Defining medical professionalism: a qualitative study

Background: Elements of professionalism are well-described in the literature and medical schools continue to struggle with how to teach these concepts effectively. Purpose: The purpose of this study was to investigate the meaning of medical professionalism to medical students, residents, academic faculty and patients and to determine areas of congruence and difference. Methods: In this qualitative study we conducted 8 focus groups to discover subjects' beliefs, perceptions and expectations of medical professionals. Sessions were audiotaped and transcribed, and themes identified through an immersion/crystallisation process. Concept maps were prepared to aid understanding. Results: Recurring primary themes of knowledge/technical skills, patient relationship and character virtues were identified. Secondary themes were medicine as a unique profession, personal congruence and the importance of peer relationships. There was a shift in emphasis reflecting differing stages in the learner continuum. Although patients desired skilled technicians, their themes focused on relationships. Several unique themes were also identified. Conclusions: Some elements of professionalism are embraced by learners at all stages and by patients. Notably, when compared to components of the American Board of Internal Medicine Physician Charter, themes relating to social justice elements were lacking. Differences in emphasis by learner groups reflect the inherent challenges to teaching professionalism successfully. Future studies investigating these differing perceptions are needed to help clarify our teaching mission.