This is a report from a movement. It presents ideas, evidence, and guidance for those interested in using the most recent advances in knowledge about learning and human development to enhance medical education's ability to form competent, caring, and publicly responsible physicians. Like all genuine social movements, this new approach is emerging from experience and experiment, in this case by the medical educators involved in articulating a new way of understanding their mission. For that reason, it is an optimistic book. The voices are those of many of the leaders, theorists, and experienced practitioners of the new approach who have found in it a promising way to confront the challenges of a new era in medicine.

Though it is not formally a manifesto, this book makes a strong case that professional identity formation needs to become the central focus in educating tomorrow's physicians. In a time when medicine in general, and medical education in particular, finds itself under great stress, the book provides a way in which the profession can respond constructively through a new focus on the professional identity of physicians. The book is also not a how-to manual. But it does provide a thorough review of the learning science and social scientific insights that underlie the changes in training that it calls for, while vividly exemplifying these new educational practices in functioning programs. Neither is this a policy document, though it ought to provide persuasive evidence to support bold proposals to implement the vision of medical education that the book sets out, one that can sustain physicians’ commitment to high standards of practice over an entire career.

Since the publication of the first edition of Teaching Medical Professionalism in 2009, medical education in the United States and Canada has seen an upsurge in efforts to ensure that physicians at all stages of their training encounter a learning environment that embodies the practice of medicine at its best. “Professionalism” is the term that is often used to encapsulate the complex but utterly essential features of such high-performance practice that is grounded in continuing improvement, focused on the needs of patients, and guided by a sense of social responsibility shared between the profession and the public it is meant to serve.

This is a pioneering book. It brings together leading figures in both the theory and the practice of teaching professionalism in medicine. The volume's chapters provide a thorough and useful guide to one of the most important topics in medical education today: how to ensure that future physicians can meet the increased expectations the public now places on medicine. The key to securing medicine's future, the authors of the volume argue, lies in understanding, transmitting, and enhancing medical professionalism.

The public wants both better medical care and a profession more responsive to its needs. But most of all, people want competent and caring physicians who are committed to the healing of their patients. Nearly all of us will be patients. We will be vulnerable and in need of medical expertise. We will want the best prepared and most knowledgeable doctors we can find. But more than that, we will need to be able to trust that our physicians will be dedicated above all else to care for us with all their ability.

ADDRESSING THREATS TO THE INTEGRITY OF THE PRACTICE OF MEDICINE

Medicine as a profession is defined by its blending of expertise in healing with responsibility for patient care. Teaching professionalism, as the authors present it, directly addresses the formation of physicians who manifest this needed integration of expertise with dedication to the care of patients. They write this in full knowledge that medicine's integrity has for some time been under threat. Those threats to the integrity of medical practice are two.

Declared in Kwangju, South Korea, May 14–17, 1998.

Preamble

For long, especially during the colonial period, the peoples of Asia suffered from gross violations of their rights and freedoms. Today large sections of our people continue to be exploited and oppressed and many of our societies are torn apart by hatred and intolerance. Increasingly the people realize that peace and dignity are possible only when the equal and inalienable rights of all persons and groups are recognised and protected. They are determined to secure peace and justice for themselves and the coming generations through the struggle for human rights and freedoms. Towards that end they adopt this Charter as an affirmation of the desire and aspirations of the peoples of Asia to live in peace and dignity.

Background to the Charter

1.1 The Asian struggle for rights and freedoms has deep historical roots, in the fight against oppression in civil society and the political oppression of colonialism, and subsequently for the establishment or restoration of democracy. The reaffirmation of rights is necessary now more than ever before. Asia is passing through a period of rapid change, which affects social structures, political institutions and the economy. Traditional values are under threat from new forms of development and technologies, as well as political authorities and economic organizations that manage these changes.

Adopted by the United Nations General Assembly, December 16, 1966.

Preamble

The States Parties to the present Covenant,

Considering that, in accordance with the principles proclaimed in the Charter of the United Nations, recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Recognizing that these rights derive from the inherent dignity of the human person,

Recognizing that, in accordance with the Universal Declaration of Human Rights, the ideal of free human beings enjoying freedom from fear and want can only be achieved if conditions are created whereby everyone may enjoy his economic, social and cultural rights, as well as his civil and political rights,

Considering the obligation of States under the Charter of the United Nations to promote universal respect for, and observance of, human rights and freedoms,

Realizing that the individual, having duties to other individuals and to the community to which he belongs, is under a responsibility to strive for the promotion and observance of the rights recognized in the present Covenant,

Agree upon the following articles:

PART I

Article 1

1. All peoples have the right of self-determination. By virtue of that right they freely determine their political status and freely pursue their economic, social and cultural development.

