의학교육논단 (Korean Medical Education Review)

  • 제12권1호
  • /
  • Pages.9-22
  • /
  • 2010
  • /
  • 2092-5603(pISSN)
  • /
  • 2093-6370(eISSN)
연세대학교 의과대학 (Yonsei university college of medicine)
권호 표지
DOI QR코드

DOI QR Code

의학 직업전문성의 특성과 실천 원리

The Attributes and Practical Principle of Medical Professionalism

  • 황은영 (연세대학교 교육연구소) ;
  • 양은배 (연세대학교 의과대학 의학교육학과)
  • Hwang, Eun Young (Educational Research Institute, Yonsei University) ;
  • Yang, Eunbae B. (Department of Medical Education, Yonsei University College of Medicine)
  • 투고 : 2010.05.10
  • 심사 : 2010.05.24
  • 발행 : 2010.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

It is the most important thing at present for physicians to posses the qualification of medical professionalism. A lot of medical schools have made all-out efforts to develop leaders of medicine, who will be able to meet the needs of medical professionalism in this complex medical environment. The purpose of this study is to review the cognitive base of medical professionalism leading the curriculum development of medical professionalism. The discussion of medical professionalism started in the 20th century. During the 1960s, there were attempts to reshape the concepts and attributes of medical professionalism. The government began to intervene in the autonomy of physician and the self regulation policy of medical society in 1970s. Physician may be asked to play as a healer and professional (what?) during their medical practice. The fundamental role of healer such as care, compassion, honesty, integrity, confidentiality, ethical behaviors, and respect with patients were nothing fresh to tell even though the age was changed. The attributes of professional which are physician's autonomy, self regulation, teamwork, and responsibility to society has been changed dramatically over the past five decades. In general, medical educators agreed that professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical and legal understanding, upon which is built application of the principles of professionalism: excellence, accountability, altruism, and humanism. If physicians fail to show professionalism in society, they will confront the crisis which can be under the government control. The only way to keep their autonomy is to practice medical professionalism. So far today, medical schools have laid more stress on competence than value standards in educational systems and it was restricted for medical students to learn the value standards for medical practice. To understand and practice the medical professionalism, it is the most realistic way to solve the complicated medical problems.

