The Increasing Complexities of Professionalism
The Increasing Complexities of Professionalism
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DOI：
10.1097/acm.0b013e3181c85b43
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发表时间：
2010-02-01
影响因子：
7.4
通讯作者：
Castellani, Brian
中科院分区：
文献类型：
--
作者：
Hafferty, Frederic W.;Castellani, Brian
有组织医学的现代专业化运动已经达到了四分之一世纪的标志。在这篇文章中，作者旅行到更早的时间来检查亚伯拉罕·弗莱克斯纳工作中的职业概念。虽然弗莱克斯纳很少使用这个概念，但很明显，他关于医学教育改革的许多著作都是基于他对医生作为专业人员和医学作为一种职业的看法。（而不是以理论为基础），（2）以案例为基础和相对框架，（3）以社会学为导向，（4）以系统为基础，专业精神被概念化为动态的，不断发展的，和多维性。在后半部分，作者建立在Flexner的系统视角上，介绍了对专业性的复杂性科学理解。他们将专业精神定义为一个复杂的系统，介绍了七部分的专业精神类型学，并探讨了医生工作的组织和当今医学中的各种闪点如何揭示工作中的专业精神的竞争形式。然后，作者在微观，中观和宏观层面的分析开发了一个三方模型的专业精神。他们的结论是，如何最好地将职业精神作为21世纪医学教育变革的力量。弗莱克斯纳的改革是基于他对两种特殊类型的职业医生和全职学术医生科学家的看法。作者提出了基于专业主义的改革，这是一个由竞争类型组成的复杂系统。2010; 85：288-301.
Organized medicine's modern-day professionalism movement has reached the quarter-century mark. In this article, the authors travel to an earlier time to examine the concept of profession within the work of Abraham Flexner. Although Flexner used the concept sparingly, it is clear that much of his writing on reforming medical education is grounded in his views on physicians as professionals and medicine as a profession.In the first half, the authors explore Flexner's views of profession, which were (1) empirically (as opposed to philosophically) grounded, (2) case based and comparatively framed, (3) sociological in orientation, and (4) systems based, with professionalism conceptualized as dynamic, evolving, and multidimensional. In the second half, the authors build on Flexner's systems perspective to introduce a complexity science understanding of professionalism. They define professionalism as a complex system, introduce a seven-part typology of professionalism, and explore how the organization of physician work and various flash points within medicine today reveal not one but several competing forms of professionalism at work. The authors then develop a tripartite model of professionalism with analysis at the micro, meso, and macro levels. They conclude with observations on how best to frame professionalism as a force for change in 21st-century medical education.Flexner's reforms were grounded in his vision of two particular types of professional-the physician clinician and the full-time academic physician scientist. The authors propose reform grounded in professionalism as a complex system composed of competing types. Acad Med. 2010; 85: 288-301.