title: Proto-professionalism: how professionalisation occurs across the continuum of medical education.
abstract: BACKGROUND
  Professionalism and its assessment across the medical education continuum have become prominent topics in recent years. We consider the nature of professionalism and how it emerges and relates to the work carried out by doctors and doctors-in-training.
  We suggest 6 domains in which evidence of professionalism can be expected: ethical practice; reflection/self-awareness; responsibility for actions; respect for patients; teamwork, and social responsibility. Furthermore, we propose that a defining characteristic is encapsulated by the Greek term phronesis, or practical wisdom. Phronesis is acquired only after a prolonged period of experience (and reflection on experience) occurring in concert with the professional's evolving knowledge and skills base. The prior period we have termed as one of 'proto-professionalism'. Influences on proto-professionalism are considered in terms of moral and psychosocial development and reflective judgement.
  
  
  CONCLUSIONS
  Curricula that develop meta-skills will foster the acquisition and maintenance of professionalism. Adverse environmental conditions in the hidden curriculum may have powerful attritional effects.
authors.affiliation: Department of Community Health Sciences, St. George's Hospital Medical School, London SW17 0RE, UK. shilton@sghms.ac.uk
authors.forename: Sean R
authors.initials: SR
authors.lastname: Hilton
authors.forename: Henry B
authors.initials: HB
authors.lastname: Slotnick
mesh_terms: D003479:Curriculum / Q000592:standards; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D011361:Professional Competence / Q000592:standards*; D024382:Professional Role