Fostering professionalism among health professionals: the essential role of self-regulated and self-directed aptitudes of learning

Arianpoor, Arash; Taylor, Silas C. R.; Huang, Pin-Hsiang; Shulruf, Boaz; Arash Arianpoor; Silas C. R. Taylor; Pin-Hsiang Huang; Boaz Shulruf

doi:10.3946/kjme.2024.316

Professionalism in health-related fields broadly refers to the professional attributes required for effective medical practice that the community can trust. While clinical proficiency is fundamental to being considered a medical professional, professionalism extends to encompass communication skills, empathy, self-reflection, integrity, reliability, cultural awareness, and legal understanding [1].

Historically, professionalism was acquired through emulating role models, especially in the medical field— a method less suited to today’s evolving health context. This ongoing evolution has prompted the reform and formalization of professionalism education and evaluation, recognizing that professionalism is learned, not an inherent attribute [1]. However, while these reforms are progressing, they often overlook individual learning aptitudes, which are crucial given the dynamic, timedependent, and societal nature of professionalism [2]. To address these aspects of professionalism, it seems beneficial to factor in individual learning aptitudes, specifically self-directed learning and self-regulation, which the literature highlights as essential for health professionals. These aptitudes, once instilled and turned into behaviors, enhance academic and clinical performance, fostering lifelong learning throughout health professionals’ careers [3,4].

This perspective discusses the essential role of these learning behaviors, focusing on self-regulated and selfdirected aptitudes of learning (SELF-ReDiAL, or in short SR), in promoting professionalism among health professionals. SR, a holistic framework that considers both self-regulation and self-directedness in learners [5], was recently introduced to clarify the definitions of selfregulated learning and self-directed learning, particularly in medical education [3]. For more detailed information, please refer to Arianpoor et al. [5].

To present our view, it is important to first describe the characteristics of learners who possess SR. These learners can recognize the need for learning when faced with challenges, define a learning goal based on that recognized need, plan to reach that goal by adopting/adapting different learning strategies, and continuously monitor the entire learning process [5]. Learners with a high level of SR are more motivated to apply lifelong learning practice throughout their career.

Since professionalism is mediated by a balance among, at least, medical knowledge, professional identity, and social responsibility [1], we will explore how SR contributes to each of these aspects of professionalism.

1. Medical knowledge

The literature on the underlying theories of SR in health professional education supports that aptitudes conforming to these theories lead to better knowledge retention and academic performance [3]. In this regard, it is suggested that higher levels of SR in health professionals would likely make them more knowledgeable and adept at their practice, and if they are not proficient, they are equipped with the ability to learn what they need [5]. This aligns with the definition of professionalism by Australian Medical Council, which considers having “adequate knowledge of medicine and adequate procedural ability” a necessary, but not sufficient, attribute for a health professional.

2. Professional identity

As individuals enter a profession, they gradually internalize its norms and values and develop an identity based on those values (i.e., professional identity) [6]. The development of professional identity is gradual, beginning with actions driven by the desire to be perceived positively by both the profession and society, and evolving into an identity based on internalized values and beliefs [7]. These values are broadly categorized into “conservation” (conformity, security, and tradition) and “openness to change” (stimulation, self-direction, and hedonism) [8]. Individuals prioritizing the latter values are more flexible and can consciously re-evaluate their own prior values. Therefore, they can more readily adapt their identity, including their professional identity, to changes in social values. Considering this, along with the description of SR [5], we posit that individuals with higher levels of SR prioritize “openness to change” values and essentially are capable of reforming their professional behavior according to the situation. Additionally, education oriented toward professional identity formation has the potential to promote SR [9]. Thus, the relationship between professional identity and SR is reciprocal, where promoting one can foster the development of the other in learners.

3. Social responsibility

Professionalism is, at its essence, a contract between medical professionals and society [10]. As such, professionalism should be contextualized within the cultural framework of each society, considering the specific needs of its members at any given time. This necessitates ongoing dialogue between the “profession” and the “public” to ensure adaptability to evolving social norms [2]. Furthermore, it is important to note the potential differences between the socio-economic and cultural factors graduates faced during their training and those encountered in practice. In this respect, graduates must be adept in adjusting their behaviors and able to acclimate to the dynamic interaction between the “profession” and “society”. Drawing from the definition of SR [5], professionals with high levels of these aptitudes recognize the evolving needs of their society and demonstrate openness to modifying their previously held values and adjusting their professional behavior. This versatility is vital because evolving social norms may redefine what constitutes professional behavior [2].

4. Conclusion

Considering the above perspectives, we posit that levels of SR are closely linked to professionalism. Moreover, to consistently demonstrate professional behavior, individuals need mindset plasticity and adaptability—qualities expected from learners with high levels of SR. In this regard, we suggest that cultivating SR is crucial for developing professionalism in health professionals, particularly during their student years and early after graduation. Therefore, identifying enablers and barriers to SR is essential to enhance these aptitudes and ensure consistent professional behavior.