Professional ethics in medicine: foundations, threats, and evidence-based education
DOI:
https://doi.org/10.5281/zenodo.21746748Keywords:
medical professionalism, medical ethics, medical education, conflict of interest, burnout, shared decision makingAbstract
Introduction: Medical professionalism forms the foundation of the social contract between medicine and society, because it links technical competence, moral integrity, public responsibility, and prioritization of patient welfare. Development: Recent evidence shows that professionalism can be analyzed as an observable and assessable competence, but also as a practice vulnerable to contemporary threats, including burnout, conflicts of interest, care fragmentation, organizational pressure, and ethical tensions associated with digital care and end-of-life decision-making. Implications: These findings support the need to strengthen longitudinal, reflective, and institutionally backed education, with mentoring, programmatic assessment, and clinical environments coherent with the values being taught.
Conclusions: In medical education and clinical practice, professionalism should be addressed as a dynamic capability that requires vigilance, explicit modeling, and educational policies that sustain public trust and quality of care.
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References
Varkey B. Principles of clinical ethics and their application to practice. Med Princ Pract. 2021;30(1):17-28. https://doi.org/10.1159/000509119
ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243-246. https://doi.org/10.7326/0003-4819-136-3-200202050-00012
Feitosa ES, Brilhante AVM, Cunha SM, Sá RB, Nunes RR, Carneiro MA, et al. Professionalism in the training of medical specialists: an integrative literature review. Rev Bras Educ Med. 2019;43(1 Suppl 1):692-699. https://doi.org/10.1590/1981-5271v43suplemento1-20180178.ing
Reimer D, Russell R, Khallouq BB, Kauffman C, Hernandez C, Cendán J, et al. Pre-clerkship medical students’ perceptions of medical professionalism. BMC Med Educ. 2019;19(1):239. https://doi.org/10.1186/s12909-019-1676-9
Yadav H, Jegasothy R, Ramakrishnappa S, Mohanraj J, Senan P. Unethical behavior and professionalism among medical students in a private medical university in Malaysia. BMC Med Educ. 2019;19(1):218. https://doi.org/10.1186/s12909-019-1662-2
Passi V, Doug M, Peile E, Thistlethwaite J, Johnson N. Developing medical professionalism in future doctors: a systematic review. Int J Med Educ. 2010;1:19-29. https://doi.org/10.5116/ijme.4bda.ca2a
Paro HBMS, Daud-Gallotti RM, Tibério IC, Pinto RMC, Martins MA. Brazilian version of the Jefferson Scale of Empathy: psychometric properties and factor analysis. BMC Med Educ. 2012;12:73. https://doi.org/10.1186/1472-6920-12-73
Santos MA, Grosseman S, Morelli TC, Giuliano ICB, Erdmann TR. Empathy differences by gender and specialty preference in medical students: a study in Brazil. Int J Med Educ. 2016;7:149-153. https://doi.org/10.5116/ijme.5704.e3d6
Liao JM, Etchegaray JM, Williams ST, Berger DH, Bell SK, Thomas EJ. Assessing medical students’ perceptions of patient safety: the medical student safety attitudes and professionalism survey. Acad Med. 2014;89(2):343-351. https://doi.org/10.1097/ACM.0000000000000102
Noreen K, Zuberi RW, Aftab K, Fatima S. Assessment of medical professionalism: development and psychometric analysis of Professionalism Assessment Tool in Pakistani context using Delphi techniques. Pak J Med Sci. 2023;39(2):330-337. https://doi.org/10.12669/pjms.39.2.6534
Yavari N, Asghari F, Shahvari Z, Nedjat S, Larijani B. Developing a comprehensive tool to assess professional attitude among physicians and medical students. J Med Ethics Hist Med. 2021;14:27.
