Professionalism in Healthcare

Original Editor - Wanda van Niekerk based on the course by Benita Olivier

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction[edit | edit source]

Professionalism is an important but complex concept in healthcare. A multitude of studies on the definition of professionalism in healthcare highlight this complexity. It is clear, though, that without professionalism, the quality of healthcare, patient and illness outcomes, patient safety and trust between healthcare professionals are negatively affected.[1]

Definitions of Professionalism in Healthcare[edit | edit source]

Literature and Dictionary Definitions[edit | edit source]

Some definitions of professionalism are listed in Table 1.

Table 1. Definitions of professionalism found in the literature
Source Definition
Merriam Webster Dictionary "the conduct, aims or qualities that characterise or mark a profession or a professional person"[2]
Cambridge Dictionary "the combination of all the qualities that are connected with trained and skilled people"[3]
Desai and Kapadia[4] "the attributes, behaviours, responsibilities, principles and objectives that characterise a profession or professional person. It implies the quality of service.”
Epstein and Hundert[5] "Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotion, values and reflections in daily practice for the benefit of the individual and community"

Defining Professionalism Difficulties[edit | edit source]

Bossers et al.[6] described professionalism according to "encompassed parameters, behaviours and responsibilities." Conceptualised themes in their definition were "what we know, how we behave and ways in which we are accountable."[6]

  • Professional parameters[6]
    • legal issues
    • ethics
    • morality
  • Professional behaviour[6]
    • skills
    • relationships
    • presentation
  • Professional responsibilities[6]
    • to the profession
    • to self
    • to the community
    • to the employer
    • to the client

Professionalism versus Professional Behaviour

Mason and Mathieson[7] distinguish between professionalism and professional behaviour as follows:

"Professionalism is more intangible and subjective[8], affected by a context-specific nature and generational interpretation of values[9], while professional behaviours are observable and more concrete."[7]

Healthcare Professional Regulatory Bodies and Professionalism Definitions[edit | edit source]

We recommend that you consult with your country’s professional body on their definition and guidelines on professionalism. The professional bodies below are used as examples.

Professionalism in healthcare requires a combination of abilities, knowledge and skill to provide services to patients. This is required for good treatment results while still focusing on patient safety.[11]


Attributes and Behaviours of Professionalism[edit | edit source]

Attributes, core competencies and behaviours of professionalism include[4][13]:

  • accountability
  • dependability
  • responsibility
  • appreciation of duty
  • selflessness
  • commitment to excellence
  • empathy
  • truth
  • honesty
  • rectitude and integrity
  • sensitivity to the needs of diverse populations
  • adherence to ethical principles
  • respect
  • altruism
  • collegiality
  • continuous learning and improvement
  • humility
    • healthcare professionals acknowledge that humility is key to high-quality, interdisciplinary team-based, patient-centred care[14] and professional humility can be a powerful force within healthcare when seen as a trait of strength and collectivity among colleagues.[15]

"Professionalism emphasises humanistic aspects (attitude, behaviour, virtues and characteristics) desirable among healthcare professionals in all circumstances in addition to biomedical aspects (knowledge, clinical reasoning and technical skill)."[4]

Prerequisite qualities for professionalism include[4]:

  • professional competence
  • good communication skills
  • being trustworthy
  • soft skills
  • ethical codes

There seems to be an overlap between ethics and professionalism. Table 2 shows some of the overlapping principles and attributes of ethics and professionalism.

Table 2. Comparison between ethical principles and attributes of professionalism (adapted from Desai and Kapadia[4])
Ethical Principles Professionalism Attributes

Respect the patient; Rights of the patient to choose or refuse treatment; Patient involved in decision-making

Respect, compassion, empathy

Decision should be made in the best interest of the patient

Altruism, commitment to excellence

First do no harm

Care, sensitivity , responsiveness

Fair selection and distribution of resources

Integrity, truth, honesty, accountability

Unprofessional Behaviour[edit | edit source]

Unfortunately, in the clinical workplace, many healthcare professionals experience and perceive unprofessional behaviour. A study investigating the type and frequency of perceived unprofessional behaviours among healthcare professionals found that 63% of workers experience unprofessional behaviour at least once a month. This unprofessional behaviour includes behaviour such as professionals not responding to calls / requests, being excluded from decision-making and blaming behaviour.[16] Examples of unprofessional behaviours include[17]:

