Skip to main content
Top
Published in: Perspectives on Medical Education 4/2021

01-08-2021 | Care | Eye-Opener

Professionalism revisited during the pandemics of our time: COVID-19 and racism

Authors: Zareen Zaidi, Saleem Razack, Arno K. Kumagai

Published in: Perspectives on Medical Education | Issue 4/2021

Login to get access

Abstract

In this article the authors review the current-day definition of professionalism through the lens of the two ongoing pandemics: COVID-19 and racism. The pandemics have led to contemporary practice-related questions, such as: does professionalism entail that health care providers (HCP) be compelled to treat patients without PPE or if patients refuse to wear masks? And what role do HCP play in society when confronted with glaring health disparities and police brutality? The authors propose using care ethics as a theory to view professionalism, as it takes into account broadly encompassing relationships between HCP and society, history and context. Professionalism viewed through a care ethics lens would require professionalism definitions to be expanded to allow for interventions, i.e., not just refrain from doing harm but actively interfere or take action if wrong is being witnessed. Principles related to the primacy of patient welfare need to be re-addressed to prevent systematic self-sacrifice which results in harm to HCP and burnout. Mature care should be a characteristic of professionalism ensuring that HCP care for the sick but be practically wise, highlighting the importance of balancing too little and too much care for self and others. Professionalism needs to be viewed as a bi-directional relational exchange, with society demonstrating solidarity with those providing care. Additionally, given the scale of health disparities, simply stating that HCP need to work towards social justice oversimplifies the problem. Professionalism needs to encompass incorporating critical action and critical pedagogy into health care training and the health care profession to demonstrate solidarity with those impacted by racism.
Literature
1.
go back to reference Cruess RL, Cruess SR, Steinert Y. Teaching medical professionalism: supporting the development of a professional identity. Cambridge: Cambridge University Press; 2016.CrossRef Cruess RL, Cruess SR, Steinert Y. Teaching medical professionalism: supporting the development of a professional identity. Cambridge: Cambridge University Press; 2016.CrossRef
2.
go back to reference Al-Rumayyan A, Van Mook W, Magzoub ME, et al. Medical professionalism frameworks across non-Western cultures: a narrative overview. Med Teach. 2017;39(suppl 1):S8–S14.CrossRef Al-Rumayyan A, Van Mook W, Magzoub ME, et al. Medical professionalism frameworks across non-Western cultures: a narrative overview. Med Teach. 2017;39(suppl 1):S8–S14.CrossRef
3.
go back to reference Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088–94.CrossRef Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med. 2013;88:1088–94.CrossRef
5.
go back to reference Gramsci A. Further selections from the prison notebooks. Minneapolis: University of Minnesota Press; 1995. Gramsci A. Further selections from the prison notebooks. Minneapolis: University of Minnesota Press; 1995.
6.
go back to reference Dillard CB. When the ground is black, the ground is fertile: exploring endarkened feminist epistemology and healing methodologies in the spirit. In: Denzin NK, Lincoln YS, Smith LT, editors. Handbook of critical and indigenous methodologies. Thousand Oaks: SAGE; 2008. pp. 277–92. Dillard CB. When the ground is black, the ground is fertile: exploring endarkened feminist epistemology and healing methodologies in the spirit. In: Denzin NK, Lincoln YS, Smith LT, editors. Handbook of critical and indigenous methodologies. Thousand Oaks: SAGE; 2008. pp. 277–92.
7.
go back to reference Dillard CB. The substance of things hoped for, the evidence of things not seen: examining an endarkened feminist epistemology in educational research and leadership. Int J Qual Stud Educ. 2000;13:661–81.CrossRef Dillard CB. The substance of things hoped for, the evidence of things not seen: examining an endarkened feminist epistemology in educational research and leadership. Int J Qual Stud Educ. 2000;13:661–81.CrossRef
8.
go back to reference Branch WT Jr. The ethics of caring and medical education. Acad Med. 2000;75:127–32.CrossRef Branch WT Jr. The ethics of caring and medical education. Acad Med. 2000;75:127–32.CrossRef
9.
