Designing a Curriculum for Professionalism and Ethics Within Radiology

Identifying Challenges and Expectations
Published:March 24, 2018DOI:
      Although professionalism and ethics represent required competencies, they are more challenging than other competencies to design a curriculum for and teach. Reasons include variability in agreed definitions of professionalism within medicine and radiology. This competency is also framed differently whether as roles, duties, actions, skills, behavior, beliefs, and attitudes.
      Standardizing a curriculum in professionalism is difficult because each learner's (medical student/resident) professional experiences and interactions will be unique. Professionalism is intertwined throughout all (sub) specialties and areas and its teaching cannot occur in isolation as a standalone curriculum. In the past, professionalism was not emphasized enough or at all, with global (or no) assessments, with the potential effect of trainees not valuing it.
      Although we can teach it formally in the classroom and informally in small groups, much of professionalism is witnessed and learned as “hidden curricula”. The formal, informal, and hidden curricula often contradict each other creating confusion, disillusion, and cynicism in trainees.
      The corporatization of medicine pressurizes us to increase efficiency (throughput) with less focus on aspects of professionalism that add value, creating a disjoint between what we do in practice and preach to trainees. Progressively, expectations for our curriculum include providing evidence for the impacts of our efforts on patient outcomes.
      Generational differences in the perception of professionalism and the increasingly diverse and multicultural society in which we live affects our interpretation of professionalism, which can add to confusion and misunderstanding.
      The objectives of this article are to outline challenges facing curriculum design in professionalism and to make suggestions to help educators avoid or overcome them.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nasca T.J.
        Professionalism and its implications for governance an accountability of graduate medical education in the United States.
        JAMA. 2015; 313: 1801-1802
        • Stern D.T.
        Measuring Medical Professionalism.
        Oxford University Press., 2006
        • Cruess R.L.
        • Cruess S.R.
        • Steinert Y.
        Teaching Medical Professionalism.
        Cambridge University Press., 2009
        • ABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine
        Medical professionalism in the new millennium: a physician charter.
        Ann Intern Med. 2002; 136: 243-246
        • Swick H.M.
        • Szenas P.
        • Danoff D.
        • et al.
        Teaching professionalism in undergraduate medical education.
        JAMA. 1999; 282: 830-832
        • Mueller P.S.
        Incorporating professionalism into medical education: the Mayo Clinic experience.
        Keio J Med. 2009; 58: 133-143
        • Irby D.M.
        • Hamstra S.J.
        Parting the clouds: three professionalism frameworks in medical education.
        Acad Med. 2016; 91: 1606-1611
        • DuBois J.M.
        • Burkemper J.
        Ethics education in U.S. medical schools: a study of syllabi.
        Acad Med. 2002; 77: 432-437
        • Lehmann L.S.
        • Kasoff W.S.
        • Koch P.
        • et al.
        A survey of medical ethics education at U.S. and Canadian medical schools.
        Acad Med. 2004; 79: 682-689
        • Egan E.A.
        • Parsi K.
        • Ramirez C.
        Comparing ethics education in medicine and law: combining the best of both worlds.
        Ann Health Law. 2004; 13 (table of contents; Winter): 303-325
        • Wald H.S.
        • Anthony D.
        • Hutchinson T.A.
        • et al.
        Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice.
        Acad Med. 2015; 90: 753-760
        • ABR core and certifying exam
        Non-interpretative skills resource guide for the Core, Certifying and Maintenance of Certification Exams 2017 edition.
        (Available at)
        • Sukher J.
        • Mine A.
        • Teunissen P.
        • et al.
        The actual versus idealized self: exploring responses to feedback about implicit bias in health professionals.
        Acad Med. 2017; ([E-pub ahead of print])
        • Kelly A.M.
        • Gruppen L.
        • Mullan P.B.
        Teaching and assessing professionalism in radiology resident education.
        Acad Radiol. 2017; 24: 563-573
      1. Choosing Wisely Campaign. An initiative of the American Board of Internal Medicine.
        (Available at)
        Date accessed: March 16, 2018
      2. Image Wisely. An initiative of the American College of Radiology, the Radiological Society of North America, the American Association of Physicists in Medicine and the American Society of Radiologic Technologists.
        (Available at)
        Date accessed: March 16, 2018
      3. Image Gently. An initiative of the Society of Pediatric Radiology, the American College of Radiology, the American Society of Radiologic Technologists and the American Association of Physicists in Medicine.
        (Available at)
        • The American College of Radiology
        2017-2018 Bylaws. Page 28. Code of Ethics.
        (Available at)
        • Swensen S.J.
        • Johnson C.D.
        Radiologic quality and safety: mapping value into radiology.
        J Am Coll Radiol. 2005; 2: 992-1000
        • The American College of Radiology
        ACR) Appropriateness Criteria.
        (Available at)
        • The American College of Radiology
        ACR) Practice Parameters and Technical Standards.
        (Available at)
        • The American College of Radiology
        Communication Guideline, 2014 Revision.
        (Available at)
        • Hoang J.K.
        • Langer J.E.
        • Middleton W.D.
        • et al.
        Managing incidental thyroid nodules detected on imaging: white paper of the ACR Incidental Thyroid Findings Committee.
        J Am Coll Radiol. 2015; 12: 143-150
        • MacMahon H.
        • Naidich D.P.
        • Goo J.M.
        • et al.
        Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017.
        Radiology. 2017; 284: 228-243
        • Patel M.D.
        • Ascher S.M.
