Speaking of Education

I recently had the privilege of co-chairing a workshop at the Institute of Medicine (IOM) Global Forum on Innovation in Health Professional Education, of which APA is a co-sponsor. (See IOM.) Our topic was professionalism in the context of a changing health-care system. A fundamental assumption was that if we are to maintain the public trust, our health-care system needs a "new professionalism" that emphasizes interprofessional collaboration, shared values and shared accountability. My interest in professionalism is not just because we need to educate and train future psychologists, but also because professionalism itself is fundamentally about individual and group attitudes, beliefs, feelings and behavior — the focus of our discipline.

Although professionalism is a core competency for many professions, each profession articulates its own standards in professional silos that list the attributes, behaviors and values that professionals should exemplify, such as accountability, altruism, non-maleficence, respect, sensitivity to diversity and so forth. The Health Service Psychology Education Collaborative, for example, has articulated competencies related to professionalism for psychologists who provide health-care services; psychology needs to promulgate these if we wish to be among the health fields.

But professionalism is more than a list of desired behaviors and codes of ethics. It is the means by which a profession keeps its social contract with society. The profession "professes" to the public that it will be altruistic, competent, self-regulating, trustworthy and address societal concerns. In return, it is granted autonomy, prestige and financial rewards. As noted by my co-chair, Matthew Wynia, MD, professionalism is not only an individual competency, but an ideology of the professional group and its organizational structures. There are other "isms" by which professions could be organized within our society, such as consumerism or statism (governmental regulation). In reality, we now have a mixed model, and these other models will increasingly dominate if professionalism is weak.

As health care has increased its focus on collaborative care to reduce error and improve quality, there has been a concomitant need to examine bridges across the health-care professions with respect to professionalism. Rather than continuing to conceptualize professionalism within the silos of the professions, there have been efforts to articulate elements that are uniquely relevant to collaboration across the health professions. Through the work of Cathi Grus, PhD, APA has been participating in the Interprofessional Professionalism Collaborative, which underscores cooperation, communication and accountability across professional boundaries. (For more information on the effort, go to Interprofessional Professionalism Collaborative.)

Will efforts to support interprofessional professionalism lead to a shared social contract that transcends all the professions but also connects them with a unifying set of beliefs and behaviors that they profess to the public? Will the multiple health disciplines and professions work together to ensure they are worthy of the trust of patients and the public? Will there be an evolution to a "transdisciplinary professionalism," which for this IOM meeting we defined as "an approach to creating and carrying out a shared social contract that ensures multiple health disciplines, working in concert, are worthy of the trust of patients and the public"? If so, how will we teach this kind of professionalism, and perhaps more important, how will we as faculty, practitioners and an organization model it for our students?

Every student must understand and embrace his or her obligations to society as professionals. It will require not only interprofessional education, training and practice, but a deeper examination of our "hidden curriculum," and what we are teaching our students through modeling. It will also require an examination of our profession's internal relationships in areas of quality assurance and maintenance of competence, as well as our relationships with other health professions and how we work together to be collectively accountable and worthy of the public's trust.