go back to reference Pettersen T. Comprehending care: problems and possibilities in the ethics of care. Lanham: Rowman & Littlefield; 2008. Pettersen T. Comprehending care: problems and possibilities in the ethics of care. Lanham: Rowman & Littlefield; 2008.
10.
go back to reference Gilligan C. In a different voice: psychological theory and women’s development. Cambridge: Harvard University Press; 1993. Gilligan C. In a different voice: psychological theory and women’s development. Cambridge: Harvard University Press; 1993.
11.
go back to reference Engster D. The heart of justice: care ethics and political theory. Oxford: Oxford University Press; 2007.CrossRef Engster D. The heart of justice: care ethics and political theory. Oxford: Oxford University Press; 2007.CrossRef
12.
go back to reference Aristotle. Nicomachean Ethics II.1. https://en.wikipedia.org/wiki/Golden_mean_[philosophy. Accessed 30 May 2020. Aristotle. Nicomachean Ethics II.1. https://​en.​wikipedia.​org/​wiki/​Golden_​mean_​[philosophy. Accessed 30 May 2020.
13.
go back to reference Pettersen T. The ethics of care: normative structures and empirical implications. Health Care Anal. 2011;19:51–64.CrossRef Pettersen T. The ethics of care: normative structures and empirical implications. Health Care Anal. 2011;19:51–64.CrossRef
14.
go back to reference Galtung J. Fred, vold og imperialisme. Oslo: Dreyer; 1974. Galtung J. Fred, vold og imperialisme. Oslo: Dreyer; 1974.
16.
go back to reference Sulmasy LS, Bledsoe TA, Ethics ACP. Professionalism and Human Rights Committee. American College of Physicians ethics manual, 7th ed. Ann Intern Med. 2019;170(2_Suppl):S1–S32. Sulmasy LS, Bledsoe TA, Ethics ACP. Professionalism and Human Rights Committee. American College of Physicians ethics manual, 7th ed. Ann Intern Med. 2019;170(2_Suppl):S1–S32.
17.
go back to reference Shabanowitz RB, Reardon JE, editors. Avian flu pandemic—flight of the healthcare worker? HEC Forum. 2009;21:365–85.CrossRef Shabanowitz RB, Reardon JE, editors. Avian flu pandemic—flight of the healthcare worker? HEC Forum. 2009;21:365–85.CrossRef
19.
go back to reference Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323:2133–4.CrossRef Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020;323:2133–4.CrossRef
21.
go back to reference Biddison LD, Berkowitz KA, Courtney B, De Jong CMJ, Devereaux AV, Kissoon N, et al. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146:e145S–e55S.CrossRef Biddison LD, Berkowitz KA, Courtney B, De Jong CMJ, Devereaux AV, Kissoon N, et al. Ethical considerations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014;146:e145S–e55S.CrossRef
23.
go back to reference Coleman CH, Reis A. Potenzial penalties for health care professionals who refuse to work during a pandemic. JAMA. 2008;299:1471–3.CrossRef Coleman CH, Reis A. Potenzial penalties for health care professionals who refuse to work during a pandemic. JAMA. 2008;299:1471–3.CrossRef
24.
go back to reference Dawson A, Jennings B. The place of solidarity in public health ethics. Public Health Rev. 2012;34:4.CrossRef Dawson A, Jennings B. The place of solidarity in public health ethics. Public Health Rev. 2012;34:4.CrossRef
25.
go back to reference Haffajee RL, Mello MM. Thinking globally, acting locally—the US response to Covid-19. N Engl J Med. 2020;382:e75.CrossRef Haffajee RL, Mello MM. Thinking globally, acting locally—the US response to Covid-19. N Engl J Med. 2020;382:e75.CrossRef
26.
go back to reference Page KR, Venkataramani M, Beyrer C, Polk S. Undocumented U.S. immigrants and Covid-19. N Engl J Med. 2020;382:e62.CrossRef Page KR, Venkataramani M, Beyrer C, Polk S. Undocumented U.S. immigrants and Covid-19. N Engl J Med. 2020;382:e62.CrossRef
27.
go back to reference Ranney ML, Griffeth V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;382:e41.CrossRef Ranney ML, Griffeth V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med. 2020;382:e41.CrossRef
28.
go back to reference Aach RD, Cooney TT, Girard DE, et al. Stress and impairment during residency training: strategies for reduction, identification, and management. Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med. 1988;109:154–61.CrossRef Aach RD, Cooney TT, Girard DE, et al. Stress and impairment during residency training: strategies for reduction, identification, and management. Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med. 1988;109:154–61.CrossRef
29.
30.
