Reframing Professionalism Around Trustworthiness

Many well-recognized challenges exist in medical professionalism education, including highly variable and fragmentary definitions that lack adaptation to changing norms, a focus on lapse detection, and assessments with limited validity, reliability, or standardization. To address local concerns related to the professionalism curriculum and student performance, in May 2022 a working group of faculty and medical students from Wake Forest University School of Medicine collaborated to develop and iteratively refine a revised definition of professionalism and an associated conceptual framework centered on establishing trustworthiness in one's workplace relationships. Within this framework, professionalism performance is categorized into 4 domains: trustworthiness in competence development, trustworthiness in humanity, trustworthiness in morality and ethics, and trustworthiness in duty fulfillment. Each domain is mapped to professional value commitments that are demonstrated through observable skills, tasks, and behaviors. The framework also emphasizes professionalism's connection with the developmental process of professional identity formation and the importance of demonstrating character, thus incorporating the 3 dominant frameworks of professionalism in the literature (virtue based, behavior based, and professional identity formation). This trustworthiness-based professionalism framework offers benefits to learners and educators, including improved clarity and comprehensiveness in defining medical professionalism, observable actions to guide learners toward successful achievement of trustworthiness, and connection to a shared purpose. Importantly, reframing professionalism around the goal of earning others' trust provides learners with an explicit, evidence-based rationale: one's professionalism performance-and the trust it generates-impacts other people. This framework provides medical educators with a practical tool for longitudinal professionalism curriculum development using a competency-based approach, with defined competencies, subcompetencies, and milestones that can be used to create meaningful training experiences, performance feedback, and assessments.