Trust between the patient and clinician is central to the therapeutic relationship. Without this requisite level of trust, patients will not reveal information about themselves nor will they follow treatment recommendations. Trust builds from the belief that the clinician possesses expert knowledge (which will be applied to the benefit of individuals and society) and will avoid self-interest while acting on behalf of those served. Growing from that public trust, a level of autonomy to self-regulate is afforded to medicine; however, the autonomy extended to the profession must be in balance with medicine’s priority of advancing the public welfare. This combination of commitment to service, the possession of a specialized body of knowledge, and the ability to self-regulate are the key components of professionalism.

Some have questioned whether the shared body of medical knowledge and participation in a supervised practice qualifies physician assistants (PAs) for consideration as professionals. Others have clearly demonstrated that PAs should be considered professionals. Soon after PAs began to practice, Tworek applied the standards of professionalism to PAs and concluded that those in the occupation had become professionalized. Picking up on that distinction later, Gianola concluded that the evolution to the modern role of PAs has resulted in our becoming a full profession.

Thus, when the four leading PA organizations adopted the Competencies for the Physician Assistant Profession, they followed the lead of our physician colleagues and included professionalism as one of the six “general competencies.” The importance of professionalism for PAs was again emphasized by the work of the 2017 Physician Assistant Education Association (PAEA) Presidents Commission. They pointed to a growing body of research that called for increased attention to be paid to noncognitive attributes of health professionals, including professionalism. Their report confirmed that professionalism is one of the top 10 noncognitive attributes that needs to be fostered by PAs. This is the result of changes in the health care system and a consequence of the move to competency-based education. Recognition as a profession brings with it opportunities and responsibilities. In recent years, a variety of pressures resulting from changes in the health care delivery system have made it more difficult for medicine to live up to those responsibilities. As a result, the professional tenets of medicine have been called into question. , A return to professionalism depends on clearly defining the term and identifying ways to foster and assess it. Lessons for PAs can be learned from the physician experience.

Understanding its importance

Early in the history of medicine, the promises of the Hippocratic Oath grounded medicine and instilled in physicians a strong commitment to service. As attention later shifted to the science of medicine, the specialized knowledge associated with medicine became the central focus. Consequently, the understanding of and commitment to the service responsibilities diminished with significant consequences to the overall impression of physicians as professionals.

Compounding the consequences of that shift in focus, the business aspects of medicine also began to affect medicine’s image. Some have suggested that medicine used its significant knowledge base to find ways to manipulate the market to increase the demand for services, dramatically increasing costs for health care. In this scenario, physicians were thought to have put their own economic interests above the needs of patients and society—an action that goes against the precepts of professionalism. ,

As health care costs escalated, government and insurer involvement in health care increased, with resulting tighter controls over medicine. Precertification and utilization review efforts by the government and insurers reduced the ability of health professionals to make autonomous medical decisions. Credentialing efforts by insurers that evaluated the performance of health professionals adversely impacted self-regulation efforts. As constraints over decision making and self-regulation have increased, the influence of medicine has decreased and the image of physicians as professionals has been affected. ,

With changes in the health care system challenging the professionalism associated with medicine, today’s clinicians must understand what it means to be a professional and must be willing to abide by the expectations that result. Nevertheless, questions have been raised concerning the uniform existence of that understanding of and commitment to professionalism. Despite a commitment to teaching clinicians in training about professionalism, those efforts have been hampered by a lack of universal agreement on the definition of professionalism. ,

The goal of teaching professionalism is to assist students with developing a professional identity. The process requires a dual focus on exploring through explicit curricula the definition of professionalism and the traits associated with professional behavior and teaching students to participate in experiential learning activities that include a component of reflection on professional behaviors.

After 2 years of observations during medical school interviews, as well as class discussions and exercises, Hafferty voiced concerns about the existence of the core values central to professionalism. He noted that medical students might feel less of an obligation to be bound by the expectations set forth in a code of ethics. He also suggested that they might not feel a need to ascribe to the values outlined in professional oaths that are generally part of most medical school graduations. In addition, he observed that even white coat ceremonies, despite all their symbolism, seem to fail to remind medical students of the values and obligations of professionals.