키워드

참고문헌

  1. 강신익(2000). 건강권과 의권：국민의 권리와 의사의 권리. 생명윤리, 1(2), 2498-258
  2. 강윤식(2000). 의사들의 전문직업성, 직무스트레스 및 직업 만족도. 경북대학교 대학원 박사학위논문
  3. 권복규(2006). 우리나라 의료윤리 교육에 대한 비판적 고찰. 한국의료윤리교육학회지, 9(1), 60-72
  4. 권상옥(2005). 의료 인문학의 개념과 의학교육에서의 역할. 한국의학교육, 17(3), 217-223
  5. 김석화, 김승호, 박선아, 서덕준, 신좌섭, 안덕선, 양은배, 조영주, 채규태(2004). 인문사회의학 교육과정 개발 연구. 서울：한국의과대학장협의회
  6. 김선, 허예라(2003). 21세기 의학전문직업성 교육：어떻게 할 것인가? 한국의학교육, 15(3), 171-186
  7. 김선, 허예라(2005). 의학직업전문성 어떻게 평가할 것인가. 한국의학교육, 17(1), 1-14
  8. 맹광호(2008). 한국에서 의학 전문직업성 교육：과제와 전망. 한국의학교육, 20(1), 3-10
  9. 박호진 역(2007). 프로페셔널리즘：전문직에 대한 사회학적 분석과 전망. 서울：아카넷
  10. 방재범, 이광윤, 이충기, 이동협, 이영환, 김재룡, 강복수 (2008). 의학 직업전문성의 기초 자질 함양을 위한 교육과정 평가 및 구성. 한국의학교육, 20(2), 109-121
  11. 안덕선(2005). 교양교육으로서의 Professionalism. Medical Professionalism 교육과 실천 심포지움자료집 (3-15). 영남대학교의과대학. 한국의학교육학회
  12. 이영미, 안덕선(2007). 좋은 의사 특성 규명을 위한 기초 연구. 한국의학교육, 19(4), 313-323
  13. 임기영(2007). 한국의료상황과 프로페셔널리즘 교육. 한국의학교육, 19(4), 267-269
  14. 전우택, 양은배(2002). 인문사회의학과 의학교육의 미래와. 연세대학교 출판부
  15. 정연재(2007). 프로페셔널리즘과 전문직 윤리 교육. 윤리교육연구, 14, 131-146
  16. 정유석(2004). 의사의 프로페셔널리즘과 진료자율권. 한국의료윤리학회지, 7(2), 140-150
  17. 정철운(2004). 우리나라 의과대학의 의학직업전문성 교육 현황. 한국의학교육, 16(3), 259-269
  18. 허예라, 이성호, 김선(2008). 의과대학생들의 의학 직업 전문성에 대한 자기 평가, 한국의학교육, 20(1), 23-35
  19. Abbot, L.C.(1983). A study of humanism in family physician. Journal of Family Practice, 16, 1141-1146
  20. Accreditation Council for Graduate Medical Education. (1999). Outcome project enhancing residency education through outcomes assessment: General competencies. Version 1.2. Chicago, IL: Author
  21. American Board of Internal Medicine Foundation, American College of Physicians-American Society of Internal Medicine Foundation & European Federation of Internal Medicine.(2002). Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine, 136(3), 243-246 https://doi.org/10.7326/0003-4819-136-3-200202050-00012
  22. American Board of Internal Medicine.(1983). Evaluation of Humanistic Qualities in the Internist. Annals of Internal Medicine, 99, 720-724 https://doi.org/10.7326/0003-4819-99-5-720
  23. American Board of Internal Medicine.(1992). Guide to awareness and evaluation of humanistic qualities in the internist: 1992-1995. (2nd ed). Philadelphia, PA: Author
  24. American Board of Internal Medicine.(1995). Project Professionalism. Philadelphia, PA: Author
  25. American Board of Internal Medicine.(1999). Project professionalism (revised). Philadelphia, PA: Author
  26. Arnold, L.(2002). Assessing professional behavior: Yesterday, today and tomorrow. Academic Medicine, 77(6), 502-515 https://doi.org/10.1097/00001888-200206000-00006
  27. Arnold, L., & Stern, D.T.(2006). What is medical professionalism. In D.T. Stern (Ed.), Measuring medical professionalism (pp. 15-37). New York: Oxford University Press
  28. Association of American Medical Colleges.(1998). Learning objectives for medical student education- Guideline for medical schools: Report I of the Medical School Objectives Project. Washington, DC: Author
  29. Barondess, J.A.(2003). Medicine and professionalism. Archives of Internal Medicine, 163, 145-149 https://doi.org/10.1001/archinte.163.2.145
  30. Batson, C.E., Bolen, M.H., Cross, J.A., & Neuringer-Benefiel, H.E.(1986). Where is altruism in the altruistic personality?. Journal of Personality and Social Psychology, 50(1), 212-220 https://doi.org/10.1037/0022-3514.50.1.212
  31. Beauchamp, G.(2004). The challenge of teaching professionalism. Annals of the Academy of Medicine Singapore, 33(6), 697-705
  32. Blank, L., Kimball, H., McDonald, W., & Merino, J.(2003). Medical professionalism in the new millennium: A physician charter 15 months later. Annals of Internal Medicine, 138, 839-841 https://doi.org/10.7326/0003-4819-138-10-200305200-00012
  33. Bloche, M.G.(1999). Clinical loyalties and the social purposes of medicine. JAMA, 281(3), 268-274 https://doi.org/10.1001/jama.281.3.268
  34. Borges, N.J., Stephen, M.R., Elam, C., & Jones, B.J.(2006). Comparing millennial and generation X medical Students at one medical school. Academic Medicine, 81, 571-576 https://doi.org/10.1097/01.ACM.0000225222.38078.47
  35. Brandeis, L.D.(1914). Business, a profession, Ernest Poole, editor. Boston, MA: Small, Maynard
  36. Brody, H.(2003). Professionalism, ethics, or both? Does it matter?. Med Hum Rep. 24: 1-4
  37. Canadian Medical Association.(2002). Medical Professionalism. Canadian Medical Association Journal, 167, 539-541
  38. Cohen, J.J.(2006). Professionalism in medical education, an American perspective: From evidence to accountability. Medical Education, 40(7), 607-617 https://doi.org/10.1111/j.1365-2929.2006.02512.x