  • Bullying
    • defined according to direction
      • lateral violence – professional against professional
      • vertical violence – bullying from the top
        • employers against employees
          • unfair work practices
          • abuse of power
      • vertical violence - bullying from the bottom up
        • employers against employees
          • strikes / work slowdowns
          • refusal to follow procedures
  • Mobbing
    • group “ganging up” on an individual with the goal of removing the individual from the group or intimidating the individual
    • methods used include sabotage, slander, petitions, votes of no confidence
  • Toxic workplaces behaviours
    • eye rolling
    • sarcasm
    • threats
    • aggression
    • withholding important patient information
    • disrespect
    • being rude
    • condescending remarks
    • scapegoating

Drivers of Unprofessional Behaviour[edit | edit source]

Bhardwaj[13] identifies some drivers of unprofessional behaviour. These are listed below:

  • high or extra workload due to limited staff or resources
  • chronic fatigue
  • sleep deprivation
  • burnout
  • low self-esteem
  • personal stressors, such as difficult relationships
  • unsupportive leadership
  • inadequate supervision
  • poor organisational culture and work environment
  • tolerance of unprofessional behaviour
  • bigotry
  • unconscious bias
  • tolerance for aggression
  • ill recognition for performance
  • lack of opportunity for professional growth and development
  • lack of social support systems
  • limited or constricted resources
  • loss of autonomy and decision-making capabilities
  • toxic and substance abuse

Patient Perspectives on the Professionalism of Healthcare Professionals[edit | edit source]

Regis et al.[18] have highlighted some aspects of professionalism that are highly regarded and valued by patients. These include[18]:

  • good communication
  • caring attitude
  • honesty
  • attitude

Research into patient perspectives on professionalism in healthcare providers has identified four interconnected themes that describe professionalism from a patient perspective.[19]

  1. Taking a collaborative human-first approach.[19] Key aspects of this theme are that patients should be perceived as complex humans who deserve to be treated as a priority and a vital part of the interdisciplinary team. One patient summarises it as follows: “It’s important for people, even if they’ve been in practice a long time, to maintain some sense of humility in the face of their patient. They don’t know what it is to be the patient and to live with whatever that is that their patient has. Clinicians must view patients as humans above all so that they maintain a collaborative person-first approach to care.”[19] You can read more about person-centred care here.
  2. Communicating with heart and mind.[19] A clinician should communicate with their heart, by demonstrating emotion and empathy, and with their head, through clinical reasoning and applying their clinical knowledge. Aspects of communication that are important to patients are listening, attentiveness and using implicit communication skills, such as using understandable language. Clinicians should be polite and respectful and build on their ability to develop a rapport with a patient. “Effective communication must balance pertinent information, explicit skills (listening, building rapport, caring, etc.), and implicit skills (come from the heart, empathy)."[19]
  3. Behaving with integrity.[19] Patients expect clinicians to tell the truth. Clinicians should maintain professional boundaries, adhere to ethical standards and maintain confidentiality. Patients ask clinicians to be honest even if clinicians need to admit that they are uncertain or don’t have the answers (as long as they are willing to take action around their limitation in knowledge to allow for optimal care of the patient).
  4. Practising competently.[19] Patients assume that their healthcare professionals are competent. This competence encompasses skill and knowledge, appropriate education and the correct licensing to practise their profession.

Professionalism Frameworks[edit | edit source]

Medical Professional Framework[edit | edit source]

The medical professional framework includes eight identified components of professionalism in healthcare professionals:[20]

  • humanism
  • communication
  • accountability
  • ethics
  • clinical competence
  • altruism
  • excellence
  • integrity

The CanMEDS Framework[edit | edit source]

The CanMEDS framework describes the abilities healthcare professionals need. The seven roles are:

  • professional
  • communicator
  • scholar
  • collaborator
  • health advocate
  • leader

You can read more about the CanMEDS framework here.


