Educating for professionalism: creating a culture of humanism in medical education Delese Wear and Janet Bickel, editors Iowa City (IA): University of Iowa Press; 2000 215 pp US$42.95 (cloth) ISBN 0-87745-741-7
Delese Wear and Janet Bickel have produced a useful volume in assembling Educating for Professionalism: Creating a Culture of Humanism in Medical Education. Thirteen chapters are divided into two major sections. The first, “Understanding the Experience of Medical Education,” examines the “often conflicting ethical, social, emotional, and intellectual messages medical institutions send to students about what it means to be a doctor.” It is excellent and achieves its objective extremely well. Clearly, these are important issues, and they are examined in depth.
A chapter by Stanley Joel Reiser on “The Moral Order of the Medical School,” is clear, concise and incisive. It discusses how the organization of medical faculties, including the processes they utilize to achieve their educational aims, influences students' behaviour and attitudes.
The chapter by Frederic W. Hafferty (“In Search of a Lost Cord”) is worth the price of the book. It is an outstanding exposition of the origins of professionalism, how it has evolved through time, what its impact has been on the practice of medicine, and how this awareness can be used in education. The hidden curriculum is also discussed in relation to issues of professionalism. Hafferty's wide experience and expertise are obvious, and his chapter is both original and unique. It makes a valuable contribution to our understanding of the issues and will be a great help to those interested in teaching professionalism.
The other chapters in this section are also valuable. “Professional Ethics and Social Activism: Where Have We Been? Where Are We Going?” by Jack Coulehan and Peter C. Williams is particularly effective in tracing the real threats posed by the educational process to the idealism of incoming medical students. The authors highlight the “dysfunction between the values of the explicit curriculum and the manifestly contradictory ones taught day to day” and offer advice as to how to overcome the problem.
The second part of the volume is in some ways less effective. Entitled “Shaping the Experience of Medical Education,” it comprises a series of monographs outlining the experience of several institutions in promoting humanism. Student advocacy, community-based projects and the place of the humanities are effectively outlined, and several authors suggest a variety of educational methods by which professionalism can be promoted. The chapter by Edward J. Eckenfels on student-run community projects that stress the fiduciary duty to service is outstanding, as is that on mentor–mentee relationships by Tana A. Grady-Weliky and colleagues. Essentially, this section is an educational buffet where one can pass down the line, selecting those techniques that might be applicable to one's own school in the promotion of professional development and behaviour.
Each contribution to the volume is well written and thoughtful. The weakness of the book — and it is significant — is that no attempt has been made to integrate the material into a coherent whole. In their introduction, the editors merely give a synopsis of the individual contributions. One would have hoped that the editors of this major effort, involving so many individuals who have contributed to our present body of knowledge, would have suggested how an integrated program on professionalism might be instituted in a curriculum and how humanism could be related to this program. Hafferty's chapter comes the closest, but even it doesn't provide a framework in which the efforts of other educators might be integrated.
Although we recommend this book for the valuable information it contains, it does leave us with an unfortunate feeling of “what might have been.”
Richard L. Cruess Sylvia R. Cruess Faculty of Medicine McGill University Montreal, Que.
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