Valuing virtue in medicine: a closer look at CanMEDS
DOI:
https://doi.org/10.36834/cmej.79246Abstract
Abstract
The CanMEDS-2015 Framework outlines seven key roles expected of practicing physicians: communicator, collaborator, manager, health advocate, scholar, and professional. Critics have expressed concern about the omission of a proposed eighth role, ‘Physician as Person’ relevant to humane qualities and personal resilience of the physician. Upon further analyses, the Framework has included several virtuous attributes in the roles of a physician as professional and communicator. However, it addresses certain virtues like creativity, love, and spirituality inadequately. Drawing on literature from Positive Psychology, the author categorizes and additional set of virtues into six classes: wisdom, courage, humanity, justice, temperance, and transcendence. Based on these, the author lists virtues and concepts relevant to a ‘Virtuous Role’ for physicians. The CanMEDS Framework should integrate these virtues as a foundational or overarching role and draw from Virtue Ethics in religious and philosophical traditions. This approach is timely, giving ongoing efforts to update and develop CanMEDS2025. By adopting a Virtuous Role within CanMEDS, we aim to train physicians who are technically skilled and deeply humane, meeting society's expectations for compassionate and virtuous healthcare professionals
Metrics
References
Frank JR, Snell L, Sherbino J, editors. CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. CanMEDS. History. Available at http://canmeds.royalcollege.ca/en/about/histor [Accessed on Mar 12, 2024].
Dagnone JD, Takahashi SG, Whitehead CR, Spadafora SM. Reclaiming physician identity: it's time to integrate 'Doctor as Person' into the CanMEDS framework. Can Med Educ J. 2020;11(4):e97-e99. https://doi.org/10.36834/cmej.69182
Annas J. Intelligent Virtue. Oxford: Oxford University Press; 2011. https://doi.org/10.1093/acprof:oso/9780199228782.001.0001
Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. 2013. https://assets.publishing.service.gov.uk/media/5a7ba0faed915d13110607c8/0947.pdf [Accessed on Apr 1, 2024].
Parliamentary and Health Service Ombudsman. Dying without dignity. 2015. http://www.ombudsman.org.uk/reports-and-consultations/reports/health/dying-without-dignity. [Accessed on Feb 23, 2024].
American Medical Association. AMA Code of Medical Ethics. 2016. Available at https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-of-medical-ethics.pdf [Accessed on Mar 23, 2024].
World Medical Association. WMA International Code of Medical Ethics. 2018. Available at https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/.
World Health Organization. Global Competency and Outcomes Framework for Universal Health Coverage. Geneva: World Health Organization; 2022.
Neumann M, Edelhäuser F, Tauschel D, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996-1009. https://doi.org/10.1097/ACM.0b013e318221e615
Andersen FA, Johansen AB, Sondergaard J, Andersen CM, Hvidt EA. Revisiting the trajectory of medical students' empathy, and impact of gender, specialty preferences and nationality: a systematic review. BMC Med Educ. 2020;20(1):52. https://doi.org/10.1186/s12909-020-1964-5
Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182-91. https://doi.org/10.1097/ACM.0b013e3181b17e55
Hojat M, Shannon SC, DeSantis J, Speicher MR, Bragan L, Calabrese LH. Does empathy decline in the clinical phase of medical education? A nationwide, multi-institutional, cross-sectional study of students at DO-granting medical schools. Acad Med. 2020 Jun;95(6):911-918. https://doi.org/10.1097/ACM.0000000000003175
Ponnamperuma G, Yeo SP, Samarasekera DD. Is empathy change in medical school geo-socioculturally influenced? Med Educ. 2019;53(7):655-65. https://doi.org/10.1111/medu.13819
Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011;84(3):269-76.
Peabody FW. The soul of the clinic. JAMA 1928;90:1193-1197. https://doi.org/10.1001/jama.1928.92690420002009
Peabody, FW. The care of the patient. JAMA. 1927;88:877-882. https://doi.org/10.1001/jama.1927.02680380001001
Nelson AR. Humanism and the art of medicine. JAMA. 1989; 262(9), 1228. https://doi.org/10.1001/jama.1989.03430090090040
Rabinowitz DG. On the arts and humanities in medical education. Philos Eth Human Med. 2021;16(1):4. https://doi.org/10.1186/s13010-021-00102-0
Reports of the Institute on Human Values in Medicine. Available at https://files.eric.ed.gov/fulltext/ED107541.pdf. [Accessed on Mar 20, 2024].
