Teaching and learning professional values

Professionalism is at the heart of medical practice. A professional is someone whose work is based upon mastery of a complex body of knowledge and skills. Commitment to competence, integrity, morality, altruism and promotion of public good are all part of the core values and responsibilities of the professional, who needs to be differentiated from an expert. A medical professional has principles of supremacy of patient welfare, patient autonomy and social justice. An expert, on the other hand, is a skilful and wellinformed individual in some special field or someone widely recognised as a reliable source of knowledge, technique or skill who conveys and is accepted as an authority by virtue of their judgement (Ericsson, 2006). Ericsson suggests that expertise then refers to the characteristics, skills and knowledge that distinguish experts from novices and less experienced people. The essential difference between professionalism and expertise relies on the fact that the latter is an adaptation by amassing considerable skills, knowledge and mechanisms that monitor and control cognitive processes to perform a delimited set of tasks efficiently and effectively (Feltovich et al. 2006) whereas professionalism has a set of core attributes and values. Expertise is defined by Feltovich et al. (2006) as a complex construction of mind and body which includes substantial self-monitoring and control mechanisms (which differ from self-regulation) to task environments (thus task focused and not broader) in service of representative task goals and activities. Experts use patterns of work, recognition and training. Professionals on the other hand go beyond being simple experts. They have a set of core values and attributes related to their responsibility to the profession, and to society, and altruism and self-regulation form key components of their characteristics. Increased technical knowledge (which has made medicine less of an art in some ways), increased public expectations of longevity without any pain or harm, further increasing complexity of health care delivery and blurring of borders across specialties and yet increasing specialisation and increasing costs of health care are all challenges that medical professionals have to deal with. For a considerable period until about the middle of the 20 century in the USA and the last quarter in the UK, doctors were trusted blindly. Doctors as a profession are still the most trusted but the trust is no longer blind, it has to be earned. Medical scandals in the UK in the last 20 years and the medical profession’s feeble response have made the public feel let down. The key challenge for doctors is the concept of altruism in the professionalism. In health care systems which are state funded and health care is free at the point of need, altruism starts to take on a different meaning. Medicine often was seen as a calling and is more of an occupation, which means that the public attitudes and expectations are quite different too. Health care has become a commodity in various parts of the world, therefore doctors are seen as commodity providers. The role of the medical professional as a healer has also shifted as a result. The role of the doctor as a healer has come through from antiquity. Healer of souls and healer of bodies is the core function of the doctor. However, often it is difficult to identify what is meant by healing. These values and expectations change as society progresses. With chronic mental illness, definitions of healing and expectations of the therapeutic encounter change too. In addition, patients expect their doctors to have emotional intelligence: this is defined as someone having self-awareness, self-regulation, selfmotivation, social awareness and social skills (Wagner, 2006). Which components of EI can be taught and which components can be abandoned? Certainly it is possible to train in social awareness and skills as well as self-awareness. Self-motivation may be difficult but