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The Concepts of Professionalism and Dual Professionalism in Education and Training

Last Updated on 02/09/2023 by James Barron

Table of Contents

This document delves into the concept of professionalism, highlighting the attributes and qualities that typify individuals trained in professional roles. Drawing from various sources, it outlines recognises professions and investigates different models for defining a profession, particularly Millerson’s “Model of Professionalism” and Hoyle’s “Model on Professionality”. Special emphasis is given to the dual roles of educators, emphasising their need to be proficient both in teaching and in their specific field of expertise. The article also discusses the evolving regulations and standards for teachers in England, highlighting the implications of these changes on the teaching profession. The role and transition from the Institute for Learning to the Education and Training Foundation as a body providing professional standards in education is also touched upon.

Introduction

Professionalism is the attributes and qualities that are associated with those that are trained and skilled at a professional role. ( GOV.UK , n.d.) states a list of 47 recognised professions, including those such as accountant, nurse, teacher or lecturer. While particular roles are deemed to be filled by professionals, it doesn’t necessarily mean that the individuals holding these roles will act with professionalism.

Criteria for Defining a Profession

In order to define what a profession is, several models have been produced that allow assessment of a role to judge if it is indeed considered a profession. (Millerson, 1964) states in his Model of Professionalism that a profession must include the following:

A skill based on theoretical knowledge
Intellectual training and education
The testing of competence
Closure of the profession by restrictive organisations
A code of conduct
An altruistic service in the affairs of others

When analysing the roles provided by ( GOV.UK , n.d.) the majority comply with each of these requirements, although some roles, while normally meeting these requirements, do not necessarily, e.g., director of a limited company.

Hoyle’s Model of Professionalism and Professionality

Another model is Professionalism and Professionality, in which two types of professionality exist, ‘restricted’ which refers to skills developed from introspective experience, perceived in isolation with value placed on autonomy while involvement in non-immediate professional activities, reading of professional literature and involvement in professional development is limited. This is in stark contrast with ‘extended’ professionality which refers to skills derived from mediation between experience and theory, with actions compared with those of colleagues in relation to policies and goals. There is a high involvement in non-immediate professional activities with considerable involvement in professional development and regular reading of professional literature. (Hoyle, 1975, p. 315) states that these extended professionality’s are “strategies and rhetorics employed by members of an occupation in seeking to improve status, salary and conditions”.

The Role of a Dual Professional in Teaching

When working as a teacher or lecturer you must normally act as a dual professional, as you must be professional while teaching but must also be professional within the field that you teach. “The best vocational teaching and learning is a sophisticated process; it demands ‘dual professionals’ – teachers and trainers with occupational expertise and experience, who can combine this with excellent teaching and learning practice.” (Commission on Adult Vocational Teaching and Learning, 2013, p. 8) Teaching establishments have always “recruited people with experience in industry/occupations relevant to the courses being delivered. These practitioners may bring new knowledge and understanding to the teaching team” (Education & Training Foundation, 2018) but unless they are effective teachers, they may not be able to effectively pass this knowledge to students, meaning they are not functioning as a dual professional.

Regulations and Expectations in Education

The Department for Education defines the Teachers’ Standards, “the standards define the minimum level of practice expected of trainees and teachers from the point of being awarded qualified teacher status (QTS).” (Department for Education, 2013) The “QTS is required in England to teach in a state school that is under local authority control and in special schools.” (TES Institute Team, 2016) “You can become a further education (FE) teacher without a teaching qualification” (AGCAS, 2017), the required qualifications are related to the specific area that is being taught; normally at least one level higher than what is being taught. Although it is not a requirement, it is normal that new lecturers are expected to study for the relevant teaching qualification, in this case the Level 5 Diploma in Education and Training which is recognised as the full teaching qualification for further education. “In 2013, the Government lifted the requirement for newly-appointed teachers to have undergone formal teacher training before working in FE.” (Pynn, 2017) “The teaching profession suffers from a vicious circle of low status, lack of competitive resources, inability to control their own selection, training and qualification, divided and consequently ineffective organisation and a degree of state interference and control suffered by almost no other profession all leading to low bargaining power, low remuneration and low status.” (Perkin, 1985, p. 8)

The Evolution of Professional Standards in Education

The Education and Training Foundation is a professional body that provides professional standards for the sector. It was established in October 2013, replacing the Institute for Learning (IfL) that ceased operating a year later on 31 October 2014. The professional standards define common expectations that should be met by teachers within FE.