Reinforcing the tenets of professionalism during medical education is critical because there is a strong link between what is learned about professionalism in medical school and what one exhibits later in practice. In a landmark study, Papadakis and colleagues at the University of California–San Francisco School of Medicine conducted a case-control study that compared medical school graduates who were disciplined by the Medical Board of California with controls matched by medical school graduation year and specialty. Of those graduate physicians disciplined by the Medical Board, 95% experienced a violation associated with a professionalism lapse. Compared with controls, the physicians who experienced professionalism lapses during medical school were twice as likely to later experience an adverse medical board action while in practice. Recognizing the importance of responding to those early lapses, many strategies for dealing with professionalism lapses have evolved, including remediation assignments; remediation contracts; professionalism mentoring; stress management or mental health intervention; and community service.

Elements of the PA competency of professionalism

Recent efforts to define professionalism have shifted from the sociologic definition to a focus on values associated with professionals. The most commonly appearing elements identified in a recent literature search included a number of ill-defined concepts, such as “altruism, accountability, respect, integrity, ethic[ism], lifelong learn[ing], honesty, compassion, excellence, self-regulating, service,” that provide little guidance to the clinician who aspires to professionalism.

Van de Camp and colleagues provide an understandable overarching structure that brings together key values with service delivery concepts. The latest model includes four areas of professional behavior: toward the patient, toward other professionals, toward the public, and toward oneself. The authors note that their behavior-based focus intentionally avoided the use of vaguely understood elements that have been associated with professionalism. Another improvement in the recent model is that it included elements that grew from the models of competency developed by the Accreditation Council on Graduate Medical Education in conjunction with the American Board of Medical Specialties. ,

The Competencies for the PA Profession incorporate nearly all of the top 10 constituent elements of professionalism mentioned most frequently in the literature and fit well into the structure outlined by Van de Camp and colleagues ( Box 35.1 ). In addition, a number of other, less frequently mentioned elements are included.

Box 35.1

Content from Physician Assistant Competencies (2005). Structure adapted from Van de Camp K, Vernooij-Dassen M, Grol R, Bottema B. How to conceptualize professionalism: a qualitative study. Med Teach 2004;26:696.

Physician Assistant (PA) Competencies

Professional behavior toward the patient

  • PAs must prioritize the interests of those being served above their own.

  • PAs must demonstrate a high level of ethical practice.

  • PAs must demonstrate a high level of sensitivity and responsiveness to a diverse patient population, including culture, age, gender, and disabilities.

  • PAs are expected to demonstrate respect, compassion, and integrity.

Professional behavior toward other professionals

  • PAs are expected to demonstrate professional relationships with physician supervisors and other health care providers.

Professional behavior toward the public

  • PAs are expected to demonstrate responsiveness to the needs of patients and society.

  • PAs are expected to demonstrate commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.

  • PAs are expected to demonstrate accountability to patients, society, and the profession.

  • PAs must demonstrate adherence to legal and regulatory requirements, including the appropriate role of the PA.

Professional behavior toward oneself

  • PAs are expected to demonstrate commitment to excellence and ongoing professional development.

  • PAs must know their professional and personal limitations.

  • PAs must practice without impairment from substance abuse, cognitive deficiency, or mental illness.

  • PAs are expected to demonstrate self-reflection, critical curiosity, and initiative.