Sciolla AF, Wilkes MS, Griffin EJ. Adverse childhood experiences in medical students: implications for wellness. Acad Psychiatry. 2019;43(4):369-374. https://doi.org/10.1007/s40596-019-01003-0
Williams BW, Welindt D, Hafferty FW, Stumps A, Flanders P, Williams MV. Adverse childhood experiences in trainees and physicians with professionalism lapses: implications for medical education and remediation. Acad Med. 2021;96(5):736-743. https://doi.org/10.1097/ACM.0000000000003870
Mak-van der Vossen M, van Mook W, van der Burgt S, Kors J, Ket JCF, Croiset G, et al. Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation. BMC Med Educ. 2017;17(1):164. https://doi.org/10.1186/s12909-017-0987-x
Harris JD, Staheli G, LeClere L, Andersone D, McCormick F. What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop Relat Res. 2015;473(5):1600-1608. https://doi.org/10.1007/s11999-014-3848-0
Hendelman W, Byszewski A. Formation of medical student professional identity: categorizing lapses of professionalism, and the learning environment. BMC Med Educ. 2014;14:139. https://doi.org/10.1186/1472-6920-14-139
Mustika R, Soemantri D. Unveiling the hurdles in cultivating humanistic physicians in the clinical setting: an exploratory study. Malays J Med Sci. 2020;27(3):117-124. https://doi.org/10.21315/mjms2020.27.3.12
Cooke GPE, Doust JA, Steele MC. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars. BMC Med Educ. 2013;13:2. https://doi.org/10.1186/1472-6920-13-2
Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L, et al. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry. 2018;42(1):11-24. https://doi.org/10.1007/s40596-017-0849-3
Rebegea L, Tarlungianu C, Anghel R, Firescu D, Corobcean N, Gales L. Burnout risk evaluation in medical oncology-radiotherapy personnel. Proc Eur Conf Psychiatry Ment Health Galatia. 2023. https://doi.org/10.35630/2022/12/psy.ro.5
Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11(5):412-420. https://doi.org/10.1370/afm.1511
Brax H, Fadlallah R, Al-Khaled L, Kahale LA, Nas H, El-Jardali F, et al. Association between physicians’ interaction with pharmaceutical companies and their clinical practices: a systematic review and meta-analysis. PLoS One. 2017;12(4):e0175493. https://doi.org/10.1371/journal.pone.0175493
Modi PK, Wang Y, Kirk PS, Dupree JM, Singer EA, Chang SL. The receipt of industry payments is associated with prescribing promoted alpha-blockers and overactive bladder medications. Urology. 2018;117:50-56. https://doi.org/10.1016/j.urology.2018.03.007
Nejstgaard CH, Bero L, Hróbjartsson A, Jørgensen AW, Jørgensen KJ, Le M, et al. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ. 2020;371:m4234. https://doi.org/10.1136/bmj.m4234
Perlis RH, Perlis CS. Physician payments from industry are associated with greater Medicare Part D prescribing costs. PLoS One. 2016;11(5):e0155474. https://doi.org/10.1371/journal.pone.0155474
Spithoff S, Leece P, Sullivan F, Persaud N, Belesiotis P, Steiner L. Drivers of the opioid crisis: an appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing. PLoS One. 2020;15(1):e0227045. https://doi.org/10.1371/journal.pone.0227045
Almaghrabi NS, Bugis BA. Patient confidentiality of electronic health records: a recent review of the Saudi literature. Dr Sulaiman Al Habib Med J. 2022;4(3):126-135. https://doi.org/10.2991/dsahmj.k.220531.001
Budiyanti RT, Herlambang PM, Fuad A, Kusumastuti W. Integration of electronic medical record and SATUSEHAT’s platform: patient’s legal protection perspective. Int J Health Lit Sci. 2023;1(2):1-8.
Qashqari AA, Almutairi DS, Ennaceur SA, Farhah NS, Almohaithef MA. Healthcare professionals’ perceptions of electronic medical record privacy and its impact on work quality in Riyadh hospitals. Saudi Med J. 2025;46(3):299-306. https://doi.org/10.15537/smj.2025.46.3.20240915
James JT. Abandon informed consent in favor of probability-based, shared decision-making following the wishes of a reasonable person. J Patient Exp. 2022;9:23743735221106599. https://doi.org/10.1177/23743735221106599
Politi MC, Kuzemchak MD, Kaphingst KA, Perkins H, Liu J, Byrne MM. Decision aids can support cancer clinical trials decisions: results of a randomized trial. Oncologist. 2016;21(12):1461-1470. https://doi.org/10.1634/theoncologist.2016-0120
Frosch DL, May SG, Rendle KAS, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled “difficult” among key obstacles to shared decision making. Health Aff (Millwood). 2012;31(5):1030-1038. https://doi.org/10.1377/hlthaff.2011.0576
Garbutt J, Brownstein DR, Klein EJ, Waterman A, Krauss MJ, Marcuse EK, et al. Reporting and disclosing medical errors: pediatricians’ attitudes and behaviors. Arch Pediatr Adolesc Med. 2007;161(2):179-185. https://doi.org/10.1001/archpedi.161.2.179
Sukumaran S. Physician challenges in medical error disclosure: a case study in undergraduate medical student education. Glob Bioeth Enq. 2017;5(1):35.