  39. Cohen, J.J., Cruess, S.R., & Davidson, C.(2007). Alliance between society and medicine: The public's stake in medical professionalism. JAMA, 298, 670-673 https://doi.org/10.1001/jama.298.6.670
  40. Coulehan, J.(2005). Today's professionalism: Engaging the mind but not the heart. Academic Medicine, 80(10), 892-898 https://doi.org/10.1097/00001888-200510000-00004
  41. Coulter, A.(2002). Patient's views of the good doctor: Doctors have to earn patients' trust. BMJ, 325(7366), 668-669 https://doi.org/10.1136/bmj.325.7366.668
  42. Coyle, S.L.(2002). Physician-industry relations-Part I : Individual physicians. Annals of Internal Medicine, 136(5), 396-402 https://doi.org/10.7326/0003-4819-136-5-200203050-00014
  43. Cruess, R.L., Cruess, S.R.(1997). Teaching medicine as a profession in the service of healing. Academic Medicine, 72(11), 941-952 https://doi.org/10.1097/00001888-199711000-00009
  44. Cruess, R.L., Cruess, S.R., & Johnston, S.E.(1999). Renewing professionalism: An opportunity for medicine. Academic Medicine, 74(8), 878-884 https://doi.org/10.1097/00001888-199908000-00010
  45. Cruess, S.R., & Cruess, R.L. (2009). The cognitive base of professionalism. In R.L. Cruess, S.R. Cruess, & Steinert, Y. (Ed.), Teaching medical professionalism (7-27). Cambridge: Cambridge University Press
  46. Cruess, S.R., Cruess, S.R., & Johnston, S.E. (2006). Professionalism and medicine's social contract. The Orthopedic Forum, 82(8), 1189-1194
  47. Cruess, S.R., Johnston, S., & Cruess, R.L. (2002). Professionalism for medicine: Opportunities and obligations. Medical Journal of Australia, 177(4), 208-211
  48. Cruess, S.R., Johnston, S., & Cruess, R.L. (2004). Profession: A working definition for medical educators. Teaching and Learning in Medicine, 16(1), 74-76 https://doi.org/10.1207/s15328015tlm1601_15
  49. Emanuel, E.J., & Emanuel, L.L. (1992). Four models of the patient-physicians relationship. JAMA, 267, 1221-1226 https://doi.org/10.1001/jama.267.9.1221
  50. Emanuel, E.J., & Emanuel, L.L. (1996). What is accountability in health care?. Annals of Internal Medicine, 124(2), 229-239 https://doi.org/10.7326/0003-4819-124-2-199601150-00007
  51. Feighny, K.M., Arnold, L., Monaco, M., Munro, J.S., & Earl, B. (1998). In pursuit of empathy and its relation to physician communication skills: Multidimensional empathy training for medical students. Annals of Bhavioral Science and Medical Education, 5, 13-21
  52. Flexner, A. (2001). Is social work a profession?. Research on Social Work Practice, 11, 152-165. This essay was originally published as Flexner, A. (1915). Is social work a profession?. Proceedings of the National Conference of Charities and Corrections at the Fortysecond Annual Session held in Baltimore, Maryland, May 12-19, Chicago: Hildmann
  53. Freidson E. (2001). Professionalism: The third logic. Chicago: The University of Chicago Press
  54. Gerabek, W.E. (1999). The tooth-worm: Historical aspects of a popular medical belief. Clinical Oral Investigations, 3, 1-6 https://doi.org/10.1007/s007840050070
  55. Gruen, R.L., Campbell, E.G., & Blumenthal, D. (2006). Public roles of US physicians: Community participation, political involvement, and collective advocacy. JAMA, 296, 2467-2475 https://doi.org/10.1001/jama.296.20.2467
  56. Hafferty, F.W. (2001 Mar. 9-11). Unraveling the Professionalism-Humanism Helix. Paper presented at the Arnold P. Gold foundation national symposia on overcoming the barriers to sustaining humanism in medicine: Influencing the culture through a humanism honor society, Rutherford, NJ.
  57. Hafferty, F.W. (2006). Definitions of professionalism: A search for meaning and identity. Clin Orthop Relat Res. 449, 193-204
  58. Hafferty, F.W., McKinley, J.B. (1993). The changing medical profession: An international perspective. Oxford: Oxford University Press
  59. Halpern, J. (2003). What is clinical empathy?. Journal of General Internal Medicine, 15, 670
  60. Ham, C. & Albert, K.G. (2002). The medical professional, the public and the government. BMJ, 324, 838-842 https://doi.org/10.1136/bmj.324.7341.838
  61. Hamilton, J.S. (1986). Scribonius Largus on the medical profession. Bull Hist Med. 60, 209-216
  62. Hensel, W.A., & Dickey, N.W. (1998). Teaching professionalism: Passing the torch. Academic Medicine, 73(8), 865-870 https://doi.org/10.1097/00001888-199808000-00011
  63. Hojat, M., Nasca, T.J., Erdmann, J.B., Frisby, A.J., Veloski, J.J., & Gonnella, J.S. (2003). An operational measure of physician lifelong learning: Its development, components and preliminary psychometric data. Medical Teacher, 25(4), 433-437 https://doi.org/10.1080/0142159031000137463
  64. Huddle, T.S. (2005). Teaching professionalism: Is medical morality a competency?. Academic Medicine, 80(10), 885-891 https://doi.org/10.1097/00001888-200510000-00002
