American Medical Student Association

At medical schools across the country, students, faculty members and deans are discussing professionalism. There is widespread agreement in several areas: Professionalism is important in the classroom and in the clin-ic; medical students have a responsibility to adhere to their schools’ honor codes; and professionalism includes humility, compassion, self-sacrifice and respectful, patient-centered clinical care.

But one topic, faculty accountability, is not resolved. Where are the honor codes for faculty? Why are med-ical students sometimes subjected to abuse at the hands of their teachers, seemingly without consequences? Why is faculty professionalism not taken into account when promotion and tenure decisions are made? Are medical students being held to a higher standard of professionalism than their teachers?

I believe strongly, as medical students do, that the administration and faculty of a medical school should be held to the highest standards of professionalism, and mistreatment of students is unforgivable. Here I offer two points on improving faculty accountability.

First, medical professionalism should be defined broadly. Certainly, professionalism includes humanism, empathy and putting patients’ interests first. But it also includes self-directed learning, volunteerism, advocacy and civic engagement.

Second, academic institutions change slowly. When it comes to regulating professional behaviors, faculty governance bodies are likely to ask: Where are the published data? Who will be the judges of faculty profes-sionalism? What metrics will faculty promotions committees use for virtues like “altruism,” “humility” and “insti-tutional citizenship?”

Medical schools will conduct surveys and literature searches, they will appoint blue-ribbon panels and task forces, and they will search for consensus and “best practices” before changes are made.
But you have only four years to be a medical student. Even as you challenge your deans and faculty lead-ers, you are not likely to wait for them to take action. In fact, you are not waiting now. You are taking action to define and model professionalism for yourselves.

For example, here, at the University of Colorado Denver School of Medicine (UCD), students are using their lunch hours and evenings to take courses in medical Spanish so they can hone their abilities to hear, speak and empathize across a lingual and cultural divide, doing their part to address health care disparities. They are not waiting for their medical school to perfect its formal cultural competency curriculum.
Because institutional citizenship is also a part of professionalism, medical students are working tirelessly on medical school admissions, accreditation and search committees.

Volunteerism is important, so medical students, with dedicated faculty physicians, are spending Saturday mornings caring for homeless patients at a clinic in downtown Denver. Medical students organize and direct this program.

A few years ago, a group of medical students founded Camp Wapiyapi, in the Colorado mountains, which provides a week of adventure, friendship, peace and comfort for kids with cancer, far from hospitals and che-motherapy. These students know that not all learning takes place in the classroom, and not all healing takes place in the hospital.

Each spring, medical students organize and lead a cadaver memorial service, so they can say thank you to the families of their first-year cadavers, while hearing from family members about the lives their first patients once led.

Advocacy and civic engagement are part of professionalism, too. Medical students here led the protest against the excessive influence of the pharmaceutical industry and helped develop the school’s new policy that prohibits faculty, residents and students from accepting free meals, gifts or industry-branded items. Self-regulation to promote ethical behavior and earn the public’s trust is a part of medical professionalism.
Hopefully, most faculty members at your school, on most days, demonstrate high levels of professionalism, humanism, integrity and institutional citizenship—that they are doing many things right and are the teachers and role models you hoped to find.

We should all agree that medical students must never be subjected to verbal insults, belittling or other of-fensive behaviors. Faculty members should adopt their own professionalism honor codes. Long overdue are the means to provide an effective, safe and confidential way for students to report abusive behaviors by faculty members. Whenever lapses in professional behaviors occur, there should be a response system with appropriate “efferent limbs,” including feedback, mediation, remediation, discipline or other corrective actions. A quarter-century ago, two faculty pediatricians at UCD first documented the common occurrence of medical student abuse. They recommended that medical schools adopt codes of conduct for all members of the community, including faculty, and they called for mandatory reporting of unprofessional behaviors. “It would be helpful,” they wrote, “for a profession that is dedicated to humanity to take a closer look at its own humanness.”

Scores of papers have been written about medical professionalism and the need for institutional change—especially how change needs to begin “at the top” of the organization. But, maybe not all institutional change has to begin at the top. For even while the medical school’s blue-ribbon task forces are meeting, and even when it seems that nothing is happening, something is: You, the medical student, are providing pa-tient-centered care at the bedside, with your laser-like focus on listening, comforting and caring. You are chal-lenging institutional policies when you feel that the public’s interest is at stake. You are trespassing into the community, volunteering and taking sides in public affairs. And whether it is through bedside care, community service, a cadaver memorial service or Spanish courses, you are helping to define the contours of your medical school curriculum and taking charge of your own professional development.

Professionalism includes charity, humanism, devotion to patients, lifelong learning, personal sacrifice, ad-vocacy and community service. If you define professionalism broadly, you may come to recognize that you, too, are the role models you have been looking for.

So, returning to your original question: Are students being held to a higher standard of professionalism than their teachers? Maybe so, although this is changing. There is reason for optimism, but it takes medical students to help lead the way. Medical school leaders seeking to codify professionalism and strengthen accountability should look to their medical students, who are exemplifying professionalism in their everyday lives.

Dr. Steven Lowenstein is professor of emergency medicine and associate dean at the University of Colorado School of Medicine.