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In his preface to the first edition of Teaching and Assessing Professionalism: A Program Director’s Guide, Stephen Ludwig, MD, wrote that the authors of this work hoped it would be useful in “rekindling the flame of professionalism … that is at the core of our work on behalf of children and their families."

Almost 10 years later, in the introduction to a new JAMA series on the teaching of professionalism, the editors wrote: “Despite the various definitions and multifaceted nature of professionalism, at its core, professionalism can be thought of as a set of behaviors that must be learned and practiced like any other skill, and they should be developed and refined continuously over a physician’s practice lifetime. Much can be learned about professionalism by studying individual case scenarios. [In this way], physicians can learn more about how professionalism can guide them when they encounter challenging clinical situations, interpersonal issues, and ethical dilemmas.”1

As the authors of this second edition of Teaching, Promoting, and Assessing Professionalism Across the Continuum, we can find no better words than those above to convey both our intent and our hope for the current version of this guide.

We are indebted to Gail McGuinness, MD, and to John Frohna, MD, for their commitment to the original work as well as their drive to update this important teaching tool. It is a direct result of their guidance and encouragement that the second edition was undertaken and that important new chapters were added to the text. Just as essential to the successful completion of this project, Franklin Trimm, MD, and Nancy Spector, MD, were the senior editors who provided the focus, guidance, and determination that brought all of us together into a functional team with a common mission. Without their thoughtful and timely leadership, this edition might never have made it to publication.

We are very appreciative of the financial and technical support of the American Board of Pediatrics in completing this project. Specifically, Kimberly Durham has been an invaluable leader for the authors, editors, and staff through every step of the process. We are also indebted to Mike Adams for his technical expertise in transforming the original print version to a web-based tool that provides much improved usability and access.

Finally, on behalf of the entire project team, we are tremendously grateful to the chapter authors of the first edition who conceptualized the key elements of this work. Their original concept, design, and content have gracefully withstood the test of time.

Richard Shugerman, MD
Chair, Education and Training Committee
American Board of Pediatrics

  1. JAMA. 2016;316(7):720-721. doi:10.1001/jama.2016.9854.

Purpose of this Guide

Each year, program directors are asked by the ABP to determine whether each resident or fellow in their program has met expectations in the area of professional conduct. In addition, the program director must certify that the trainee has achieved competence in professionalism at the end of training in order to be eligible to take the certifying examination.

This guide was created initially through a joint effort of the Program Directors Committee of the ABP and the Association of Pediatric Program Directors (APPD) in order to help program directors answer three questions:

  1. What are the important elements of professionalism?
  2. How can expectations regarding professionalism be communicated to pediatric residents?
  3. What methods are appropriate for assessing professionalism during residency training?

The first edition was later updated by the Education and Training Committee of the ABP, which includes member representatives from the Council of Medical Student Education in Pediatrics (COMSEP), APPD, and the Council of Pediatric Subspecialties (CoPS). It was expanded to address the needs of the continuum of learners from students, residents, and fellows into continuous professional development. The guide also is presented in an online, searchable format.

This guide lays out the dimensions of professionalism in pediatrics and provides suggested methods for teaching and assessing professionalism among pediatric trainees. Chapters 2–8 outline aspects of professionalism as seen from different perspectives. In developing this guide, we have attempted to follow the model described by David Thomas Stern, author of Measuring Medical Professionalism: “setting expectations, providing experiences, and evaluating outcomes.”4

Figure 1

It also reflects the maturation of competency-based assessment as we begin to move toward entrustment decisions that are fundamental to the assessment of entrustable professional activities (EPAs). Figure 1 (as depicted by Burke, Carraccio, and Englander) illustrates the interactive continuum of EPAs with domains of competence, competencies, and milestones. Domains of competence are the six original ACGME competencies. The language related to competency-based education and training has evolved, and we intend to continue to update this guide to remain contemporary and relevant. The pediatric competencies and their associated milestones referred to throughout this guide include the full set included in the Pediatrics Milestone Project (PDF), incorporating a number of additional areas not part of the subset reported biannually to the ACGME by residency and fellowship directors.

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