Behavior toward the patient

Values—respect, compassion, integrity

Respect, compassion, and integrity are the hallmarks of being an admirable PA. Professionalism first and foremost involves respect for one’s patients, meeting them as equals no matter the situation. It requires a commitment to truly caring for and about another human being. Respect for others (e.g., the patient’s families, co-workers, physicians, nurses, residents), as stated in the American Board of Internal Medicine’s Medical Professionalism Project, is the essence of humanism, and humanism is central to professionalism and fundamental to the collegiality of medical providers. Compassion, like respect, embodies the ideals of a caring practitioner. Like the Norman Rockwell pictures of the kindly physician caring for the young child and also demonstrating concern for the parents, we are charged with providing that same compassion in all of our interactions with our patients and others. We must treat each person as an individual, not allowing lifestyles, beliefs, idiosyncrasies, or family systems to influence or shape our respect or compassion. This unconditional compassion for patients serves as the foundation for another key element needed in patient care: empathy. Compassion and empathy are essential elements of a positive relationship with patients. Faced with a compassionate and empathetic clinician, patients are more likely to follow treatment plans and be satisfied with the care received.

Integrity is the base from which respect and compassion grows. The definition of integrity is to be forthcoming with information and to not withhold or use that information for power. Integrity requires that we admit to our errors, acknowledge that sometimes the patient’s situation is unclear and the path forward is uncertain, use resources appropriately, and exercise discretion, especially in areas of confidentiality. In addition to these three, there are other humanistic values that foster positive relationships with patients. These include accountability, taking responsibility, punctuality, being organized, politeness, courtesy, patience, a positive demeanor, and maintaining professional boundaries. These qualities demonstrate our respect and compassion for ourselves, our patients, their families, and our fellow health care providers.

Primacy of patient welfare

Altruism is central to professionalism, but the concept is both controversial and difficult to understand. Definitions of altruism include a focus on actions that benefit others and are voluntary without the promise of external rewards.

Arguing that the actions of health professionals are not altruistic, critics note that health professionals experience both external and internal rewards from their efforts. They note that the knowledge and skill applied by health professionals often bring wealth, status, and power to those individuals. The critics also point to the internal rewards gained (the gratitude from patients served, satisfaction from being involved in the lives of those patients, feeling good about growing knowledge and skills, the satisfaction of curiosity, the acquisition of wisdom, and the attainment of the respect of colleagues for those achievements). Those who believe the actions of health professionals are indeed altruistic counter that, although those rewards do accrue, they follow the service, are secondary to them, and are not conditions that are set before services are delivered. Those proponents also remind us that health professionals attempt to deliver the highest quality service even when no reward is anticipated.

It seems logical then that gaining rewards through service does not invalidate altruism for health professionals; however, what is equally clear is that clinicians must avoid conflicts of interest that result from financial or organizational arrangements. For example, referral decisions cannot be influenced by managed care agreements that return bonuses when visits to specialists fall below projections.

In addition to meeting the needs of patients, altruism also means advocating for patients. Some have even suggested that the PA acronym should stand for “patient advocate.” In this environment of preauthorization before the use of diagnostic studies or treatment modalities, it often takes a lot of effort to assist patients in understanding the system and overcoming the obstacles it presents. Another dimension of altruism relates to making yourself available to patients, even if it means your personal plans might be affected. Wilkinson believed that the responsibilities of meeting such an expectation were lost in the broader term of altruism, which led this dimension to be characterized as “balance availability to others with care for oneself.”

Ethical principles and practice

When focusing on the value-based aspects of professionalism, it is often assumed that ethics and professionalism are the same. Although they are related, ethical practice makes up one of the dimensions of professionalism. Four ethical principles underpin clinical decision making: (1) autonomy, the respect for the patient’s right to self-determination; (2) beneficence, the duty to “do good”; (3) nonmaleficence, the duty to “not do bad”; (4) and justice, to treat all people equitably and equally. Building on the expectations of justice and nonmaleficence is the expectation that information learned from and about the patient should be kept confidential. (See Chapter 36 for a further exploration of ethics). Ethical components are evident in approximately 25% of all clinical decisions that occur in the inpatient setting. In outpatient settings, estimates of the involvement of ethical components have ranged from 5% to 30%. , The ethical components result from value judgments regarding the consequences of decisions made by the decision maker and fulfillment of the rights of others. Usually, the ethical aspect is not explicitly considered because it is a garden-variety ethical conflict for which universal agreement on the resolution exists. To develop skills in applying ethical principles, PAs should make a habit of recognizing the presence of ethical dilemmas that surface even when they are a minor component of the decision-making process.