Professionalism remains a cornerstone in various occupations, ensuring not just skill and expertise but also integrity and ethical conduct. As outlined by various models, the definition of a profession extends beyond mere job titles, demanding rigorous theoretical knowledge, competence testing, and adherence to codes of conduct, among others. Particularly in the realm of education, the concept of the ‘dual professional’ underscores the multifaceted responsibilities educators hold. While regulatory bodies and standards, such as those established by the Department for Education and the Education and Training Foundation, provide a framework for professionalism, the true essence of a profession lies in the confluence of expertise, ethical conduct, and continuous learning. The ongoing evolution of standards and qualifications underlines the dynamic nature of professions, emphasising the need for professionals to adapt and evolve in their roles.

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What are the key points of dual professionalism?

Dual professionalism emphasises the importance of educators possessing expertise in both the subject they teach and the pedagogical skills required for effective teaching. It demands that educators be updated with developments in their field of expertise while also continuously refining their teaching methods. This concept underscores the multifaceted responsibilities of educators, ensuring they deliver content knowledge while also employing best practices in teaching and learning.

What are the 3 core values of professionalism?

The three core values of professionalism are integrity, which entails adhering to ethical principles and honesty; accountability, which involves taking responsibility for one’s actions and decisions; and excellence, which requires continual learning and striving for top-quality performance in one’s profession.

What are the 4 P’s of professionalism?

The 4 P’s of professionalism refer to Pride in one’s work, Punctuality in delivering tasks and commitments, Preparation to ensure readiness and competence, and Positive attitude towards challenges and collaborative efforts. These elements emphasise the importance of self-respect, timeliness, thoroughness, and a constructive mindset in professional settings. Embracing these attributes helps individuals excel in their professions and fosters a conducive work environment.

What are the 4 C’s of professionalism?

The 4 C’s of professionalism are commonly understood as Competence, indicating the necessary skills and knowledge for a job; Communication, emphasising effective interactions and clarity; Commitment, denoting dedication and persistence in one’s profession; and Conduct, referring to ethical behaviour and adherence to professional standards. Together, these attributes guide professionals in maintaining a high standard of work and behaviour in their respective fields. Embodying these qualities ensures individuals uphold the trust and respect of their peers, superiors, and clients.

What are the 5 E’s of professionalism?

The 5 E’s of professionalism are not as universally recognised as some other models, but in various contexts, they can be referred to as Expertise, indicating mastery in one’s field; Ethics, emphasising moral integrity and uprightness; Engagement, denoting active participation and commitment to one’s profession; Effectiveness, which means delivering results consistently; and Efficiency, referring to the ability to achieve results with optimal use of resources. Together, these attributes help professionals deliver quality service and maintain credibility in their fields. By embodying these principles, individuals can ensure excellence, trustworthiness, and value in their professional endeavours.

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Teaching professionalism – Why, What and How

Due to changes in the delivery of health care and in society, medicine became aware of serious threats to its professionalism. Beginning in the mid-1990s it was agreed that if professionalism was to survive, an important step would be to teach it explicitly to students, residents, and practicing physicians. This has become a requirement for medical schools and training programs in many countries. There are several challenges in teaching professionalism. The first challenge is to agree on the definition to be used in imparting knowledge of the subjects to students and faculty. The second is to develop means of encouraging students to consistently demonstrate the behaviors characteristic of a professional - essentially to develop a professional identity.

Teaching of professionalism must be both explicit and implicit. The cognitive base consisting of definitions and attributes and medicine’s social contract with society must be taught and evaluated explicitly. Of even more importance, there must be an emphasis on experiential learning and reflection on personal experience. The general principles, which can be helpful to an institution or program of teaching professionalism, are presented, along with the experience of McGill University, an institution which has established a comprehensive program on the teaching of professionalism.

“Teaching professionalism is not so much a particular segment of the curriculum as a defining dimension of medical education as a whole” (Sullivan WM, 2009, p. xi).

Why teach Professionalism?

