From the March 3, 2023 P-METaL issue of the Transformational Times
A Case for Consultations in Character Integration
Fabrice Jotterand, PhD, MA – Director, Kern Institute Philosophies of Medical Education Transformation Laboratory (P-METaL)
“Medicine is the most humane of the sciences, the most scientific of the humanities.”
Edmund Pellegrino (1979)
Physicians are familiar with clinical consultations. They provide an opportunity to get advice on a diagnosis, management of a disease, or a procedure's adequacy. Clinical work comprises many uncertainties and complexities that can be clarified and potentially addressed by seeking input from an experienced clinician through consultation. Our lives, likewise, are complex, full of uncertainties and sometimes require an outsider’s help to understand why we are in a potentially dicey situation; how best to proceed and make the appropriate adjustments. When confronted by a serious moral dilemma, we welcome the input of a family member, a friend, or an individual we hold in high esteem for their wisdom and moral discernment. In both instances, it is through the participation in a community, be it the medical profession, the close family, or a circle of friends, that individuals can get input, support, and advice.
Medicine is inherently a moral practice and therefore physicians form a community with its own moral identity, professional identity, and obligations. But such a moral community is constantly challenged by outside constraints due to socio-political and techno-scientific factors. Therefore, preparing the next generation of physicians to confront these challenges requires careful strategizing. Specifically, in discussions regarding the moral formation of future physicians, the danger is to reduce the debate to systems, structure, or frameworks. Often the assumption is that putting trainees on the conveyor belt of professionalism will guarantee standards of moral and professional excellence. I wish to challenge this assumption in what follows.
Education ought not aim for the formation of a “technician” that knows the right technique to achieve a particular (moral) end. Rather, the purpose of education is to form a human being, which implies the crucial role of the humanities in such enterprise (Brague, 2019). Unfortunately, the humanities have been gradually marginalized in higher education and consequently there is less and less clarity of what it means to educate an individual qua human being in the professional context.
The Philosophical Consultations in Character Integration for Medical Education (P-Coaching for Med Ed) was created to facilitate the incorporation of the important contributions of the humanities in professional identity formation. Our team provides consultations in character integration to medical educators aiming to clarify and address conceptual and practical issues related to integrating character formation in the development of innovative curriculum. While our work is mostly philosophical in nature, we want to act as collaborators and participants in the transformation of medical education.
P-Coaching is constituted by individuals with expertise in medical education, clinical practice, character development, and professional identity formation. Our approach to consultations in character integration uses methods of philosophical inquiry, critical thinking and the implementation of principles, basic concepts, and strategies in medical education transformation. Key to our consulting philosophy is to promote character formation toward human flourishing and the development of intellectual, moral, civic and performance virtues essential for professional identity formation (Jubilee Center). The ultimate goal is to move beyond mere “moral instruction” and work on moral and professional identity formation in a wholistic approach. This means that professionalism ought to be grounded in a virtue-based ethic, informed by substantive principles and norms that provides a deeper understanding of moral agency essential for the development of professional integrity. Our ultimate goal is to promote an approach emphasizing the development of a personal moral philosophy of clinical practice.
Advancing Professional Identity through Character Formation
The P-Coaching team offers resources and expertise in character formation to medical educators in various ways. As stated on our website, we collaborate with individuals seeking our input in 1) assisting with developing and implementing best practices in character formation education; 2) providing resources to clarify conceptual challenges associated with virtues essential for professional identity formation, their measurement, and their implementation; and 3) offering pedagogical strategies to facilitate the integration of character formation in medical education transformation. The P-Coaching team is eager to work with all stakeholders involved in the transformation of medical education, including medical educators, early career scholars, medical students, residents, fellows, and program directors.
Sir William Osler once wrote that “the practice of medicine is an art, not a trade, a calling, not a business; a calling in which your heart will be exercised equally with our head.” The scientific and technical aspects of medical education ought to integrate the teaching of softer skills that train the heart. These softer skills are often marginalized, if not disregarded, in medical education. P-Coaching offers a platform to reevaluate their importance in the training of future physicians.
I invite those seeking to engage in the transformation of medical education to contact the P-Coaching team via our website. We want to partner with you and participate in the movement initiated at the Kern Institute toward equipping future physicians with the “habits of the heart” that will allow them to flourish as human beings and professionals as well as to serve our communities through compassion and excellence in healthcare delivery.
For further reading:
Pellegrino ED. Humanism and the Physician. Knoxville: University of Tennessee Press, 1979.
Brague R. Moderately Modern. South Bend: St. Augustine’s Press, 2019
Fabrice Jotterand, PhD, MA, is a Professor of Bioethics and Medical Humanities and Director of the Graduate Program in Bioethics in the Institute for Health and Equity at MCW. He is the Director of the Philosophies of Medical Education Transformation Laboratory (P-METaL) in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.