Cultural humility and responsiveness to a diverse population

The U.S. Census Bureau highlights dramatic changes in our country’s ethnic makeup over the next 45 years. For example, the portion of the population identified on the census as “White alone, not Hispanic” is expected to drop from the current level of 63% to 44% by 2060. As a result of these changes, health care professionals will be practicing in an increasingly diverse cultural environment and will be called on to provide services to individuals from cultures other than their own. In addition, increasing attention is focused on existing racial/ethnic disparities in health care delivery that are affecting outcomes.

The success of the health care encounter depends primarily on accurate and effective communication between patient and clinician. Failures of communication can result from differences in language, culture, and perspectives regarding health. Communication between patient and clinician affects “patient satisfaction, adherence to medical instructions, and health outcomes.” It is clear that the education of health professionals must address cultural humility. (See Chapter 43 for a further exploration of Health Disparities).

Behavior toward other professionals

Professional relationships with physicians and other health care providers

Team practice has been fundamental to the PA profession and has been identified as an essential component of the effort to improve the quality of health care. The characteristics of collaboration and mutual consultation are considered to be the elements of professional relationships in any well-designed health system. The Institute of Medicine (IOM) has called for a campaign of “Cooperation among Clinicians.” Effective teams require that team members work together with clear goals and expectations. Leadership, communication, and conflict management are key to that clarity. Matching the roles and training of team members to the tasks at hand will promote cohesiveness in interdependent teams. (See Chapter 2 for a further exploration of the physician–PA relationship). Mounting consensus exists that a failure of teams to establish a culture of professionalism can lead to disruptive behaviors, which can result in medical errors adversely impacting patient safety.

Behavior toward the public

Responsiveness to patient needs and the needs of society

At first glimpse, this principle seems straightforward, without need of explanation—”I will be responsive to the needs of my patients.” Similar language is used in the Hippocratic Oath, as well as in the Guidelines for Ethical Conduct for the PA Profession, but are we responsive and do we act on those needs? For instance, is being responsive to your patients simply filling that antibiotic prescription or casting a broken arm? Or is it the aforementioned plus actively listening and being “in the moment” with your patient instead of thinking about the next item on the review of systems? Do your actions speak louder than your words when meeting with your patients? Will they say you are responsive to their needs, even if they do not get what they think they need (an antibiotic for a 2-day history of a sore throat) or will they say you are distracted, not listening, and ultimately not caring or responsive to them as individuals? Common lapses in the responsiveness to patients include a failure to meet responsibilities; failure to maintain appropriate relationships within the health care environment; and inability to practice self-improvement. Some more serious lapses have been reported, including cheating, felonies, falsifying information, and forging prescriptions.

In the same way, we need to be responsive to society’s needs. On the surface this again seems clear, that we devote a part of our time to serving society (working in a free clinic or homeless shelter). However, it also includes monitoring our actions and the impact they have on society. It is being responsive and working with local, state, and national leaders to address health care needs, whether through access to health, coverage for care, or developing healthy lifestyle programs. It is advocating for individuals who have no health insurance by working at the state and national level to change or effect policy. We bring to light the individuals in society who have little voice in how they receive health care. We are given a white coat to wear when we graduate from a PA program that tells those around us that we have specialized knowledge. Even when we are not “officially” wearing the white coat, we are still health care providers and, as such, must always be ready to respond to society at large or to those immediately beside us.

Accountability to patients, society, and the profession

Accountability includes commitment, dedication, duty, legal/policy compliance, self-regulation, service, timeliness, and work ethic. The inclusion of accountability demonstrates that once the white coat is placed on the new professional, it remains on at all times. One cannot choose to be timely in the care of patients sometimes and not at other times, just as we cannot be committed to the profession part of the time. By being accountable to the profession, society, and our patients, the profession itself will be better able to provide care, advance its status, and drive changes needed for the future of health care.

Examples of accountability include coming to class on time, participating in class, completing assignments, arriving to work on time, and meeting deadlines. It also means being accountable to the profession by paying your dues on time, keeping your licensure up to date, complying with state filing laws, and accepting and performing under state practice laws as currently stated. Additionally, accountability to society includes reporting errors. The importance of this responsibility is well documented in IOM’s To Err is Human, which quantifies the cost to society, patients, and the profession if errors go unreported. It also involves reporting poor behavior in peers, practicing medicine in an ethical and responsible manner, being aware of your own limits, and identifying developmental needs and ways to improve.

There is much overlap between responsiveness to society, patients, and the profession and accountability, but each has distinct attributes as well. We must constantly strive to be responsible (in many ways an inward approach) and accountable (an outward approach) to how we practice medicine, participate in our community, and interact within our profession.

Adherence to legal and regulatory requirements

State laws and regulations dictate who may practice as a PA and the medical services a PA may perform. It is your responsibility as a PA to make sure that you have a valid and current state license and have met any additional state requirements before you begin to practice. It is also your responsibility to ensure that everything you do is within the limits of your state law and regulations. Finally, it is essential that PAs understand and adhere to established standards of care. (See Chapter 37 for further exploration of the adherence to legal and regulatory requirements).

Behavior toward oneself

Commitment to excellence and professional development

Excellence has been defined as “a conscientious effort to exceed ordinary expectations and to make a commitment to lifelong learning.” Professionals must be committed to lifelong learning, maintaining our medical knowledge, and the provision of quality clinical care. Professionals also need to be flexible and able to adapt to change. As a profession, we must strive to keep all our members competent and to ensure appropriate mechanisms are in place to accomplish this goal.

Not only is professional development the ongoing maintenance of a current certificate, the maintenance of continuing medical education, or the learning of new procedures, but it also goes beyond the self and out to the profession as a whole. We are committed to maintaining and advancing our knowledge, and by this standard we are also committed to “work collaboratively to maximize patient care, be respectful of one another, and participate in the process of self-regulation, including remediation and discipline of members who have failed to meet professional standards.” We have an obligation to participate in these processes by volunteering for review boards, working on educational and standard-setting processes, and accepting an external review of everything that we do.

Examples of excellence and professional development include, but are not limited to, mastering techniques (whether new or already learned), developing and setting goals, teaching self and others, and helping to develop or maintain a climate that fosters professionalism. Wilkinson defines this as having a commitment to autonomous maintenance and continuous improvement of competence. Professional development also extends to working on local, state, or federal levels to promote the profession and access to health care; giving back to society, which helped educate us through being our patients/care receivers/teachers; and teaching the next generation of care providers by mentoring new students and demonstrating professionalism firsthand.

Demonstrate self-reflection, critical curiosity, and initiative

A key part of lifelong learning is the ability to reflect on performance in practice. Self-reflection starts with the identification of an incident that challenged one’s values, beliefs, or understanding. Learning from the incident involves accessing resources to increase understanding, followed by considering how the situation might have been handled differently. In many situations, things are made more challenging by the complexity and uncertainty that is an ever-present part of caring for patients. Often, it leads to making plans for future learning. Studies have shown that a student’s inability to effectively self-reflect is strongly associated with lapses in professionalism.

Another aspect of lifelong learning is self-assessment, which involves assessing one’s strengths; identifying areas for additional learning; and then showing initiative to pursue appropriate learning experiences. Self-regulation is a hallmark feature of professionalism, and self-assessment is essential to that process.

Know professional and personal limitations

One specific aspect of self-assessment is to know your limitations. During the process of patient care, PAs may be challenged by situations in which they may need to judge whether or not they possess the knowledge and skill necessary to address the patient’s needs. The quality of care delivered and patient safety depend on the PA engaging in effective self-assessment. Simply put, it is essential that you know what you do not know and know where to get help. With the physician–PA team, immediate access to assistance is built in the patient care delivery model.

