be a caregiver and health professional. Despite efforts to enhance the effectiveness of medical education, role modeling remains one crucial area where standards are elusive and where repeated negative experiences may adversely impact a learner's development of professionalism (the learning how to be). This article identifies some foundational questions regarding role models and professional character formation, describes the major social and historical reasons for inattention to the character formation of new physicians, draws insights from disciplines outside medical education that can inform our understanding of this important area, and suggests the practical consequences of this work for faculty recruitment, affirmation, and development.
Enhancing role modeling and professional character formation in medical education are recent concerns in medicine's long-standing attention to educational reform. Throughout this history, change has focused on improving knowledge and skill development, which has evolved greatly over the last century of advancing science and technology. Progress rested within these skill sets, and although the essential values and attitudes for professional practice were regularly espoused, they remained in the background. Consequently, although medical education features sophisticated strategies for achieving knowledge and skill objectives, until recently little attention has been given to value, attitude, and professional character development, which has, instead, depended on vague notions of role modeling as a means of teaching and learning. Assumptions about the effectiveness of role models in professional character development are pervasive yet insufficiently examined among otherwise thoughtful and challenging approaches to medical education. The lack of attention to role modeling is a key reason that meaningful reform of professional character formation can be characterized as a history of reform without change, of repeated modifications of the medical school curriculum that alter very slightly, or not at all, the experience of the critical participants, the students and teachers.1
Medical educators increasingly understand professional education to be a process of moral enculturation, of taking the values, attitudes, character, and identity of the chosen profession (and, implicitly, of the good professional) as one's own.2 Role models are central to enculturation because professional behavior is learned in the experience of practice. We distinguish here between mentors and role models, however. Mentors are senior members of a group who intentionally encourage and support younger colleagues in their careers. Mentoring often includes role modeling. Role models, on the other hand, teach by example and influence professional identity in multiple ways. Role modeling is less intentional and often unaware, more informal and more episodic than mentoring.