  65. Ihara, C.K. (1988). Collegiality as a professional virture. In A. Flores (Ed.), Professional ideals (56-65). Belmont, CA: Wadsworth
  66. Inui, T.S. (2003). A Flag in the wind: Educating for professionalism in medicine. Washington DC: Association of American Medical Colleges
  67. Irvine, D. (2005). Patients, professionalism, and revalidation. BMJ, 330(7502), 1265-1268 https://doi.org/10.1136/bmj.330.7502.1265
  68. Johnson, M.P., & Abrams, S.L. (2005). Historical perspectives of autonomy within the medical profession considerations for 21st century physical therapy practice. Journal of Orthopaedic and Sports Physical Therapy, 35(10), 628-636 https://doi.org/10.2519/jospt.2005.35.10.628
  69. Johnston, S.(2006). See one, do one, teach one: Developing professionalism across the generations. Clinical Orthopaedics and Related Research, 449, 18-192
  70. Kilpatrick, S.D., McCullough, M.E.(2004). An annotated bibliography of research on personality and individual differences in altruism. Retrieved May 1, 2010 from http://www.unlimitedloveinstitute.org/publications/pdf/annotated/Annotated_Bibliography.pdf
  71. Ludmerer, K.M.(1985). Learning to heal. New York: Basic Books Inc.
  72. Ludmerer, K.M.(1999a). Time to heal. New York: Oxford University Press, Inc.
  73. Ludmerer, K.M.(1999b). Instilling professionalism in medical education. JAMA, 282(9), 881-882 https://doi.org/10.1001/jama.282.9.881
  74. Marcus, E.R.(1999). Empathy, humanism, and the professionalism process of medical education. Academic Medicine, 74(11), 1211-1215 https://doi.org/10.1097/00001888-199911000-00014
  75. McGaghie, W.M., Mytco, J.J., Brown. N,, & Cameron, J.R. (2002). Altruism and compassion in the health professions: A search for clarity and precision. Medical Teacher, 24. 374-378 https://doi.org/10.1080/01421590220145734
  76. Miettinen, O., & Flegel, K.(2003). Elementary Concepts of Medicine: X. Being a Good Doctor: Professionalism. Journal of Evaluation in Clinical Practice, 9(3), 341-343 https://doi.org/10.1046/j.1365-2753.2003.00423.x
  77. National Board of Medical Examiners.(2002, May 15-17). Embedding professionalism in medical education: Assessment as a tool for implementation. (This report documents themes from the invitational conference cosponsored by the AAMC & NBME). Philadelphia: Author
  78. Neufeld, V.R., Maudsley, R.F., Pickering, R.J., Turnbull, J.M., Weston, W.W., Brown, M.G., & Simpson, J.C. (1998). Educating future physicians for Ontario. Academic Medicine, 73(11), 1133-1148 https://doi.org/10.1097/00001888-199811000-00010
  79. Norcini, J.J.(1999). Recertification in the United States. BMJ, 319(7218), 1183-1185 https://doi.org/10.1136/bmj.319.7218.1183
  80. Novak, D.H., Epstein, R.M., & Paulsen, R.H.(1999). Toward creating physician-healers: Fostering medical students' self-awareness, personal growth, and wellbeing. Academic Medicine, 74(5), 516-520 https://doi.org/10.1097/00001888-199905000-00017
  81. Oxford English Dictionary. 2nd ed. [CD]. Oxford, UK: Oxford University Press. 1989
  82. Relman, A.S.(2007). Medical professionalism ina commercialized health care market. JAMA, 298, 2668-2670 https://doi.org/10.1001/jama.298.22.2668
  83. Rosenbaum, S.(2003). The impact of United States law on medicine as a profession. JAMA, 289, 1546-1556 https://doi.org/10.1001/jama.289.12.1546
  84. Royal College of Physicians.(2005). Doctors in society: Medical professionalism in a changing world. London: Author
  85. Smith, R.(1998). All changed, changed utterly. British medicine will be transformed by the Bristol case. BMJ, 316(7149), 1917-1918 https://doi.org/10.1136/bmj.316.7149.1917
  86. Starr, P.(1982). The social transformation of American medicine. New York: Basic Books
  87. Stern, D.T.(2006). Measuring medical professionalism. New York: Oxford University Press
  88. Sullivan, W.(2005). Work and integrity: The crisis and promise of professionalism in North America (2nd ed.). San Francisco, CA: Jossey-Bass
  89. Swick, H.M.(2000). Towards a normative definition of professionalism. Academic Medicine, 75(6), 612-616 https://doi.org/10.1097/00001888-200006000-00010
  90. Thompson, H.L.(1988). World Medical Association scientific session on "Professional autonomy and self-regulation". World Medical Journal, 35(1), 12-5
  91. Van De Camp, K., Vernooij-Dassen, M.J., Grol, R.P., & Bottema, B.J.(2004). How to conceptualize professionalism: A qualitative study. Medical Teacher. 26(8), 696-702 https://doi.org/10.1080/01421590400019518
  92. Wynia, M.K., Lathan, S.R., Kao, A.C., Berg, J.W., & Emanuel, L.L.(1999). Medical professionalism in society. NEJM, 341, 1612-1616 https://doi.org/10.1056/NEJM199911183412112