Practice without impairment

When identifying strengths and weaknesses in the self-assessment, you need to demonstrate a commitment to personal wellness and to be aware of any limitations from impairment. Such assessments also extend to being aware of impairment in other members of the team. Impairment has been defined as “any physical, mental, or behavioral disorder that interferes with the ability to engage safely in professional activities.” Other conditions that may ultimately result in impairment include fatigue, stress, and burnout. It is a professional obligation to ensure the public that its practitioners are capable of practicing safely. It is the responsibility of the PA to self-identify or for colleagues to intervene. A key goal is to remove the PA from practice either temporarily or permanently, which may ultimately mean placing the profession ahead of personal and professional relationships.

Professionalism and social media

New challenges to professionalism are surfacing as dramatic increases are occurring in the use of social media by a wide variety of people to communicate with friends and family, participate in common interest groups, and find entertainment. Medical training is an exciting time and students are often enthusiastic to share their new knowledge and unique experience with friends and family. Sharing one’s journey in PA school on social media can be inspiring to peers, those just starting to research the field, or hopeful applicants determining which program they want to apply to. For some users of social media, however, the boundary between personal and professional communication can become blurred. Before posting on social media it is important to use the concept of respect for the patient as a filter. It may be tempting to take a picture of an interesting rash or x-ray to share with fellow students or family. Even if no specific patient data has been included in a post, such as date of birth, name, or medical record number, it may be possible to identify a patient based on the author’s known location and the date of the post, violating patient confidentiality and the Health Insurance Portability and Accountability Act (HIPAA). Friends or family of the patient may also stumble upon a social media post involving their loved one. Sharing this very personal information can feel violating to the patient and their community. It is easy to find examples of students and practitioners who have posted private patient information without considering the full impact of their actions. Sharing protected patient information with the public is a breach of trust between patient and professional. In the worst cases, unprofessional posts result in loss of employment and involved providers are held personally responsible for libel for the resulting negative impact on the patient.

The patient-provider relationship may also be affected when social media is used as a platform to vent about experiences, current events, beliefs, or policy opinions. This is not to imply that these types of posts are inherently unprofessional, but one should consider whether a post on social media will cause a patient to question whether the medical assessment and recommendations are unbiased. If a PA posts about their belief that pregnancy termination is wrong, will a patient believe that they will receive the unbiased options in counseling that they are entitled to? Will a patient withhold information important to their medical care for fear of judgment after reading a social media post?

Many medical organizations and practices use social media to recruit and educate patients and connect medical professionals. Use of social media can strengthen collaboration and serve as a platform for professionals to engage, advocate, and support one another. In 2017, Dr. Esther Choo posted on her Twitter thread about patient prejudice in the emergency room. This posting resonated with thousands of providers and opened the door for medical professionals to support each other on a national level. In 2018, the American College of Physicians released a position paper aimed at reducing firearm injury and death. Dialogue responding to this position paper inspired groups of providers to take a united stance and collaborate to evolve practice recommendations and advocate for policies that aimed to improve the safety of their patients. Following professional organizations on social media can be a way to keep up to date on the latest research and guidelines, which directly affect future practice.

There are differing opinions on the role of social media platforms in medical education and practice. Vague or inconsistent guidance on how employees and students should interact with social media complicate the issue. Students should be aware of the policies on social media at their institution. As a PA student and future medical provider, interactions on digital sites function within the same professional framework and expectation as in-person interactions. To interact with the American Academy of Physician Assistants (AAPA) social media site, one must agree not to post “material which defames, abuses, or threatens others”; “statements that are bigoted, hateful, or racially offensive”; “material that advocates illegal activity”; “material that contains vulgar, obscene, or indecent language or images”; and “unauthorized posting of personal information of other users.” General application of the AAPA guidelines on professional online conduct facilitates users to avoid misrepresentation of themselves, the profession, and their employer.

In addition, professionalism includes reporting members of our community who are not meeting the standards of the profession. If you observe content posted by a colleague that appears unprofessional, it is your responsibility to inform them so that they can take it down. If the content significantly violates professional norms and standards and it is not removed, it is the professional responsibility of a provider to report the content, just as one would be expected to report unprofessional behavior observed in person.

