Teaching and Assessing Professionalism in an Era of Corporate Medicine�

Joe Gravel MD

Professor & Chair, DFCM, Medical College of WI

ADFM July Hot Topic

July 8, 2026

Today’s Learning Objectives:

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1. Review current practice & the need for updating GME professionalism training.�
2. Recognize strategies and resources for teaching and assessing professionalism. �
3. Discuss approaches by STFM taskforce to achieve desired professionalism outcomes.

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Does our Professionalism teaching and assessment need an update?�(If so, why?)

Trust in physicians and hospitals: �71.5% April 2020 -> 40.1% in Jan 2024

4 C’s of Effective Primary Care�(Starfield’s 4 Pillars of Primary Care) �

• Comprehensive Care
• First Contact Care
• Coordination of Care
• Continuity of Care

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• Corporatization
• Consolidation
• Commoditization
• Commercialization

Physician unionization- Increasing

Danielle Ofri MD ���https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html�

Danielle Ofri MD

NY Times

Traditional Professionalism Models

Lists of prohibited behaviors-HR or disciplinary framing, often vague and inconsistently applied

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Task: Finding the bad apples

Task: Teaching/assessing

bruised apples

Mangoes!

Professionalism-Lite in Residency Teaching�

• Dress code / Personal appearance
• Punctuality
• Respectful communication with team members
• Timely task completion (e.g. charting)
• Substance use
• Social media use
• Boundary issues +/-?

(HR/ sexual harassment. If consensual?)

• Competency/outside reading +/-?

(does pursuing excellence=non-wellness?)

• Wellness– weaponized? (in evolution- is there a middle ground?)

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Beyond Job Duties or Misconduct- Aspirational Professionalism

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Why This Matters Now

• Professionalism:
• underpins medicine’s social contract
• provides the foundation for all competencies�
• Practice environments continue to change rapidly�
• Teaching, Fac Dev, & Assessment have not kept pace

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The Shift in Practice

• Autonomous practice → employed physicians�
• Productivity and system pressures�
• Conflicting Plurality of Interests:
• patients’ interests
• employers’ interests
• insurers’ interests

The Resulting Tension

• Moral distress and moral injury�
• Frequent professionalism-related conflicts�
• Explicit and Hidden Curricula
• Learners experience these challenges early in their professional identity formation

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Quiet Quitting in FM Residency Programs

“Contributing factors to quiet quitting reflected generational shift in work values, systemic issues, faculty modeling, and lack of training or work experience.”

A Core Question

“Is professionalism mostly about following rules—or is it doing the right thing/making the extra effort (including advocating for patients) when it’s hard?”

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“The forces of professionalism, markets, and bureaucracy are all necessary to delivering good medical work… A professionalism that fails to dissect and distinguish itself from its two counterparts is a professionalism that is more about conformity than resistance. This is a neutered professionalism more about sheep than cats.”

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Frederic Hafferty et al.

Medical Professionalism Best Practices: Professionalism in the Modern Era,

AOA Medical Society, 2017

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ACGME Requirements- Current Focus

• Resident (and faculty) wellness
• Sustainable responsibilities for residents
• Culture that supports patient safety & personal responsibility
• Respectful, equitable, and civil environment without harassment
• Process to teach and report unprofessional behavior
• Faculty role modeling
• Can be expanded to incorporate…… (e.g., recognition for professional behavior)

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ACGME Common Program Requirements

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VI.B. Professionalism section 714 words (p 38-40)

VI.C. Well-Being, Fatigue Mitigation, Clinical Responsibilities, Teamwork, Transitions, Maximum Hrs of Work, Mandatory Free Time sections - 3297 words (p 40-48)

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ACGME Program Requirements- Faculty�

“(Faculty) are role models demonstrating compassion, commitment to excellence in teaching and patient care, professionalism, collaboration, and a dedication to lifelong learning.”

Faculty (Salmon) Role-Modeling is Often Countercurrent

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Bears:

Local health system

Larger health system

Societal

Governmental policies

Pharma

Insurers

Others?

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Learner Perspectives

• Expectations feel vague
• Inconsistent application
• Positive behaviors rarely/inconsistently reinforced
• Norms often reflect dominant culture
• Risk of inequitable assessment
• Professionalism ≠ cultural conformity

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A Modern View of Professionalism

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• Inspirational and developmental
• Context-aware
• Grounded in professional identity formation

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STFM Strategic Plan 2025-2029

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Professionalism in Family Medicine Summit �September 2025

• Hosted by STFM, co-sponsored by AMA, supported by ABFM Foundation grant
• Attendees: AAFP, ABFM, ABIM, ABMS, ABP, ACGME, ACOFP, AFMRD, AMA, NAPCRG, STFM, STFM Task Force on Professionalism, 2 residents, 8 others