Bain LE. Revisiting the need for virtue in medical practice: a reflection upon the teaching of Edmund Pellegrino. Philos Eth Human Med. 2018 ;13(1):4. https://doi.org/10.1186/s13010-018-0057-0.
Pellegrino ED. Professionalism, profession and the virtues of the good physician. Mt Sinai J Med. 2002;69(6):378-84.
Duffy TP. The Flexner Report--100 years later. Yale J Biol Med. 2011;84(3):269-76
Miles A. Mezzich JE. The care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice. Internat J Person-Centered Med. 2011;1:207-222. https://doi.org/10.5750/ijpcm.v1i2.61
Evans HM, Greaves DA. Ten years of medical humanities: a decade in the life of a journal and a discipline. Med Humanit. 2010;36(2):66-8. https://doi.org/10.1136/jmh.2010.005603
Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: a mixed methods systematic review. Front Public Health. 2023;11:1133484. https://doi.org/10.3389/fpubh.2023.1133484
General Medical Council: Our strategy: 2021-25. In. Edited by Council GM. Manchester: General Medical Council; 2020.
Verstegen PMB, Kole JJJ, Groenewoud AS, van den Hoogen FJA. Virtues in competency-based assessment frameworks: a text analysis. Perspect Med Educ. 2023;12(1):418-426. https://doi.org/10.5334/pme.996
Peterson C, Seligman MEP. Character strengths and virtues: a handbook and classification. Oxford University Press; American Psychological Association; 2004.
Coulehan J, Williams PC. Vanquishing virtue: the impact of medical education. Acad Med. 2001;76:598-605. https://doi.org/10.1097/00001888-200106000-00008
McKinnon, C. Character, virtue theories, and the vices. Orchard Park, NY: Broadview Press;1999.
Nissbaum M. Non-relative virtues: an Aristotelian approach. World institute for development economics research of the United Nations University. WP 32;1987. https://doi.org/10.1111/j.1475-4975.1988.tb00111.x
Hursthouse R, Pettigrove G. Virtue ethics. The Stanford Encyclopedia of Philosophy. Winter 2018 Edition. Edward N. Zalta (ed.), Available at https://plato.stanford.edu/archives/win2018/entries/ethics-virtue/.
Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician humanism in CanMEDS 2025. Can Med Educ J. 2023;14(1):13-17. https://doi.org/10.36834/cmej.75536
Dahlsgaard K, Peterson C, Seligman MEP. Shared virtue: the convergence of valued human strengths across culture and history. University of Pennsylvania Rev Gen Psychol. 2005;9 (3):203-213. https://doi.org/10.1037/1089-2680.9.3.203
Keown D. Buddhist ethics: a very short introduction. Oxford University Press; 1st edition; 2005.
Keown D. The nature of Buddhist ethics. Palgrave Macmillan London;1992
Sen, A. The idea of justice. Cambridge, MA: Harvard University Press; 2009.
Sreekumar S. An analysis of consequentialism and deontology in the normative ethics of the "Bhagavadgītā". J Indian Phil. 2012; 40(3):277-315: https://doi.org/10.1007/s10781-012-9154-3
Gupta B. "Bhagavad Gītā" as duty and virtue ethics: some reflections. J Relig Eth. 2006; 34(3):373-395: https://doi.org/10.1111/j.1467-9795.2006.00274.x
Bhavna O a & Parmar N: Qualities of the Physician Mentioned in Brihattrayi -A Review. Intern Ayurvedic Med J.. 2017; 5(7). https://www.iamj.in/posts/images/upload/2635_2644_1.pdf
Krishnan G, Singh S, Pathania M, et al. Artificial intelligence in clinical medicine: catalyzing a sustainable global healthcare paradigm. Front Artif Intell. 2023;6:1227091. https://doi.org/10.3389/frai.2023.1227091
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Saroj Jayasinghe
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