Your digital professional image should be actively managed and monitored. The American Medical Association recommends that physicians routinely monitor their online presence. Become familiar with privacy settings but keep in mind these settings are often not as robust as they seem. Finally, it is important to maintain the same boundaries with patients on social media that you would in any other context.

Fostering professionalism

Medical training can be viewed as entering a “community of practice” that requires specific skills and knowledge that are shared and developed. Integration into the community of practice begins in PA school and is based on mutual trust and respect. Developing a professional identity is an important component of training as you transition from a member of the lay public to a classroom participant and, ultimately, a practicing PA. The motivation to invest the significant time and energy it takes to become a PA moves from achieving good grades to an awareness of responsibility for the health of your future patients.

Professionalism can best be learned when students see positive examples modeled by their instructors, clinical preceptors, and peers. Conversely, what is taught in the classroom setting can be undermined when unprofessional practices by preceptors are observed in clinical settings. , As a student observes faculty, preceptors, mentors, and teams of interprofessional providers, they will decide which approaches and attitudes will inform their professional identity formation and best serve their future practice. If a learner observes unprofessional practice, it is helpful to speak with a mentor to reflect on what specifically felt unprofessional about an action or behavior. Reflection is an essential component of developing a professional identity. Students must demonstrate an awareness of their strengths and limitations and develop a plan to address gaps in knowledge or skills, as well as practice ongoing self-reflection and a commitment to self-improvement and lifelong learning. A PA training program should provide a safe community to practice self-reflection because it is important that students build comfort and confidence in processing clinical successes, uncertainties, and the inherent stresses of medical education. In addition to reflection, learners can actively practice self-assessment during their time as a student so that this skill will have a solid foundation when they start their career. Maintaining a portfolio with examples of written work and faculty and mentor feedback allows a learner to compare self-assessments to external feedback and generate short-term and long-term goals, a skill essential to maintaining lifelong learning and advancing knowledge at many levels, not just medicine. Students can observe preceptors and mentors to build confidence and skill in advocating for patients, families, and the profession and balancing availability and care for oneself.

Taking the PA professional oath at graduation is a powerful symbol, signifying entry into the profession of medicine and a commitment to adopting the tenets of professionalism. Developing the skills of self-reflection and self-monitoring, such as by setting learning goals that mitigate gaps in knowledge and skill, will help in the development of resilience, which is “the ability to maintain personal and professional wellbeing in the face of ongoing work stress and adversity.” , It remains incumbent on all PAs, whether in the learning phase or during practice, to make every effort to regularly assess, advance, and reflect on professionalism and all that it means because by doing so, we advance ourselves, our practice, and our profession.


With the defining of competencies for the PA profession, the competency of professionalism is receiving increased attention. In fact, the National Commission on Certification of Physician Assistants (NCCPA) has revised the certification maintenance process to include the completion of self-assessment modules. PAs are reminded of the importance of developing a “professional self,” one that maintains a commitment to practicing in accordance with the values of medicine, particularly caring for the patient, and not just focusing on knowledge and skills. Success in learning about professionalism depends on recognizing that the purpose of such education is to reinforce the public, collective promise to make the patient’s interest a priority; such endeavors require hard work and focused attention over one’s career. Caring for the patient means focusing on the needs and welfare of that patient rather than the PA’s self-interest. ,

Clinical applications

  • 1.

    Think of a time when a “professional” treated you with unprofessional behavior. How did that make you feel and how could the situation have been handled more appropriately?

  • 2.

    Discuss with a classmate how you might handle a clinical encounter when a patient requests something that you feel morally opposed to. Which of the Physician Assistant Competencies concerning professionalism might apply to this situation?

  • 3.

    Think about areas in your own professional development that might need to be worked on and how you might approach these areas in a positive manner.

Jun 15, 2021 | Posted by in MEDICAL ASSISSTANT | Comments Off on Professionalism

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