Professionalism Summit: Goals

• Discuss current state & future directions for professionalism in family medicine (and others)
• Develop strategies/get input on ways to optimize curriculum and faculty development
• Identify opportunities for interdisciplinary and interprofessional collaboration
• Map next steps

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Professionalism Summit: First Steps

• Identify a living definition of professionalism
• Move towards shared understanding/aspiration and away from professionalism as a punitive word
• Make space for individualism while forming a coherent collective identity
• Reimagine FM professionalism as a means to address the crisis of trust and engagement

Professionalism Summit: ABFM Strategic Plan

• Learn what physicians and the public mean by the word professionalism 
• Promote change in the clinical environment that supports professional behavior
• Explore a new compact or statement of core values that can be applied across family medicine and beyond
• Reframe professionalism as a core competency
• Build tools and curricula that support professionalism throughout physicians’ careers. Advocate professionalism as key to developing trust.

Professionalism Summit: �Reclaiming the Word ‘Professionalism’

• Professionalism has at times been “weaponized” by employer institutions (and residencies?)
• Recommendation:

Reclaim the word professionalism while communicating clear distinctions between misconduct, job expectations, and inspirational professionalism.

Professionalism Summit: �Key Recommendations

• Prioritize action over definitions
• focus on behaviors & their sources
• Shared Identity vs. Punitive Framework
• Shift professionalism away from a punitive/compliance-based concept → pride, identity, and shared responsibility.
• Generational and Cultural Shifts - “Yes, and…”
• Consider the ways that younger colleagues’ expectations and AI are shaping professional norms (e.g., work-life balance, equity, advocacy)

Summit: Proposed steps to reclaiming the word���

• Develop a Family Physician Oath grounded in values unique to the specialty.
• Formalize white coat or graduation ceremonies tied to family medicine identity.
• Make attestation to core values shared principles part of certification and recertification.

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STFM Task Force on Professionalism:�Work to Date / Next Steps�

STFM Task Force on Professionalism in Medical Education

• July 2025-May 2027�
• Curriculum, Fac Dev, �Assessment, Advocacy�
• Goal: develop implementable tools, not another “white paper”

Environmental Scan: What Works?

• Longitudinal curricula
• Case-based (ideally real world) discussions
• Medical Humanities:
• Reflective Practice, Narrative medicine, Med Improv, Visual Thinking Strategies
• Explicit role modeling

Potentially Useful Tools

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• Arts: Visual Arts, Performing Arts, Literary Arts (Poetry, Storytelling)
• Narrative Medicine
• Reflective Practice
• Case-Based Learning
• Team-based learning
• Simulation (including OSCE and self-assessment)
• Small Group Discussion
• Patient Mentorship Programs (patients as teachers)
• Rituals and Ceremonies (White Coat Ceremonies, etc.)
• Coaching
• Direct Observation
• Portfolio Assessment

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Curriculum Development: Approach

• Initial focus: PGY 1-3; Future: expand to MS-3/MS-4�
• Model
• Small group, discussion-based, protected time
• Readings/Watchings/Listenings as stimuli
• Reflective Prompts
• Group members come with reflections on real-world scenarios�
• Topics: align with Family Physician PIF

Proposed Curriculum Topics (Year 1-3)

* Topics both designed to develop habits of thought and linked to the 26 behaviors of focus identified by the Task Force

Professionalism Curriculum Pilot Project

• Approx. 15 programs-Will provide feedback for improvement prior to rolling out more broadly
• Virtual launch meetings with facilitation training on (July 27 and July 28 at 8:30 pm ET)
• IRB- through AAFP
• Activities will occur either during regularly scheduled residency teaching sessions or during “off-hours” according to each site’s individual preference.
• Will ask average amount of time it took for facilitator preparation and time spent by the residents in pre-work and required sessions.
• Post-module and end-of-year curriculum surveys will be completed by faculty and residents.

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Professionalism Is a Coached Practice

• Observation
• Reflection
• Feedback
• Goal setting
• Reinforcement

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Professionalism Faculty Development Toolkit

Modules, videos, other resources being developed.

Connections to curriculum and assessment subgroup work.

Create a certificate of completion to recognize the work?

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Which best reflects how professionalism is currently assessed in your program?

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A. Primarily Milestones / global ratings

B. Narrative comments

C. Incident-based reporting

D. Multiple data points with reflection

E. No consistent approach

Assessment Dilemmas

• Reliance on ACGME Milestones�
• Relative subjectivity�
• Focus on lapses, not growth�
• Feedback can happen only at extremes�

What would most improve professionalism assessment in your program?

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A. Clearer shared expectations

B. Behaviorally anchored tools

C. Faculty development

D. Time and workflow support

E. Leadership prioritization

Principles of Better Assessment

• Behaviorally anchored
• Developmentally staged
• Multiple data points, including self-assessment
• Include micro/macro acts and lapses

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Thank You���Questions and Discussion