The past half century has seen major changes in the practice of medicine. The explosion of science and technology, as well as the development of multiple specialties and sub-specialties, has made the profession both more diverse and disease oriented (Starr, 1984). The increased complexity of care and its cost have brought third party payers, either governments or the corporate sector, into the business of health. Society has also changed. Starting in the 1960s all forms of authority were questioned, including the professions (Krause, 1996; Hafferty & McKinley, 1993). Medicine in particular was seen as self serving rather than promoting the public good and was felt to self-regulate poorly with weak standards applied irregularly. There was a feeling that the professions did not deserve the trust or their privileged position in society. As a result medicine began to examine the threats to its professionalism and, starting in the mid-1990s, realized that if professionalism was to survive, action would be required. It was concluded that one important step would be to teach professionalism explicitly to students, residents, and practicing physicians (Cruess & Cruess, 1997a; Cruess & Cruess, 1997b; Cohen, 2006). In many western countries this has become a requirement for accreditation of medical schools and training programs. There has been an amazing increase in the medical literature on professionalism and medicine’s social contract with society, as well as how best to teach and evaluate professionalism (Cruess et al., 2009; Stern, 2005; Hodges et al., 2011).

The Challenges

There are several challenges inherent in teaching professionalism (Cruess et al., 2009; Cruess & Cruess, 2006). The first is to obtain agreement on a definition. The next is how best to impart knowledge of professionalism to students and faculty. Of great importance is how to encourage those behaviors characteristic of a professional (developing a professional identity). Traditionally professionalism was taught by role-models (Wright et al., 1998; Kenny et al., 2003; Cruess et al., 2008). This is still an essential method but it is no longer sufficient. Both faculty, many of whom are role-models, and students should understand the nature of contemporary professionalism. In the literature there are two approaches to teaching professionalism; to teach it explicitly as a series of traits (Swick, 2000) or as a moral endeavor, stressing reflection and experiential learning (Coulehan, 2005; Huddle, 2005). Neither alone is sufficient. Teaching it by providing a definition and listing a series of traits gives students only a theoretical knowledge of the subject. Relying solely on role modeling and experiential learning is selective, often disorganized, and actually represents what was done in the past. Both approaches must be combined in order that students both understand the nature of professionalism and internalize its values (Ludmerer, 1999).

The first step to be taken in teaching professionalism is to teach its cognitive base explicitly. (Cruess et al., 2009; Cruess & Cruess, 2006) This will allow both faculty and students to have the same understanding of the nature of professionalism and share the same vocabulary as they reflect upon it. A medical institution should therefore select and agree on the definition of a profession and its attributes. There is some confusion in the literature on the exact nature of the words profession and professionalism, with some believing that it is difficult to define professionalism as it is too complex and context driven. There are however several definitions available, and all contain similar content (Stern, 2005; Swick, 2000; Steinert et al., 2007; Sullivan and Arnold, 2009; Todhunter et al., 2011). There are also attributes, drawn from the literature, which outline what is expected of a medical professional and these can form the basis of identifying the behaviors which reflect these attributes (Cruess et al., 2009).

Profession and Professionalism

The literature contains many definitions which can serve as the basis of the teaching of professionalism. While the arrangement of the words may vary, the content of these definitions is remarkably similar. The International Charter on Medical Professionalism (Brennan et al., 2002), the Royal College of Physicians of London (2005), Swick (2000), Stern (2005) and others have published acceptable definitions. We developed and published the following definition of profession which has served us well in our teaching programs (Cruess et al., 2004).

Profession: An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning or the practice of an art founded upon it is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served, to the profession and to society.

Professionalism as a term is obviously derived from the word profession. The definition provided by the Royal College of Physicians of London is useful for teaching (2005).

Professionalism: A set of values, behaviors, and relationships that underpins the trust that the public has in doctors.

We believe that physicians serve two separate but interlocking roles as they practice medicine, those of the healer and the professional ( Figure 1 ). While they cannot be separated in practice, for teaching purposes it is useful to distinguish them (Cruess et al., 2009). The healer has been present since before recorded history and the characteristics of the healer appear to be universal. In every society those who are ill wish healers to demonstrate competence, caring and compassion, and treat them as individuals. While the word profession has been used since the time of Hippocrates, the modern professions arose in the guilds and universities of medieval England and Europe (Starr, 1984; Hafferty & McKinley, 1993). The medical profession had little impact on society until science provided a base for modern medicine and the Industrial Revolution provided sufficient wealth so that health care could actually be purchased. At this time, society turned to the pre-existing professions and organized the delivery of healthcare around them by granting licensure. This provided a monopoly over practice, considerable autonomy, the privilege of self-regulation, and financial rewards. The attributes of the healer and of the professional are shown in Figure 2 . Together, they outline societal expectations of individual physicians and the medical profession under medicine’s social contract.