        • Paspulati R.M.
        • et al.
        Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR incidental findings committee II on adnexal findings.
        J Am Coll Radiol. 2013; 10: 675-681
        • Nasca T.J.
        • Philibert I.
        • Brigham T.
        • et al.
        The next GME accreditation system–rationale and benefits.
        N Engl J Med. 2012; 366: 1051-1056
        • Vydareny K.H.
        • Amis Jr, E.S.
        • Becker G.J.
        • et al.
        Diagnostic radiology milestones.
        J Grad Med Educ. 2013; 5: 74-78
        • Cruess R.L.
        • Cruess S.R.
        • Boudreau J.D.
        • et al.
        Reframing medical education to support professional identity formation.
        Acad Med. 2014; 89: 1446-1451
        • Accreditation Council for Graduate Medical Education Website
        Olle ten Cate Presentation.
        (Available at)
        • Deitte L.A.
        • Gordon L.L.
        • Zimmerman R.D.
        • et al.
        Entrustable professional activities: ten things radiologists do.
        Acad Radiol. 2016; 23: 374-381
        • Ten Cate O.
        Nuts and bolts of entrustable professional activities.
        J Grad Med Educ. 2013; 1: 157-158
        • Bolin J.N.
        Strategies for incorporating professional ethics education in graduate medical programs.
        Am J Bioeth. 2006; 6: 35-36
        • Field A.
        Understanding the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees.
        Ultrasound. 2014; 22: 118-122
        • Wilson I.
        • Cowin L.S.
        • Johnson M.
        • et al.
        Professional identity in medical students: pedagogical challenges to medical education.
        Teach Learn Med. 2013; 25: 369-373
        • Holden M.
        • Buck E.
        • Clark M.
        • et al.
        Professional identity formation in medical education: the convergence of multiple domains.
        HEC Forum. 2012; 24: 245-255
        • Cruess R.L.
        • Cruess S.R.
        • Boudreau J.D.
        • et al.
        A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators.
        Acad Med. 2015; 90: 718-725
        • University of Michigan
        Department of Service Excellence.
        (Available at)
        Date accessed: March 16, 2018
        • Adusumilli S.
        Professorship and Award.
        (Available at)
        • Stern D.T.
        Practicing what we preach? An analysis of the curriculum of values in medical education.
        Am J Med. 1998; 104: 569-575
        • Hafferty F.W.
        • Franks R.
        The hidden curriculum, ethics teaching, and the structure of medical education.
        Acad Med. 1994; 69: 861-871
        • Levinson W.
        • Ginsburg S.
        • Hafferty F.
        • et al.
        Understanding Medical Professionalism.
        First ed. Lange, 2014
        • Coulehan J.
        • Williams P.C.
        Vanquishing virtue: the impact of medical education.
        Acad Med. 2001; 76: 598-605
        • Kassebaum D.G.
        • Cutler E.R.
        On the culture of student abuse in medical school.
        Acad Med. 1998; 73: 1149-1158
        • Dunnick N.R.
        • Applegate K.E.
        • Arenson R.L.
        The inappropriate use of imaging studies: a report of the 2004 Intersociety Conference.
        J Am Coll Radiol. 2005; 2: 401-406
        • Schoen C.
        • Collins S.R.
        • Kriss J.L.
        • et al.
        How many are underinsured? Trends among U.S. adults, 2003 and 2007.
        Health Aff (Millwood). 2008; 27: w298-w309
        • United States Census Bureau
        Income, Poverty and Health Insurance Coverage in the United States.
        (Available at)
      4. The Affordable Health Care Act. Enacted by the Democratic Government in March 2010.
        (Available at)
        • Horn S.D.
        • Sharkey P.D.
        • Tracy D.M.
        • et al.
        Intended and unintended consequences of HMO cost-containment strategies: results from the managed care outcomes project.
        Am M Man Care. 1996; 2: 253-264
        • Song Z.
        • Safran D.G.
        • Landon B.E.
        • et al.
        Health care spending and quality in year 1 of the alternative quality contract.
        N Engl J Med. 2011; 365: 909-918
        • Song Z.
        • Rose S.
        • Safran D.G.
        • et al.
        Changes in health care spending and quality 4 years into global payment.
        N Engl J Med. 2014; 371: 1704-1714
      5. Protecting Access to Medicare Act of 2014, Pub. L. No. 113-93 (April 1, 2014).
        (Available at)
        • Kaba R.
        • Sooriakumaran P.
        The evolution of the doctor-patient relationship.
        Int J Surg. 2007; 5: 57-65
        • Yedidia M.J.
        Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.
        J Pain Symptom Manage. 2007; 33: 40-57
        • Laine C.
        • Davidoff F.
        Patient-centered medicine: a professional evolution.
        JAMA. 1996; 275: 152-156
      6. The American Board of Radiology. Maintenance of Certification Guideline.
        (Available at)
      7. The Center for Generational Kinetics.
        (Available at)
        • Lourenco A.P.
        • Cronan J.J.
        Teaching and working with millennial trainees: impact on radiological education and work performance.
        J Am Coll Radiol. 2017; 14: 92-95
        • Ellaway R.H.
        • Coral J.
        • Topps D.
        • et al.
        Exploring digital professionalism.
        Med Teach. 2015; 37: 844-849
        • Gholami-Kordkheili F.
        • Wild V.
        • Strech D.
        The impact of social media on medical professionalism: a systematic qualitative review of challenges and opportunities.
        J Med Internet Res. 2013; 15: e184