Osler, Guilds, and Community

In Reply: We are delighted and gratified by Dr. Fins' sentiments. Although the findings of our research may, to some extent, have seemed foreseeable, we admit to being somewhat startled ourselves at the intensity and directions of the emotions expressed by the Osler Fellows. Dr. Fins alluded to a fascinating historical root, The Merchant of Prato, conveying the notion of communal life. To great effect, he also summoned the spirit of Sir William Osler to conjure up a vision of professional life as overlapping with family life. We wish to cite another legendary figure: Abraham Flexner. In an essay in which he defines the term profession, Flexner1 states: “A profession is a brotherhood …. Professional activities are so definite, so absorbing in interest, so rich in duties and responsibilities, that they completely engage their votaries.” These words suggest that the process of professionalization affects individuals at the very core of their beings, values, and beliefs. Although the descriptor “brother” is decidedly anachronistic, the spirit of this metaphor for physicianhood vividly evokes the notion of kinship and community. The Osler Fellows have come to realize their (potentially) critical role in the personal transformations undergone by their student learners. Although it was not an explicit objective of the Physician Apprenticeship course when designed and first implemented, it has become obvious from our ongoing program evaluation that a desired outcome is for the students and teachers, in partnership, to keep the flame of physicianship alive: the physician as a compassionate, caring, and competent healer. In the faculty development workshops in which they are prepared for the tasks and responsibilities that lie ahead, successive cohorts of Osler Fellows have been advised that students might very well be surprised, perplexed, and, at times, even shocked during the medical school experience. In fact, it has been suggested that a subtitle for the Osler Fellows could quite possibly be borrowed from Maimonides'2 magnum opus, The Guide for the Perplexed. The ideal teacher in the apprenticeship has been described as one who will mentor, accompany, and guide students on a voyage of self-discovery, one who will preserve their humanity and a sense of appreciation of the art as well as the science of medicine. We believe that the teachers understood and accepted this responsibility. However, what was unexpected, and what our research has begun to clarify, is the impact that participating in the apprenticeship has had on the teachers themselves. It seems as if they, too, can benefit from a reimmersion in the journey of personal transformation common to the community of all physicians. In reflecting on his experience, one Osler Fellow summarized it thus: “It's [like] a kind of falling in love again with your wife or spouse or significant other, because this program, on a personal level, brought back all of the things that you had initially fallen in love with … what it is to be a physician, exactly.” J. Donald Boudreau, MD Core faculty, Centre for Medical Education, Arnold P. Gold Foundation Associate Professor of Medicine, and associate professor, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; [email protected]. Yvonne Steinert, PhD Associate dean for faculty development, director, Centre for Medical Education, and professor, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. Mary Ellen Macdonald, PhD Core faculty, Centre for Medical Education, Faculty of Medicine, and assistant professor, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.

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