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Richard L Cruess, Sylvia R Cruess, Yvonne Steinert, editors.
Teaching Medical Professionalism.
New York: Cambridge University Press; 2008. ISBN 978-0-521-88104-3. Hardback, 310 pages, $ 94.99 US; Paperback, $ 49.00 US.
Drs. Cruess, Cruess, and Steinert have crafted a book that carefully examines and provides guidance for development of programs to directly teach professionalism to individuals and to promote professionalism within academic organizations. In the introduction to the book, the editors state their hope that the book will be helpful to “those responsible for designing and implementing programs of instruction on professionalism.” I think the book meets this goal and would thus recommend it to those charged with designing professionalism curricula for faculty, for organizations, or for learners at any level of training, from undergraduate chiropractic education through the continuing education of seasoned practitioners.
Although the book has many chapter authors, it provides a consistent message of the need for professionalism to be, “addressed directly and explicitly at all levels of medical education.” Further, this education should combine teaching of the “cognitive base” with activities in “authentic” contexts and opportunities for reflection. Explicit teaching should be provided at all levels: student, resident, practitioner, and faculty member. In addition, attention needs to be placed on the professional atmosphere within the target organization and its clinical sites and, thus, to the professionalism of role models within those sites. This is a strength of the book.
The organization of the book is also a strength. It has a foreword and introduction that provide the context for the book. The 15 chapters are divided into four parts: what is to be taught, theory, principles, and practice (case studies in teaching professionalism across the spectrum). In Part one, Drs. Sylvia and Richard Cruess provide a discussion that should resonate with chiropractic educators, describing the attributes of a physician through comparing those generally associated with the “healer” versus the “professional,” as well as those attributes that overlap. This, along with the discussion of the theory of situated learning in Part two, provides a clear grounding for curriculum developers. The readers can use this or the alternative definitions provided in Appendix A to guide selection of their program's or institution's agreed upon definition of professionalism.
Another strength of the book is the examples provided for teaching professionalism at multiple levels and for differing groups, for example, teaching professionalism to students in an organ system versus a problem-based curriculum. The examples in Part three and case studies in Part four provide interesting stories with lessons learned and offer some interesting ideas for future leaders of professionalism education programs. Finally, the appendices provide some of the most practical materials in the book, including a set of case vignettes for each level of learner, used at McGill University, the home institution of the editors.
This book adds to the field in a significant way and complements the recent book, Measuring Medical Professionalism, edited by David Thomas Stern (New York: Oxford University Press, 2005). As indicated by their titles, the Stern book focuses on measuring professionalism, while the Cruess et al book focuses on teaching professionalism, and they are wonderfully complementary. The Stern book is very practical with guidance on how to develop and use a variety of assessment methods. I believe that it could be read and used by clinical educators to help enhance their clerkship, residency, continuing education, or faculty development programs. In contrast, I feel that the Cruess book requires a higher level of educational expertise to use its contents. In the introduction the authors also noted their hope that the book might also be useful to faculty and learners. In my opinion, learners and faculty instructors new to teaching or learning about professionalism would find this book difficult to read on their own. If portions of the book are to be recommended to learners or faculty instructors, those chapters should be carefully selected by program organizers or course directors, in order to place the readings in context and ensure that each would be appropriate in relation to local goals.
In closing, I highly recommend this book to future curriculum developers. If your institution needs to develop a coherent educational program in relation to professionalism, you will find your mind buzzing with exciting ideas after reading this book.