Borz-Baba C, Johnson M, Gopal V. Designing a curriculum for the disclosure of medical errors: a requirement for a positive patient safety culture. Cureus. 2020;12(2):e6931. https://doi.org/10.7759/cureus.6931
Lazzara EH, Salisbury M, Hughes AM, Rogers JE, King HB, Salas E. The morbidity and mortality conference: opportunities for enhancing patient safety. J Patient Saf. 2022;18(1):e275-e281. https://doi.org/10.1097/PTS.0000000000000803
Haimi M, Wheeler SQ. Safety in teletriage by nurses and physicians in the United States and Israel: narrative review and qualitative study. JMIR Hum Factors. 2024;11:e50676. https://doi.org/10.2196/50676
Zafra-Tanaka JH, Najarro L, Tenorio-Mucha J, Lazo-Porras M, Bartra D, Bazán G, et al. COVID-19’s impact on type 1 diabetes management: a mixed-methods study exploring the Peruvian experience. Int J Health Plann Manage. 2022;37 Suppl 1:S129-S143. https://doi.org/10.1002/hpm.3418
Asante A, Price J, Hayen A, Jan S, Wiseman V. Equity in health care financing in low- and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PLoS One. 2016;11(4):e0152866. https://doi.org/10.1371/journal.pone.0152866
Diaconu K, Chen YF, Cummins C, Jimenez Moyao G, Manaseki-Holland S, Lilford R. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review. Glob Health. 2017;13(1):59. https://doi.org/10.1186/s12992-017-0280-2
Cheng SPS, Heo K, Joos E, Vervoort D, Joharifard S. Barriers to accessing congenital heart surgery in low- and middle-income countries: a systematic review. World J Pediatr Congenit Heart Surg. 2024;15(1):94-103. https://doi.org/10.1177/21501351231200161
Luna-Meza A, Godoy-Casasbuenas N, Calvache JA, Díaz-Amado E, Gempeler Rueda FE, Morales O, et al. Decision making in the end-of-life care of patients who are terminally ill with cancer: a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers. BMC Palliat Care. 2021;20(1):76. https://doi.org/10.1186/s12904-021-00748-6
Abarshi EA, Papavasiliou ES, Preston N, Brown J, Payne S, EURO IMPACT. The complexity of nurses’ attitudes and practice of sedation at the end of life: a systematic literature review. J Pain Symptom Manage. 2014;47(5):915-925.e11. https://doi.org/10.1016/j.jpainsymman.2013.06.011
Byszewski A, Gill JS, Lochnan H. Socialization to professionalism in medical schools: a Canadian experience. BMC Med Educ. 2015;15:204. https://doi.org/10.1186/s12909-015-0489-z
Byszewski A, Hendelman W, McGuinty C, Moineau G. Wanted: role models--medical students’ perceptions of professionalism. BMC Med Educ. 2012;12:115. https://doi.org/10.1186/1472-6920-12-115
Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Acad Med. 2010;85(11):1709-1716. https://doi.org/10.1097/ACM.0b013e3181f57899
Izadabadi F, Amini M, Kiani M. Implementation and evaluation of extracurricular theme for undergraduate basic sciences medical courses at Shiraz Medical School. J Educ Health Promot. 2021;10(1):98. https://doi.org/10.4103/jehp.jehp_1024_20
AlKhater SA. Perception of Saudi undergraduate students towards professionalism in medicine. Sultan Qaboos Univ Med J. 2021;21(3):378-385. https://doi.org/10.18295/squmj.4.2021.027
Ghobain MA, Alghamdi A, Arab A, Alaem N, Aldress T, Ruhyiem M. Patients’ perceptions towards the participation of medical students in their care. Sultan Qaboos Univ Med J. 2016;16(2):e224-e229. https://doi.org/10.18295/squmj.2016.16.02.012
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