References[edit | edit source]

  1. Chan LY, Ganapathy S. Exploring the understanding of healthcare professionalism and perceived barriers and enablers towards the display of professionalism: a qualitative study. MedEdPublish. 2024 Mar 20;14:15.
  2. Merriam Webster Dictionary. Professionalism. Available from (last accessed 30/3/2024)
  3. Cambridge Dictionary. Professionalism. Available from (last accessed 30/03/2024)
  4. 4.0 4.1 4.2 4.3 4.4 Desai MK, Kapadia JD. Medical professionalism and ethics. Journal of Pharmacology and Pharmacotherapeutics. 2022 Jun;13(2):113-8.
  5. Epstein RM, Hundert EM. Defining and assessing professional competence. Jama. 2002 Jan 9;287(2):226-35.
  6. 6.0 6.1 6.2 6.3 6.4 Bossers A, Kernaghan J, Hodgins L, Merla L, O'Connor C, Van Kessel M. Defining and developing professionalism. Canadian journal of occupational therapy. 1999 Jun;66(3):116-21.
  7. 7.0 7.1 Mason VC, Mathieson K. Occupational therapy employers’ perceptions of professionalism. The Open Journal of Occupational Therapy. 2018;6(1):9.
  8. Robinson AJ, Tanchuk CJ, Sullivan TM. Professionalism and occupational therapy: An exploration of faculty and students’ perspectives. Canadian Journal of Occupational Therapy. 2012 Dec;79(5):275-84. in Mason VC, Mathieson K. Occupational therapy employers’ perceptions of professionalism. The Open Journal of Occupational Therapy. 2018;6(1):9.
  9. Gleeson PB. Understanding generational competence related to professionalism: Misunderstandings that lead to a perception of unprofessional behavior. Journal of Physical Therapy Education. 2007 Dec 1;21(3):23-8. in Mason VC, Mathieson K. Occupational therapy employers’ perceptions of professionalism. The Open Journal of Occupational Therapy. 2018;6(1):9.
  10. Hill Jr WT. White Paper on Pharmacy Student Professionalism: What we as pharmacists believe our profession to be determines what it is. Journal of the American Pharmaceutical Association (1996). 2000 Jan 1;40(1):96-102.
  11. Ploylearmsang C. Health professionalism and health profession education in the 21 st century: an example of pharmacy education. MedEdPublish. 2022 Jul 25;11(3):3.
  12. Advanced eClinical Training (ACT). Professionalism in a Healthcare Setting. Available from: [last accessed 30/03/2024]
  13. 13.0 13.1 Bhardwaj A. Medical professionalism in the provision of clinical care in healthcare organizations. Journal of Healthcare Leadership. 2022 Jan 1:183-9.
  14. Michalec B, Cuddy MM, Felix K, Gur-Arie R, Tilburt JC, Hafferty FW. Positioning humility within healthcare delivery-From doctors’ and nurses’ perspectives. Human Factors in Healthcare. 2024 Jun 1;5:100061.
  15. Michalec B, Xyrichis A, Arenson C. “Professional humility”: introducing a new framework to advance interprofessionalism. Journal of Interprofessional Care. 2024 Mar 21:1-6.
  16. Dabekaussen KF, Scheepers RA, Heineman E, Haber AL, Lombarts KM, Jaarsma DA, Shapiro J. Health care professionals’ perceptions of unprofessional behaviour in the clinical workplace. PLoS One. 2023 Jan 19;18(1):e0280444.
  17. MacLean L, Coombs C, Breda K. Unprofessional workplace conduct... defining and defusing it. Nursing Management. 2016 Sep 1;47(9):30-4.
  18. 18.0 18.1 Regis T, Steiner MJ, Ford CA, Byerley JS. Professionalism expectations seen through the eyes of resident physicians and patient families. Pediatrics. 2011 Feb 1;127(2):317-24.
  19. 19.0 19.1 19.2 19.3 19.4 19.5 19.6 Bulk LY, Drynan D, Murphy S, Gerber P, Bezati R, Trivett S, Jarus T. Patient perspectives: four pillars of professionalism. Patient Experience Journal. 2019;6(3):74-81
  20. Ho MJ, Yu KH, Hirsh D, Huang TS, Yang PC. Does one size fit all? Building a framework for medical professionalism. Academic Medicine. 2011 Nov 1;86(11):1407-14.
  21. Premed Doctor. Lesson 5: What are CanMEDS Roles? Available from: [last accessed 30/03/2024]