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Psych Progress

Professionalism: Can We Know It Without Seeing It and Can It be Taught?

Ann Robinson Endowed Chair in Psychiatry, Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School; Attending Psychiatrist, Sentara Norfolk General Hospital, Norfolk, Va.

First published in Psychiatry Weekly, Volume 8, Issue 7, March 18, 2013

Residents are to be evaluated on their professionalism, a complex construct with multiple dimensions that can include dress and personal appearance, behavior, integrity, maturity, responsibility, and attitude. Unfortunately, there are no uniformly accepted definitional criteria for the all-encompassing term of professionalism. One may wonder legitimately if professionalism is akin to good artwork, where, although a comprehensive and fully satisfying definition may be elusive, you still know it when you see it.

Professionalism and Dress

Dress and appearance can often communicate and simultaneously command respect. Appropriate dress can convey respect for the patient and for the serious nature of the collaborative work psychiatrists and patients perform together, to say nothing of the work that attendings and residents perform together. Wearing the “white coat” is important, because it reinforces for the patient that the psychiatrist is a physician. Excepting instances where it is forbidden or discouraged for male psychiatrists to wear ties (eg, the ED and acute inpatient units), it may be appropriate and expected for male psychiatrists to wear ties.

Residents must also learn to work together collegially and to be supportive of each other. Psychiatry is a difficult discipline, and it is not infrequent—especially in the context of conducting psychotherapy—for residents to wonder if what they are doing is technically correct and effective. It may be helpful and revealing for residents to discuss these types of uncertainties with colleagues. Dysfunctional resident classes are often characterized by reluctance to discuss technical issues and concerns, especially as they pertain to their outpatient psychotherapy practices. Dramatic examples of poor professionalism would certainly include instances where residents would disagree openly, even heatedly, with each other in public areas. This not only exposes patients to this particular type of unprofessionalism but it may actually border on abuse, especially for patients with severe and persistent mental illness.

Conclusion

The development and practice of professionalism is a legitimate and important goal of residency training. The challenges are how to define it and measure it objectively, and how to translate its assessment into something constructive that promotes the professional growth of the resident.

Disclosure: Dr. Deutsch reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest.

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