Resculpting Professionalism for Equity and Accountability

Jessica P. Cerdeña; Emmanuella N. Asabor; Sara Rendell; Tony Okolo; Elle Lett

doi:10.1370/afm.2892

Article Figures & Data

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Table 1.

Minoritized Trainees’ Experiences¹⁹ of Unprofessionalism

Professionalism Domain	Trainee	Trainees’ Experiences	Axes of Oppression Upheld
Disrespectful communication	Black man	“On my pediatrics rotation, I met a Black family whose child was meeting all their developmental goals. I said this was ‘lit’ and the family agreed. Later my resident told me this was ‘unprofessional.’”	Racism
Disrespectful communication	Black man	“I was given feedback after a 2-week family medicine inpatient rotation. I was told I performed excellently, however there was concern that the way I speak and my body language during rounds brought down the morale of the group. I was asked to smile more and speak more softly and assigned faculty from the psychosocial department to help me do so.”	Racism
Limited availability	Latina woman	“I asked for permission to miss my pre-clinical clerkship to accept an award on behalf of my school’s Student National Medical Association chapter. Peers of mine had missed to attend academic and clinical conferences, so it didn’t seem like a big deal, especially since we were receiving a national award. I had missed once before due to chronic migraine but thought I was in good standing. After sending my request, I was called in to speak with the director about ‘professionalism,’ and they told me my absences were excessive and unjustified.”	Ableism Racism
Lack of initiative	Latina woman	“I was deemed unprofessional once for considering missing a clinical skills opportunity that involved a 30-minute and $65-dollar round-trip Uber ride because my car was in the shop. When I responded that I was experiencing financial and mental stress, which was why I was considering missing the session, the faculty member never responded to my email. I still feel stress any time I run into this faculty member.”	Ableism Economic inequality
Lack of self-awareness	Black woman	“During a clinical skills debrief of a pediatric emergency simulation, a White pediatrician led a panel of faculty to evaluate and provide feedback for the 4 student (2 Asian men, and 2 Black women) participants. Over the course of a half hour, [the evaluator] repeatedly attributed the clinical suggestions and contributions of the Black women to the men in the group. The 2 Black women received feedback asking them to take notes from their [male] classmates who demonstrated ‘leadership’ during the simulation.”	Racism Sexism

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Table 2.

Proposed Pillars of Professionalism for Equity and Accountability

Pillar of Professionalism	Key Points	Example of Equitable and Accountable Approach
1. Patient-centered care	Assessments of professionalism should relate directly to safe and ethical patient care. Physicians should engage structural humility, particularly with marginalized patients.²⁹ Physicians should attend to how their own subjectivity, positionality, and countertransference can bias their perception and behavior.	Situation: A Black medical student sees that a Black child has met all their developmental goals and comments, “that’s lit.” The supervising resident tells the student the behavior was unprofessional. Alternative: The supervising resident should consider how cultural, generational, racialized, and gendered differences in experience might shape their interpretation of the interaction. The supervising clinician should reflect on how the comment shaped the clinical encounter prior to making assessments about professionalism.
2. Inclusivity and accountability	Clinical teams should value the diverse contributions of each member based on both training (ie, rank, profession) and lived experience. Physicians should center mutual trust and effective communication to optimize patient care.³⁰ Individual professionalism should include honesty and accountability for colleagues.	Situation: A surgeon working with a resident in a laparoscopic procedure needed adjustment in the camera position and yells at the resident holding the camera, “Are you blind?!” Alternative: As valued as clinical team members, residents and technicians should be empowered to call attention to this behavior and encourage the surgeon to engage more positive skills to cope with stress.
3. Equity	Physicians should seek to dismantle racism, sexism, economic inequality, and other forms of oppression within medicine as an institution.¹⁰ Assessments of professionalism should promote justice for minoritized trainees.	Situation: A disabled student of color with 1 excused absence for chronic illness requests another excused absence to attend a conference on leadership for racially minoritized students in medicine. The supervisors lecture the student on professionalism and excessive absences. Alternative: Institutions should provide disabled students of color with accommodations, and time and funding to accept an award at a conference that would promote their professional development.