EDITORIAL

Bologna and the professional acculturation

Bolonia y la aculturación profesional

Albert Oriol Bosch

Presidente de la Fundación Educación Médica.
E-mail: aoriolb@terra.es

The education needed to nurture a physician requires much more than the acquisition of formal knowledge and clinical skills. It also requires a personal transformation that can be called secondary socialization or acculturation.

Some authors, like Hafferty [1] would very much criticize the 'or' used between secondary socialization and acculturation, adducing that it shows a certain confusion between different concepts. Nevertheless, it is possible to understand that they correspond to the different views of the transformational process that occurs in the education of physicians, as seen from the sociological and anthropological perspectives, two fields of knowledge unfortunately absent in the medical education at home.

The vision of medical education as a personal transformation of the learner may be considered as 'brain washing', and therefore rejected by those whose way of thinking conforms either to a strict reductionism of scientific positivism or to a libertarian moral relativism. But ignoring the personal transformation that occurs along the making of a physician means to also ignore the differences between a lay person, someone that possesses the every day general knowledge on health and diseases, and a professional physician. The evident differences among them are not only restricted to the possession of the specialized knowledge of the medical sciences or the required clinical skills to practice. The difference is also found in the specific ethos of the physicians that evolves in a personal transformation during the learner's long formative period fueled by her desire to become a physician. Although the successful accomplishment of this transformational process by the learner depends on her capacity to conform to the established requirements, it is something inherently depending on the learner's desire to become a physician, and not being imposed by the system, since nobody forces anyone to become one. But if someone wants to be recognized as a physician, she has to fulfill the requirements that have evolved over time in accordance to the implicit agreement of the profession with society.

There seems to be no reason to continue upholding beliefs that justify the carelessness condoned by an educational system as it relates to its consideration of the professional values that support attitudes that are expressed in the expected professional behaviors that conform to the cultural patterns of society.

William M. Sullivan [2] describes metaphorically the acculturation occurring during the educational process not so much as a transformation caused by external pressures, as it would be in the case of a sculptor working with clay, but rather, as a transformation derived from the internal desire and the personal effort, in a way similar to the athlete that develops the body musculature trough energetic exercises.

It is time to ask if the Bologna process will mobilize enough energy and set the proper direction to produce the needed teaching and learning processes changes at our Medical Schools. Will Medical Schools attend to their social responsibility that now demands from them to produce something more that experts in diagnosis, treatment, rehabilitation and prevention of diseases? Will they be able and willing to activate new educational approaches in order to produce professionals of healing, physicians willing to care for the sufferers of diseases, the patients? An answer in the affirmative should not be reduced to words, but rather a hands on institutional response!

References

1. Hafferty FC. In search of the lost cord: professionalism and the medical education's hidden curriculum. In Wear D, Bicker J, eds. Educating for professionalism: creating a culture of humanism in medical education. Iowa: University of Iowa Press; 2000. p. 11-34.        [ Links ]

2. Sullivan WM. Teaching medical professionalism. In Cruess RL, Cruess SR, Steinert Y, eds. Teaching medical professionalism. New York: Cambridge University Press; 2009. p. IX-XVI.        [ Links ]