2. All peoples may, for their own ends, freely dispose of their natural wealth and resources without prejudice to any obligations arising out of international economic co-operation, based upon the principle of mutual benefit, and international law. In no case may a people be deprived of its own means of subsistence.

3. […]

The chapters in this volume represent an experiment in dialogue among a group of the ethical traditions that shape the contemporary world. Reporting in their several voices, the authors provide notable essays in moral imagination for our time. While they speak from quite different perspectives, the authors meet within a common, if complex, space of discourse. All the contributors have developed their thinking against the backdrop of intensified interaction among various peoples and parts of the globe, rooted in today's expanding technological webs of communication and economic interdependence. These circuits of interaction and awareness provide the material basis for the much-discussed phenomenon of globalization.

Only a decade ago, proponents of globalization, especially in the United States, were hailing the arrival of a new era of worldwide security and prosperity sustained by a global economy and the rule of law. Since then, however, a series of conflicts, including catastrophic violence and savage warfare, have made all too plain the naiveté of that premature celebration. The contributors to this volume are committed to dialogue in the search for ways to strengthen the fragile global web of human solidarity, but they are fully aware of the harsh realities and moral precariousness of the present. They acknowledge the plurality not only of material interests but of moral values and aspirations as well.

Ethical principles are related in complex ways to social institutions. Principles can be used to justify or rationalize an existing social-political order by showing how institutions embody or approximate ethical ideals.

Adopted at the Nineteenth Islamic Conference of Foreign Ministers, Cairo, August 5, 1990.

The Member States of the Organization of the Islamic Conference,

Reaffirming the civilizing and historical role of the Islamic Ummah which God made the best nation that has given mankind a universal and well-balanced civilization in which harmony is established between this life and the hereafter and knowledge is combined with faith; and the role that this Ummah should play to guide a humanity confused by competing trends and ideologies and to provide solutions to the chronic problems of this materialistic civilization;

Wishing to contribute to the efforts of mankind to assert human rights, to protect man from exploitation and persecution, and to affirm his freedom and right to a dignified life in accordance with the Islamic Shari'ah;

Convinced that mankind which has reached an advanced stage in materialistic science is still, and shall remain, in dire need of faith to support its civilization and of a self-motivating force to guard its rights;

Believing that fundamental rights and universal freedoms in Islam are an integral part of the Islamic religion and that no one as a matter of principle has the right to suspend them in whole or in part or violate or ignore them in as much as they are binding divine commandments, which are contained in the Revealed Books of God and were sent through the last of His Prophets to complete the preceding divine messages thereby making their observance an act of worship and their neglect or violation an abominable sin, and accordingly every person is individually responsible – and the Ummah collectively responsible – for their safeguard.

Endorsed by the Parliament of the World's Religions in Chicago, September 4, 1993.

The Principles of a Global Ethic

Our world is experiencing a fundamental crisis: A crisis in global economy, global ecology, and global politics. The lack of a grand vision, the tangle of unresolved problems, political paralysis, mediocre political leadership with little insight or foresight, and in general too little sense for the commonweal are seen everywhere: Too many old answers to new challenges.

Hundreds of millions of human beings on our planet increasingly suffer from unemployment, poverty, hunger, and the destruction of their families. Hope for a lasting peace among nations slips away from us. There are tensions between the sexes and generations. Children die, kill, and are killed. More and more countries are shaken by corruption in politics and business. It is increasingly difficult to live together peacefully in our cities because of social, racial, and ethnic conflicts, the abuse of drugs, organized crime, and even anarchy. Even neighbors often live in fear of one another. Our planet continues to be ruthlessly plundered. A collapse of the ecosystem threatens us.

Time and again we see leaders and members of religions incite aggression, fanaticism, hate, and xenophobia – even inspire and legitimize violent and bloody conflicts. Religion often is misused for purely power-political goals, including war. We are filled with disgust.

We condemn these blights and declare that they need not be.

Adopted by the United Nations General Assembly, December 10, 1948.

Preamble

Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,

Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,

Whereas it is essential to promote the development of friendly relations between nations,

Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,

Whereas Member States have pledged themselves to achieve, in cooperation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,

Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realization of this pledge.