Teaching Professionalism

By Steve Frandzel

How can faculty and administrators guide students toward professionalism through their academic careers and into their professional lives? Can they instill in students the desire to approach their professional affairs within a strong ethical framework? Can professionalism be meaningfully measured? These and other questions were raised at the recent CFDE panel discussion, Teaching Professionalism Across The University.

Panelist Mark Risjord, an Associate Professor in the Department of Philosophy and Associate Dean of the Laney Graduate School, began by saying that the graduate school is using grant money from the Council for Graduate Schools to initiate a Phd-level program designed to nurture scholarly integrity and ethical behavior. Five such grants were awarded nationally to encourage leading graduate schools to focus more attention on professional development.  “In partnership with the Center for Ethics, we’re just beginning the conversation about how we can professionalize graduate students in ethical matters broadly speaking,” Risjord said.  “This is the beginning of a conversation. Over the next year, we’ll listen to different voices and determine how to put together an entire program.”

Simply providing students with a list of rules is not enough to engender professional behavior, so the new program will provide students with the tools they need to anticipate and reason through complicated issues before they become impediments to academic progress.

Authorship – where a name stands on a paper – is a good example of applying the concept: It’s easy to tell students that they should discuss the matter with their advisor, but they also need to know how to start the conversation and why it’s necessary, Risjord said.

In contrast, the medical school routinely evaluates student professionalism, said panelist William Eley, Executive Associate Dean for Medical Education and Student Affairs in the School of Medicine. Students are told explicitly that they should not expect to be promoted based on grades alone: their level of professionalism will be taken into consideration. “We tell them that from admission to graduation, anything that happens to them in school or in public counts,” Eley said. He agreed that a litany of rules, while delineating boundaries of acceptable behavior, do little to promote professionalism.

Emory’s medical school incorporates as much ethics teaching as any curriculum in the country, according to Eley. But when students step into the culture of professional medicine when they begin their clinical work, they’re bombarded by often-conflicting demands from multiple constituencies (instructors, clinical supervisors, colleagues, patients). Those powerful cultural influences are bound to trump didactic lectures. “Our students are thrown into a system where people don’t have insurance and which maximizes profits,” he said. “They could be working in what could be construed as an unethical system. It’s very hard to overcome that.”

All new medical students are assigned to a faculty mentor with whom they meet regularly until they leave the program. The thirty-two mentors, who are paid for their service, have been chosen from a list of a hundred applicants. Within the close and trusting relationship that typically develops, students feel safe to discuss sensitive issues candidly, including ethics and professionalism. “It’s one of the antidotes to the culture they find themselves in,” Eley said. “With all the demands placed on them students wonder how they can possibly be ethical and professional amidst the maelstrom we call medical care.” He plans to establish benchmarks that can be used to identify successful graduates after they’ve established themselves in careers, and also what impact the mentor program may have had.

One participant observed that students frequently encounter contradictions between what they’re told is acceptable behavior within a profession and blatant infractions among practitioners. Faculty must, therefore, be willing to talk openly about such inconsistencies if they expect students to act any differently. Eley added that the mentor program represents one step toward that goal and is a strong statement to the 1,800 or so clinical faculty “that these matters matter. In medical school, to get paid to do anything other than see patients or do research is a real statement of value.”

Bonna Wescoat, Associate Professor of Art history and Archaeology, explained that archaeology, unlike other humanities, is highly collaborative, but formal training about professionalism or ethics is practically nonexistent. “We have instances when people act unprofessional and are regarded as bold, daring, or innovative. That has to shift,” she said. In their urgent quest to stand above the crowd by claiming parts of a project, students sometimes have no clear sense of how to proceed.

That can manifest itself as submitting a conference paper before clearing it with other project members, or literally crawling out the back window of an excavation and surfacing in Florence two weeks later. But just as important as post-infraction remediation and rebuke is to move to a point where the student regains the trust of advisors, who need to be able to respond comfortably and confidently to inquiries from a search committee. “It’s not fair either to recount an incident that occurred eight years ago in full detail or to treat it like it never happened,” Wescoat said.

Evaluating professionalism presents a separate set of challenges and strategies. In the physician’s assistant (PA) program, students anonymously rate their peer’s professionalism, honesty, and integrity. The results are often very accurate, said one participant, because students interact with their peers in varied social and scholastic settings. Eley noted that faculty nowadays are less prepared to evaluate their students as honestly as they once did: When reading dean’s letters from thirty-five years ago, he found “the honesty is shocking and refreshing.” Now, though, “there’s hardly a negative thing said, even for people who didn’t perform as well as they should have.” Without faculty documentation of student transgressions, he said that he cannot take action. “It makes faculty complicit.”

It is the faculty’s responsibility to be truthful when evaluating students, particularly if they witness unprofessional behavior, said Risjord. In too many cases “we let them slide; we’re making a mistake trying to put that responsibility on their student peers.”

Opinions about anonymous peer review varied. One participant felt that students are rarely willing to say anything unenthusiastic about their peer group. Eley said that such evaluations are most effective when initiated early, before students have established bonds with one another. The practice then becomes part and parcel of their academic/professional culture right from the start. “That says we’re serious about this and about your own policing of each other,” he said. But another participant had serious concerns about the ethics of anonymous peer evaluations and that bad comments might be written because of personal animus.

Unprofessional behavior, observed another participant , is often entrenched and takes root early in life, making it difficult to alter. Because kernels of unethical behavior can often be identified long before a student is admitted to graduate or professional school, screening out potentially troublesome applicants is one way to decrease unprofessionalism. But, noted Eley, even though every medical school applicant is interviewed, assessing their character has become increasingly difficult when references are top heavy with glowing appraisals. Sometimes, undergraduate records have actually been purged of disturbing reports about an applicant.

Laurie Patton, Charles Howard Candler Professor of Religion and director of the CFDE, said that her ethical obligation to find employment for her graduate students sometimes conflicts with her obligation to respond honestly to inquiries from potential employers. “If I say something negative am I obstructing that person’s access to employment?”

Eley concluded by saying that professionalism is a lifelong quest for everyone, and that we shouldn’t “leap on people when their behavior doesn’t meet our standards.” Students, after all, are often under enormous stress from multiple sources: academic, publishing, medical care, to name a few. “We have to understand that. When we ask people to judge their own behavior, they’re much more likely to evoke situational ethics, but when they judge others, they say it’s character. We have to be careful.”