go back to reference Milam AJ, Furr-Holden D, Edwards-Johnson J, Webb B, Patton Iii JW, Ezekwemba NC, et al. Are clinicians contributing to excess african american Covid-19 deaths? Unbeknownst to them, they may be. Health Equity. 2020;4:139–41.CrossRef Milam AJ, Furr-Holden D, Edwards-Johnson J, Webb B, Patton Iii JW, Ezekwemba NC, et al. Are clinicians contributing to excess african american Covid-19 deaths? Unbeknownst to them, they may be. Health Equity. 2020;4:139–41.CrossRef
33.
go back to reference Kumagai AK, Naidu T. Reflection, dialogue, and the possibilities of space. Acad Med. 2015;90:283–8.CrossRef Kumagai AK, Naidu T. Reflection, dialogue, and the possibilities of space. Acad Med. 2015;90:283–8.CrossRef
34.
go back to reference Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84:782–7.CrossRef Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med. 2009;84:782–7.CrossRef
35.
go back to reference Sharma M, Pinto AD, Kumagai AK. Teaching the social determinants of health: a path to equity or a road to nowhere? Acad Med. 2018;9:25–30.CrossRef Sharma M, Pinto AD, Kumagai AK. Teaching the social determinants of health: a path to equity or a road to nowhere? Acad Med. 2018;9:25–30.CrossRef
36.
go back to reference Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai AK. Remembering Freddie Gray: medical education for social justice. Acad Med. 2017;92:312–7.CrossRef Wear D, Zarconi J, Aultman JM, Chyatte MR, Kumagai AK. Remembering Freddie Gray: medical education for social justice. Acad Med. 2017;92:312–7.CrossRef
37.
go back to reference Freire P. Pedagogy of freedom: ethics, democracy, and civic courage. Lanham: Rowman & Littlefield; 1998. Freire P. Pedagogy of freedom: ethics, democracy, and civic courage. Lanham: Rowman & Littlefield; 1998.
38.
go back to reference Halman M, Baker L, Ng S. Using critical consciousness to inform health professions education. Perspect Med Educ. 2017;6:12–20.CrossRef Halman M, Baker L, Ng S. Using critical consciousness to inform health professions education. Perspect Med Educ. 2017;6:12–20.CrossRef
39.
go back to reference Frambach JM, Martimianakis MAT. The discomfort of an educator’s critical conscience: the case of problem-based learning and other global industries in medical education. Perspect Med Educ. 2017;6:1–4.CrossRef Frambach JM, Martimianakis MAT. The discomfort of an educator’s critical conscience: the case of problem-based learning and other global industries in medical education. Perspect Med Educ. 2017;6:1–4.CrossRef
40.
go back to reference Airhihenbuwa CO, Iwelunmor J, Munodawafa D, Ford CL, Oni T, Agyemang C, et al. Culture matters in communicating the global response to Covid-19. Prev Chronic Dis. 2020;17:E60.CrossRef Airhihenbuwa CO, Iwelunmor J, Munodawafa D, Ford CL, Oni T, Agyemang C, et al. Culture matters in communicating the global response to Covid-19. Prev Chronic Dis. 2020;17:E60.CrossRef
41.
go back to reference McCullough LB, Coverdale J, Chervenak FA. Teaching professional formation in response to the Covid-19 pandemic. Acad Med. 2020;95:1488–91.CrossRef McCullough LB, Coverdale J, Chervenak FA. Teaching professional formation in response to the Covid-19 pandemic. Acad Med. 2020;95:1488–91.CrossRef
42.
go back to reference Hegel GWF, Elster J. Andens fenomenologi: I utvalg [In Norwegian]. Oslo: Pax Forlag; 1967. Hegel GWF, Elster J. Andens fenomenologi: I utvalg [In Norwegian]. Oslo: Pax Forlag; 1967.
43.
go back to reference Wortley S. Justice for all? Race and perceptions of bias in the Ontario criminal justice system—a Toronto survey. Can J Criminol. 1996;38:439–67.CrossRef Wortley S. Justice for all? Race and perceptions of bias in the Ontario criminal justice system—a Toronto survey. Can J Criminol. 1996;38:439–67.CrossRef
44.
go back to reference Lorde A. The master’s tools will never dismantle the master’s house. In: Sister outsider: essays and speeches. No place: Crossing Press; 2012. Lorde A. The master’s tools will never dismantle the master’s house. In: Sister outsider: essays and speeches. No place: Crossing Press; 2012.
Metadata
Title
Professionalism revisited during the pandemics of our time: COVID-19 and racism
Authors
Zareen Zaidi
Saleem Razack
Arno K. Kumagai
Publication date
01-08-2021
Publisher
Bohn Stafleu van Loghum
Keywords
Care
COVID-19
Published in
Perspectives on Medical Education / Issue 4/2021
Print ISSN: 2212-2761
Electronic ISSN: 2212-277X
DOI
https://doi.org/10.1007/s40037-021-00657-w

Other articles of this Issue 4/2021

Perspectives on Medical Education 4/2021 Go to the issue