Why is professional identity important? Healthcare

It has been noted that the domain of social identity has been subjected to a wealth of theorisation but the work of sociologist Erving Goffman (1922–1982) continues to have currency for research about professional identity (Atkinson and Housley, 2003). Goffman built on the work of philosopher and sociologist, George Mead to explore the social organisation of professional identity. He was particularly interested in the relationship between the psychological preoccupation with self and the ways through which identity is formed by social processes and accomplished through interactions with others (Atkinson and Housley, 2003). Goffman’s concept of identity is multilayered and concerns what the individual says, thinks, imagines and what the person ‘is’ (Atkinson and Housley, 2003). He argued that professional status involves more than achieving a prestigious place in society. It also concerns a public presentation of oneself as being close to commonly respected societal values and, therefore, allows individuals to adopt a highly regarded sense of self (Goffman, 1969). Certainly this fits in with the early sociologists’ view of the professions’ close approximation to high moral values.
Goffman established the idea that professional identity can be generated through rituals that occur within interactions (Atkinson and Housley, 2003). When clients expect professionals to be imbued with trust and that expectation is fulfilled, then the idea that trust is an important professional characteristic is perpetuated (Hughes, 1981). The ritualistic offering and receiving of trusting actions highlights the ethicality of the professional person. Thus, the manifestation of a trusting relationship is one of the ways through which individuals can ‘perform’ their professionalism and, therefore, confirm their identity. Bruhn (2001) noted that the opportunity to be ‘good’ by doing good is what motivates people to become health professionals and permits a positive answer to the question, ‘Can I be proud of who I appear to be?’ Being a professional is closely bounded with who a person ‘is’. As Moline (1986) reported, if a plumber loses his or her job it might be annoying but if the same thing happened to a doctor it would be catastrophic, because the foundation for that individual’s self-belief has been removed.
It is therefore important for health and social care practitioners to become confident in their sense of self as a professional person and to have the necessary resilience to remain committed to ethical ideals whatever the circumstances. Where an individual’s professional identity stems from common values, this also means that members of the same group share work practices, procedures, the ways in which they perceive the knowledge base and solutions to problems as well as views on interactions with clients (Evetts, 2003). In this way, each individual is responsible for contributing to the way in which the whole profession is perceived.

Time for reflection
Think about that phrase: ‘Can I be proud of who I appear to be?’ How would you answer this question? What values does your profession uphold and do you share them? How do your clientele know that you have these values?
Let us now turn our attention to professionalism. To start: What is the difference between ‘profession’ and ‘professionalism’? The suffix ‘ism’ is used to convert the noun (profession) into an active noun. So, in ‘doing’ professionalism you are ‘being’ a profession.
Professionalism concerns knowledge and skills (competence) and also values, beliefs and attitudes, which drive behaviours (conduct). As we have seen, some of these characteristics are inherent in individuals who choose professional careers. The next section explains how these are further developed in education.

Learning professionalism

Many authors have identified the importance of the educational curriculum in developing professionalism in doctors (Shapiro, Rucker and Robitshek, 2006; O’Sullivan and Toohey, 2008; van Mook et al., 2009a; Passi et al., 2010) and to some extent amongst allied health professionals (Kasar and Muscari, 2000; Lindquist et al., 2006). Medical schools have previously focused their assessment strategies on knowledge and skills acquisition (Stark et al., 2006). In the United Kingdom, the General Medical Council now recommends that attitudinal learning objectives should be given equal importance in the curriculum to knowledge and skills objectives (GMC, 2009). For example, outcome 3 of the ‘Outcomes and standards for undergraduate medical education’ (page 25) concerns the doctor as a professional. Graduates must behave according to ethical principles, including being polite, considerate, trustworthy and honest. They must respect all patients and colleagues and recognize the rights and the equal value of all people (GMC, 2009).

Traditionally, it had been assumed that health students would absorb the elements of professionalism through socialisation. This remains important but it is now recognised that the concept must also be explicitly taught (Cruess and Cruess, 2006) and assessed (van Mook et al., 2009b, 2009c). Studies within the medical profession suggest that learning about professionalism should take into account cognitive (factual) knowledge of the topic. Students must be informed about theoretical underpinnings and understand what professionalism is. They can then learn the behavioural components, which might include performance and skills acquisition (Hodges et al., 2011). In addition, specific character traits, attitudes and values need to be fostered (van Mook et al., 2009b; Wearn et al., 2010). Learning and assessment, therefore, require a combination of approaches that address each of these components. Chapters 1 and 2 have shown that employers are not just looking for skilled competence but also the values, beliefs and attitudes that harmonise with those of their organisation.

Cruess and Cruess (2006) have argued that situated learning theory is the most appropriate way to develop professionalism in students. Briefly, this theory has a fundamental tenet that learning should be embedded in authentic activities. It is important to provide students with a definition of professionalism and then give opportunities for long-term experience and reflection on performance in different contexts and situations, particularly in practice, and to offer constructive feedback (van Mook et al., 2009b; Goldie, 2013). Through these means, knowledge can be transformed from the theoretical to the useable and useful (Cruess and Cruess, 2006).Principal among the factors to consider when using situated learning theory is a stipulation that the educational institution must agree on both the definition and description of professionalism and that these must be consistently portrayed throughout the educational process. The definition provided by Cruess, Johnston and Cruess (2004) at the opening of this chapter is a good one. We will now consider a description of professionalism.

For the benefit of the medical profession, three organisations – the European Federation of Internal Medicine, the American College of Physicians and American Society of Internal Medicine and the American Board of Internal Medicine – developed a ‘Charter on Medical Professionalism’. This charter was written in response to a perceived need to make explicit the ideals to which doctors throughout the world are committed (Charter on Medical Professionalism, 2002). This was a global exercise that seems to have reached an agreement on the responsibilities required of physicians. Notwithstanding that there is some continuing debate about describing professionalism (van Mook et al., 2009c), the School of Health Sciences (HSC) at the University of East Anglia (UEA) used this work to inform the development of its own ‘Professionalism Charter’, the details of which have been published elsewhere (Mason et al., 2012a, 2012b). The UEA has described professionalism as a collection of nineteen values, attitudes skills and aspects of knowledge (collectively termed 'responsibilities') organised within five concepts (Table 3.1). The Professionalism Charter is used as a framework to inform all teaching and assessment of professionalism for a range of health and social care students.