Linda Blank's research while affiliated with Association of American Medical Colleges and other places

Until recently professionalism was transmitted by respected role models, a method that depended heavily on the presence of a homogeneous society sharing values. This is no longer true, and medical schools and postgraduate training programs in the developed world are now actively teaching professionalism to students and trainees. In addition, licensing and certifying bodies are attempting to assess the professionalism of practising physicians on an ongoing basis. This is the only book available to provide guidance to those designing and implementing programs on teaching professionalism. It outlines the cognitive base of professionalism, provides a theoretical basis for teaching the subject, gives general principles for establishing programs at various levels (undergraduate, postgraduate, and continuing professional development), and documents the experience of institutions who are leaders in the field. Teaching aids that have been used successfully by contributors are included as an appendix.

Feedback from others on how we perform as individuals is an essential part of physician education from medical school through medical practice. As R. B. Gunderman recently noted: In this issue of the ARCHIVES, Brinkman and colleagues² present evidence that using multisource feedback from ratings provided by parents and nurses, coupled with specific interventions of self-assessment, standardized reporting, and tailored coaching, improved the communication skills and professionalism of pediatric residents. This important finding should be examined closely for its potential impact on the more than 8300 currently accredited residency programs in the United States that are responsible for nurturing and assessing the professional development of more than 103 000 physicians in training.

Conflicts of interest between physicians' commitment to patient care and the desire of pharmaceutical companies and their representatives to sell their products pose challenges to the principles of medical professionalism. These conflicts occur when physicians have motives or are in situations for which reasonable observers could conclude that the moral requirements of the physician's roles are or will be compromised. Although physician groups, the manufacturers, and the federal government have instituted self-regulation of marketing, research in the psychology and social science of gift receipt and giving indicates that current controls will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to small gifts, pharmaceutical samples, continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts. We propose a policy under which academic medical centers would take the lead in eliminating the conflicts of interest that still characterize the relationship between physicians and the health care industry.

At probably no point in the history of modern medicine have physicians and medical educators been pulled by so many demands of accountability from such diverse constituencies. Although these demands are varied and sometimes even contradictory, all the constituencies concur that physicians must demonstrate professional behavior. In this issue of the Journal, Papadakis and colleagues1 provide evidence from three medical schools of the association between disciplinary action by state medical boards against practicing physicians and a documented lack of professional behavior (particularly, irresponsibility, diminished capacity for self-improvement, and poor initiative) when those physicians were medical students. William Sullivan of the . . .

Almost in all cultures and societies the modern medical practice faces tough and unusual challenges. These concern unevenness between legitimated patients needs, resources aimed to their satisfaction, higher dependence of the sanitary systems from the market forces, the temptation for the doctors to give up their traditional prioritary engagement towards patients welfare and interests. To respect the social contract of medicine in our turbulent era, the doctor must re-state their active dedication to the principles of professionality. This not only means personal engagement in acting for patients' welfare, but also collective efforts for the improvement of the sanitary system addressed to the social welfare. Aim of the Chart of Medical Professionality is the encouragement of such dedication and promotion of initiatives and actions of universal value and interest.

Annals and The Lancet published the Charter on Medical Professionalism 15 months ago. This paper describes the rationale for the charter, provides an update on what has happened since initial publication, and outlines future activities to promote the charter. The interested reader will find additional commentary and response in this issue in the Letters section and in the editorial by Reiser and Banner.

The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients' interests. To maintain the fidelity of medicine's social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose.

The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients' interests. To maintain the fidelity of medicine's social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose.