Volume 8, Issue 10 - November 2025

Dear Nicole,

Our November issue takes up the idea of flourishing as it relates to healthcare professionalism. There are vast literatures, especially with the discipline of philosophy, on the notion of flourishing, but its practical application in health professionalism spaces is not as prevalent. In our lead article, “Flourishing and Professionalism: Growing Who We Are, Not Just What We Do” Asia Ataide and Alice Fornari do exactly that. Applying the rich notion of flourishing to the practices of professionalism, ultimately arriving at four pillars and, in the process, offering an explanation and way to address health professions burnout. In our second article, “Professional Coaching: A Resource for Professional Growth and Well-being,” Halle Ellison and Susan Parisi describe the practice of coaching. Coaching is a topic that has received increasing attention in professionalism spaces and Ellison and Parisi carefully describe the phenomenon, connecting it to key features of healthcare professionalism. In the final article of this issue, Frederic Hafferty discusses The Rewrites, the fourth part of his Swick Exercise work, and the fifth such installment in our publication. This series has garnered a good deal of attention, both for its professionalism implications and – I suspect – reader interest in a continued conversation: something like The Academy’s version of longform or an extended essay.

The issue concludes with the usual announcements from members, reminders about roundtables, and other APHC and healthcare professionalism-related news. If the topics discussed in the issue are of interest, please consider writing a letter to the editor or submitting an article to jump start discussion on a healthcare professionalism topic that we have not spent sufficient time on or one which is simply close to your interests. Though we cannot accept all submissions, what we receive – regardless of publication – helps to shape our understanding of the field and the future topics showcased in The Academy.

Bryan Pilkington, PhD, is Professor of Bioethics, in the Department of Medical Sciences, at Hackensack Meridian School of Medicine, and the Editor-in-Chief of The Academy: A Forum for Conversations about Health Care Professionalism.

1. Last Week to Register: APHC Virtual Conference - Professionalism in a Time of Change | Nov. 12-13

2. Flourishing and Professionalism: Growing Who We Are, Not Just What We Do

3. Professional Coaching: A Resource for Professional Growth and Well-being

4. The Swick Exercise: Part 4: The Rewrites

5. Healthcare Professionalism: Education, Research & Resources Podcast

6. APHC Member Announcements

7. APHC Member Benefits

Professionalism in a Time of Change

“The only constant in life is change.” – Heraclitus, c. 500 BC

Change can inspire—or intimidate. In healthcare, where professionalism is grounded in core values and evolving expectations, our ability to anticipate, manage, and adapt to change is essential. New challenges can spark innovation and growth—or, without support, lead to burnout and decline.

Join us for the Academy for Professionalism in Healthcare’s International Virtual Conference, where we’ll explore what professionalism in a time of change truly means—across individual, team, institutional, national, and global levels.

📅 When: Wednesday, November 12 & Thursday, November 13, 2025
🕗 Time: 8:00 AM – 1:00 PM ET (both days)
💻 Where: Zoom

What You’ll Experience

• 40+ highly interactive sessions, including:
  • Hands-on workshops
  • Problem-solving sessions
  • Panel discussions & Roundtables
  • Games, Orals, and Flash presentations
  • A keynote on Professionalism and Change Management: Theory and Practice
  • A symposium on Expected and Unexpected Change Agents

💡 Can’t join live? All sessions will be recorded and available on demand.

🤝 Connect and collaborate with healthcare professionals and trainees from around the world in a dynamic, inclusive environment.

Don’t miss this opportunity to gain insight, share ideas, and reimagine professionalism for a rapidly changing healthcare landscape.

👉 [Click here to register now]

📅 [View the full conference schedule]

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Professionalism is at the heart of healthcare. It shapes how we show up for our patients, our teams, and for ourselves. But sometimes, if we are honest, professionalism can start to feel like a checklist — a set of expectations we are trying to meet rather than something we truly live. Most of us have had moments when we are just trying to keep up, doing what is expected, staying composed, while slowly losing sight of why we started in the first place. Flourishing helps us find our way back to that “why.”

Flourishing invites us to redefine professionalism from the inside out. While our understanding of professionalism has often focused on virtue, behavior, and identity, Flourishing provides a powerful framework that seamlessly integrates these perspectives. Its four guiding pillars—character, caring, practical wisdom, and purpose—effectively embody the moral center (virtue), guide daily enactment (behavior), and shape the lived identity essential for every healthcare professional. These pillars also deepen and animate the core values we already champion: integrity, accountability, respect, and excellence. By cultivating these intrinsic qualities, professionalism transcends mere standards, becoming a deeply personal reflection of who we are and what truly matters. This shift means it is no longer about simply performing professionalism; it is about authentically embodying it.

Character keeps us grounded in our values, even when taking shortcuts might be easier. It is our continuous self-examination that changes our lens. Caring helps us to spend time to extend compassion to others and recognize skills that we have that can be brought to our relationships with others. Practical wisdom reminds us to self-reflect on our own lived experiences and learn from them as context varies. To deeply listen to one another and to gain wisdom from past experiences that we engage with personally and professionally. Purpose and mattering ties it all together, it reminds us of the why in our work and what called to us in the first place, and what keeps us coming back.

Expectations keep rising for health professionals, not only in what we know, but in how we show up. It is no longer about technical skill; it is about bringing both knowledge and kindness to the work. Flourishing happens in that balance—where what we do well meets how deeply we care.

We see the connection between flourishing and professionalism in the small, everyday moments — the ones that rarely make it into reports or meetings. The environmental service worker who gets the patient a cup of water, a nurse who sits down with an anxious patient that is about to have surgery or the colleague who takes a quiet breath before responding when tension runs high. It's these small moments that show us what professionalism really looks like, not perfect or performative, but deeply human.

As we grow, our professional identities evolve and are shaped within these communities of practice and learning environments that foster belonging, reflection, and mentorship.

Maybe it was a mentor who gave us a little faith when we did not have it ourselves. A piece of feedback that stayed with us longer than we thought it would. Or a moment when we realized we handled something with more patience and compassion than we might have before. Those moments change us. They remind us that becoming a professional is not about getting everything right — it is about becoming more grounded, more aware, and more whole.

Let's face it, things get tough in healthcare. And when they do, flourishing helps us stay steady. Healthcare moves fast, and the expectations often feel endless. It is easy to feel overwhelmed, to lose our way a bit, and to get caught up in external expectations when it comes to professionalism. Flourishing reminds us that professionalism is not about being perfect; it is about finding that crucial balance. This, in turn, truly strengthens the bond of trust between healthcare and society. When we naturally nurture character, caring, practical wisdom, and purpose, into our lives we are staying true to medicine's foundation, which is to provide care with integrity, competence, and compassion. These are the qualities that truly earn and keep societies trust. That positive energy that ripples outward, shaping how we listen, how we collaborate, and how we lead, helps us build those vibrant communities of practice where we feel a real sense of belonging, where our work feels deeply meaningful, and where integrity shines bright. At its core, flourishing does not just make us better professionals; it quite literally transforms our entire culture, creating genuinely better cultures of care for everyone.

Flourishing helps us cultivate this kind of professional. It imbues meaning into our journey—the long days, the mistakes, and the unexpected lessons. True growth is not a single leap; it unfolds gradually, in subtle ways—when we listen a little longer, speak a little softer, and find understanding where frustration once lived.

Asia Ataide, MHA, serves as Project Manager in the Office of Academic Affairs at Northwell Health, where she leads initiatives through the Kern National Network for Flourishing in Health. Her work focuses on fostering character, caring, practical wisdom, and purpose across diverse professional and community groups. With a background in healthcare administration and sociology, she brings an interdisciplinary lens to advancing flourishing, professional identity formation, and human-centered leadership.

Alice Fornari, EdD, RDN, FAMEE, HEC-C, ACC/ICF, is Professor and Associate Dean of Educational Skills Development and Vice President of Faculty Development, Northwell Health Organization, Barbara & Donald Zucker School of Medicine (SOM) at Hofstra/Northwell. She has additional certifications in clinical bioethics and coaching.

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Coaching is gaining momentum in healthcare as a powerful tool for clinician development and well-being. While it has long been a resource used in other industries, professional coaching is relatively new to medicine and healthcare. This article introduces professional coaching, clarifies coaching from other forms of support, presents supporting evidence, and offers ways for healthcare organizations to support coaching initiatives.

What is Professional Coaching?

The term coaching is often used loosely, leading to confusion about what it is and isn’t. Professional coaching is a structured, formalized practice, defined by the International Coach Federation (ICF) as “partnering with clients in a thought-provoking and creative process that inspires them to be their best personal and professional selves.”¹ Professional coaching requires formal training to meet established competencies, adherence to ethical standards and confidentiality, clear boundaries for scope, and guidelines for circumstances out of scope.² 

Coaching is a voluntary developmental process that works best when people are open to reflection, growth, and self-discovery. A fundamental tenet of coaching is that individuals are whole, resourceful, and capable. Through a relationship built on trust and active listening, coaches partner with clients to challenge assumptions, support goal achievement, and help overcome barriers. In a coaching relationship, the client is the expert and the coach is a guide, helping individuals find their own solutions and move forward with clarity and purpose.

What Coaching Is Not

Coaching is distinct from other forms of support or remediation often used in healthcare. Coaching differs from remediation, mentorship, sponsorship, therapy, and peer support. Coaching focuses on future growth, offering nonjudgmental support, enabling clients to identify and develop their own path forward. Remediation, on the other hand, is usually a reactive response to performance concerns. Generally, remediation involves addressing deficiencies or performance concerns and includes a process to help clinicians improve their knowledge and skills to meet certain standards. Mentoring in healthcare usually involves a more experienced person guiding someone less experienced, sharing advice based on their knowledge and personal and professional experiences. Unlike coaching, where the coach and client are equal partners, mentoring relationships tend to be hierarchical.

Professional coaching can be offered in a peer-to-peer format, yet it is distinct from peer support. Peer support in healthcare involves individuals of similar backgrounds supporting one another, often after adverse events. Clinician coaching, however, is future-oriented and not solely based on shared experiences. It is not a substitute for therapy, and coaches must be trained to recognize when a client’s needs fall outside the scope of coaching and are better met by referral to mental health professionals. Coaching is also not a punitive measure and should not be mandated as a component of disciplinary action.

Coaching and Professionalism

In healthcare, burnout can be misinterpreted as unprofessional behavior. When clinicians show signs of emotional exhaustion or disengagement, their actions can be labeled as unprofessional, leading to punitive action. However, burnout is not a failure of professionalism. Coaching offers a non-punitive alternative to support clinicians experiencing burnout.

What Are the Benefits of Clinician Coaching?

A growing body of evidence supports clinician coaching as a powerful tool to enhance well-being, reduce burnout, and improve professional fulfillment.3–6 In a recent randomized clinical trial, physicians who received three months of coaching from professionally trained peers experienced a 30% reduction in interpersonal disengagement, a 21.6% decrease in overall burnout, and a 10.7% increase in professional fulfillment compared to controls.6 A 2023 systematic review found that coaching consistently improved at least one wellness-related outcome, including reduced distress and burnout.7 Another study showed that small group coaching led to a nearly 30% reduction in burnout, suggesting it may be a scalable and cost-effective solution for healthcare organizations.³

Beyond individual benefits, coaching has been linked to improved communication, clinical decision-making, and team collaboration, all of which contribute to enhancing culture in the work environment and better patient outcomes. Therefore, coaching has the potential to support clinicians and enhance the quality of care delivered across healthcare systems.

Despite growing evidence supporting coaching, it is not a panacea. Coaching alone does not address the systemic organizational or workplace factors that contribute to burnout or professional dissatisfaction.

How Can Healthcare Organizations Support Coaching?

Coaching programs require time, resources, and organizational commitment to be successful and sustainable. Leadership support is essential. To experience the benefits of coaching, healthcare organizations should actively support and invest in it. This can include offering accredited training programs for internal peer coaches and/or establishing formal coaching programs. With thoughtful design, organizational coaching programs can simultaneously support individuals while also identifying systems issues that require organizational action. Organizations should also consider the return on investment of professional coaching in line with institutional priorities. While financial metrics are important, we recommend a holistic view that includes factors such as fulfillment, engagement, retention, and communication.

Bibliography

1. International Coaching Federation. Guide to Experience Coaching: Working with a Coach. https://coachingfederation.org/guide-to-experiencing-coaching-for-individuals/. Accessed October 18, 2025.
2. International Coaching Federation. https://coachingfederation.org/. Accessed October 18, 2025.
3. Khalili J, Miotto K, Wang T, et al. Professional Coaching to Reduce Physician Burnout: A Randomized Clinical Trial. J Gen Intern Med. Published online 2025. doi:10.1007/s11606-025-09653-w
4. Dyrbye LN, Shanafelt TD, Gill PR, Satele D V., West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1406-1414. doi:10.1001/jamainternmed.2019.2425
5. McGonagle AK, Schwab L, Yahanda N, et al. Coaching for primary care physician well-being: A randomized trial and follow-up analysis. J Occup Health Psychol. 2020;25(5):297-314. doi:10.1037/ocp0000180
6. Kiser SB, Sterns JD, Lai PY, Horick NK, Palamara K. Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(4):E245645. doi:10.1001/jamanetworkopen.2024.5645
7. Boet S, Etherington C, Dion PM, et al. Impact of coaching on physician wellness: A systematic review. PLoS One. 2023;18(2 February). doi:10.1371/journal.pone.0281406

Dr. Halle Ellison is a board-certified general surgeon and hospice and palliative medicine physician. She serves as the Director of Physician and Advanced Practice Provider Well-being at Geisinger and is an Associate Professor of Medical Education at Geisinger College of Health Sciences. Dr. Ellison earned her MD from Ross University and holds a Master of Applied Science in Patient Safety and Healthcare Quality from the Johns Hopkins Bloomberg School of Public Health.

Dr. Parisi joined Geisinger as the Chief Wellness Officer in July of 2022. She brings three decades of experience in healthcare, spending the earlier part of her career caring for patients in obstetrics and gynecology. She’s held leadership roles in several organizations, most recently serving as the director of well-being for Nuvance Healthcare, where she worked to implement a strategic and collaborative well-being program that accommodates seven hospitals, a multispecialty group and 2,500 physicians across New York and Connecticut.

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Background

In our previous two postings (Ranking Data Results: Wave 1 & 2) we briefly reviewed the two-part structure of the Swick Exercise (rankings followed by rewrites), along with data findings across two (2004, 2009) different medical schools/student cohorts. In Part 3A, we focused on three professionalism “high fliers” (ethical and moral standards, humanistic values; commitment to excellence). We also highlighted Swick’s altruism item (“Physicians must subordinate their own interests to the interests of others”) with its “fall from grace” from its marquee position in Swick’s list of professionalism behaviors to a consistent last place (13th) in student rankings. In addition, we noted that this “fall” is a consistent finding across the 20+ years of using this discussion tool with multiple medical student, nursing, and physician-clinician groups.  In Part 3B, we focused on other item rankings including a tension between two different ethic statements: (1) Swick’s “Physicians must adhere to high ethical moral standard,” and (2) one added by Ed Hundert (“Physicians must place professional ethics ahead of one’s own personal beliefs”). While the latter garnered consistently high rankings, Hundert’s item proved to be more contested.

In Part 2 of the Swick Exercise, students were instructed to take one of the statements they had trouble accepting and “reword/edit/rewrite it so that they would feel comfortable committing to it as a core professional principle” [italics in original]. Perhaps unsurprisingly, Swick’s altruism item is the most chosen rewrite – sometimes garnering half to three-quarters of all rewrites in a given exercise. While all item rewrites provide a revelatory window into how students view, or at least prefer to view, professionalism, we will focus here on only two of the exercise’s 13 items: (1) the rewrite-compelling phrasing of Swick’s altruism item, and (2) a behavior that thus far has escaped mention in our earlier (Part 3A and 3B) analyses - Swick’s “Physicians must hold colleagues to professional standards, and report those who fail to uphold those standards.”  Core to medicine’s social contract with society is a promise that medicine will regulate itself on behalf of the public.¹ Swick’s item touches upon this promise, but in a particularly entangled way (given its two verbs, “hold” and “report” coupled with the coordinating conjunction “and”). While Swick’s call to self-regulate never appears at the top or the bottom of any ranking list, it consistently does rank near the bottom of the middle third. In short, our two (2004, 2009) cohorts of students found it an enticing target for a rewrite.

Below are examples of how students revamped these two behaviors to make them something they felt they could now commit to.

1. Physicians must subordinate their own interests to the interests of others.

A common first order strategy was to ax the verb “subordinate” in favor of less sycophantic words like “consider,” “put,” “balance,” or “should think of placing.”

“Physicians should consider others [sic] best interest while maintaining their own.”

Students also deployed a variety of other attenuations by inserting the adjective “personal” (as in “one’s own personal interests”), by substituting “patients” for the more general “other,” or to flip Swick’s own-other ordering by placing others/patients first.

“Physicians must put the interests of their patients before their own personal interests.”

“Physicians should balance their own interests with those of their patients.”

Another strategy was to substitute “needs” for “interests.”

“Physicians must subordinate their own interests to the needs of their patients” [italics by student]

Or to specify that the call applied only to clinical or work settings.

“Physicians must place patient needs above their own wants in a clinical setting.”

Or to do so only “when necessary.”

“When necessary, the physician must put their own interests below the interests of others.”

Other modifications included calls to “consider” doing so, to “respect” or to “take into account” patient interests/needs, as a way of strategically softening the obligatory word “must.”

“Physicians should consider their own interests and the interest of others and find a balance.”

In short, while students were willing to embrace altruism as a core professionalism principle, they preferred a softer, kinder, equivocal, or at least less demanding version.

2. Physicians must hold themselves and colleagues to professional standards and report those who fail to uphold those standards.

Although replacing the obligatory “must” with alternative phrasal verb constructions was common…

“Physicians need to hold colleagues to professional standards.”

…a related strategy was to retain the first (standards) half of Swick’s call while altogether axing the second half mandate to report those “who fail” – which also included dropping any and all reference to others.

“Physicians must hold colleagues to professional standards.”

“Physicians must hold colleagues to professional standards and start with their own professional standards.”

“Keep your personal beliefs to you and follow professional standards with your patients.”

If the back side of Swick’s statement was retained, students might replace “report” with calls to “be supportive,” to “create an awareness,” to remediate, or to “speak up” rather than use the legalistic or imperative sounding “report” – and do so even when using the imperative “must.”

“Physicians should foster colleagues and themselves to professional standards and provide support for colleagues to uphold those standards.”

“Physicians must hold colleagues to professional standards and help those who fail to uphold these standards.”

“Physicians must support colleagues to uphold professional standards and create awareness of failures to do so.”

“Physicians must engage in dialogue with colleagues on how to advance professional standards.”

“Physicians must compare themselves to others in terms of professional standards and share their standards with others.”

“Health care professionals must continuously remind fellow colleagues to keep to professional and ethical standards when lapses occur and report gross offenses.”

“Physicians must model, counsel and commit to actively upholding professional standards.”

“Physicians must support colleagues to uphold professional standards and create awareness of failures to do so.”

Overall, while a number of students did infuse Swick’s self-regulation item with a variety of “softening” strategies, similar to what they did with altruism, they also seemed to highlight a more collegial and remedial turn, perhaps driven by the statement’s more officious or aggressive verbs “report” and “fail.”

Comments

Asking students to rewrite one of the exercise’s 13 professionalism behaviors not only provided them with an opportunity to reimagine professionalism “from their own perspective,” but offers us insights into potential differences between what might be considered a more classic or traditional view of professionalism (Swick) versus what might be seen as a more student/learner, generational, or even contemporary centric view.  Across both accordance and difference, students were more than willing – and able - to reconceptualize professionalism cannon. 

In closing, there are important caveats about the exercise itself. First, Swick’s published list of behaviors did not include the modal verb “must.”  This was our decision, given Swick’s framing of these behaviors as normative. Second, while both of the student-cohorts covered in this report are first years, their views are quite similar to those of more advanced students, including practitioners, who have completed this exercise.  This cadence leads us to wonder whether otherwise reported faculty-student professionalism differences^4-5 are not so much the product of neophyte-outsiders versus grizzled-insiders as they are a tension between a more nostalgic^2-3 or codified view of professionalism versus one situated more in the demands and cultural pragmatics of work (be that student or clinician-based).  Third, and perhaps most important, asking students what they think, and doing so in an open and potentially countervailing way, allows us, as educators, to learn where we might, presumptively, have gotten professionalism “wrong,” or better yet, where we need to “get things right” as we look at the futures of both professionalism and medicine.

REFERENCES

1. Cruess, RL, and SR Cruess. 2020. Professionalism, Communities of Practice, and Medicine’s Social Contract. J Am Board Fam Med 33 (Suppl): S50-56.
2. Hafferty, FW, and D Levinson. 2008. Moving Beyond Nostalgia and Motives: Towards a Complexity Science View of Medical Professionalism. Perspect Biol Med 51 (4): 599-615.
3. Hafferty, Frederic W., and Brian Castellani. 2010. The Increasing Complexities of Professionalism. Acad Med 85 (2): 288-301.
4. Tabatabaei, Z.S., Mirzazadeh, A., Amini, H. et al. 2022.  What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students. BMC Med Educ 22, 866. https://doi.org/10.1186/s12909-022-03874-x
5. Sattar K, Roff S, Meo SA. 2016. Your professionalism is not my professionalism: congruence and variance in the views of medical students and faculty about professionalism. BMC Med Educ;16(1):1–7

Frederic W. Hafferty, PhD is a medical sociologist and Senior Fellow, Accreditation Council for Graduate Medical Education.

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Professional Formation and APHC collaborate on a podcast, Healthcare Professionalism: Education, Research & Resources.

Over 125 podcast episodes have been released with over 17,000 downloads.

Released every other Saturday morning, recent episodes include Rachel Pittmann discussing Telehealth Etiquette and Amal Khidir talking about Designing the Faculty Development Professionalism Program with Multi-cultural Perspectives.

You can access the podcast episodes on your favorite platform or at: https://bit.ly/PF-APHC-Podcast

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For those interested in questions of health professionalism associate with conscience considerations, check out Bryan Pilkington's new book: The Medical Act: Conscientious Practice in a World of Dissention and Disagreement, which comes out later this month.

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Our annual membership fees are very inexpensive and are valid for one year from the payment date. Select from seven types of membership, including the institutional membership for four people. See the descriptions.

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Editor-in-Chief: Bryan Pilkington | Managing Editor: Yvonne Kriss

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