Re-defining professionalism in medicine in an era of rapid change: a modified Delphi study

Introduction: Medical professionalism has traditionally been defined by core standards for practitioners, yet consensus on its defining elements remains limited. Shifts in society, medical practice, and trainee perspectives have influenced how professionalism is understood and applied. This study aimed to establish a contemporary, consensus-based framework for medical educators and learners. Methods: Using a modified Delphi approach, 39 medical education experts from eight U.S. medical schools participated in three survey rounds and one in-person session. Participants rated 51 behaviorally-based items categorized under four domains: commitments to patients, colleagues, institutions/society, and self. Items were rated "essential," "important but not essential," or "not important," with consensus defined as 70% agreement. Results: Consensus was reached on 24 "essential" elements emphasizing patient-centered care, ethical practice, equitable care, communication, and cultural humility. Participants highlighted the importance of a shared framework while recognizing the risks of bias and the need for contextual sensitivity. Items related to physician self-sacrifice, attire, and social justice failed to reach consensus, reflecting concerns about burnout, subjectivity, and scope. Emphasis was placed on fostering professionalism through dialog, reflection, and context-aware evaluation. Conclusion: The resulting framework captures evolving perspectives on professionalism, offering educators practical, adaptable guidance for teaching, reflection, and assessment across diverse educational settings.