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The definitions and list of attributes which serve as the basis of the cognitive base should be taught as early as possible in the curriculum and expanded in later sessions to reinforce the knowledge base and provide experience in using the vocabulary. As students gain experience, the concept of the social contract between society and medicine (Cruess & Cruess, 2008) can be introduced. Sociologists tell us that society uses professions to organize the essential complex services that it requires, including those of the healer. It has been described by Klein (2006) as a “bargain” in which medicine is granted prestige, autonomy, the privilege of self-regulation and rewards on the understanding that physicians will be altruistic, self-regulate well, be trustworthy, and address the concerns of society. Although it is not a written contract with deliverables, there are reciprocal expectations and obligations on both sides. The concept of the social contract assists in introducing the obligations of a physician arising from the contract and provides a justification for their presence. In addition, as medicine and society change, the contract, as well as the professionalism which is linked to it, must evolve.

Developing professional identity

As experience in teaching professionalism has been gained, the realization has grown that the educational objective is to assist students as they develop a professional identity, a process that we are only beginning to understand. Identity can be defined as: “A set of characteristics or a description that distinguishes a person or thing from others” (Oxford Dictionary, 1989). Students enter medicine with an established identity and wish to acquire the identity of a physician. Professional identity formation is an evolving process that involves “a combination of experience and reflection on experience” (Hilton & Slotnick, 2005).

Professional identity develops through socialization which is”the process by which a person learns to function within a particular society or group by internalizing its values and norms” (Oxford Dictionary, 1989). Students must understand the identity they are to acquire and must be exposed to the experiences necessary for the formation of this identity (Hafferty, 2009). Finally, they require time to reflect on these experiences in a safe environment. Fundamental to the process is the presence of role models who demonstrate the behaviors characteristic of the healer and the professional in their daily lives. Finally, the learning environment must be supportive of the development of a professional identity. Teaching institutions are responsible for providing this environment, something that requires them to pay attention to the formal, the informal and the hidden curricula.

General principles

When an institution initiates a program of teaching professionalism, experience has shown that there are some general principles that are useful to follow (Cruess & Cruess, 2006).

Institutional Support

It is difficult to initiate a major teaching program without the support of the Dean’s office and of the Chairs of the major departments. As many bodies accrediting teaching and training programs now require professionalism to be taught and evaluated, administrative and financial support is becoming somewhat easier to obtain. Time must be mobilized in the curriculum, although experience has shown that the amount of additional time required is often not great. Most faculties already have activities taking place whose objective is to develop the professionalism of its students. These can frequently be reorganized into a coherent course to which can be added new learning experiences. In addition some administrative and financial support is almost always required.

Allocation of responsibility for the program

Someone must be responsible for the program and accountable for its performance. Ideally a respected member of the faculty is chosen to lead the design and implementation of the professionalism program and be its champion. In addition the program can benefit from the presence of an advisory committee with broad representation from the faculty. It must be remembered that professionalism crosses departmental lines and ideally exposure to it should come within the context of many departmental activities.

The definition, attributes, and behaviors serve as the basis for instruction at all levels – undergraduate, postgraduate, and practicing physician. Ideally they should inform the admission policies of the medical school, be used for teaching students, residents, and faculty, and for continuing professional development. The unifying theme is a common understanding of nature of professionalism. How it is taught and evaluated will vary depending upon the educational level. There is general agreement that “stage appropriate educational activities”, including assessment, should be devised and that they should represent an integrated entity throughout the continuum of medical education.

Incremental Approach

A comprehensive program for teaching professionalism is difficult to implement at all levels simultaneously. One should start with those activities devoted to the teaching of professionalism that are already in place. New programs often represent a combination of these activities and new learning experiences developed to complement what was previously taught. Once the objectives for the program on teaching professionalism have been developed, the program can be designed and introduced in incremental fashion.

The Cognitive Base

It is important to outline precisely what is to be taught. Thus, the cognitive base requires special attention. The definitions and attributes of the professional, which are to be the foundation of the teaching program, should be developed within the institution and general agreement on the educational approach to the subject obtained. Both the medical school and its teaching hospitals should participate in this process as all share the responsibility to understand and articulate what is expected of both students and faculty. The cognitive base must be taught explicitly and often, with increasing levels of sophistication appropriate to the student’s level of learning.

Experiential learning and Self-Reflection

The introduction of the cognitive base provides learners with both knowledge of the nature of professionalism and its value system. Medicine’s values must then be internalized so that they can serve as the foundation of a professional identity (Hafferty, 2009). There is wide consensus that students must experience situations in which these values become relevant or challenged as a necessary first step in the process of internalization. Learners must also have opportunities and time to reflect upon these experiences in a safe environment (Schon, 1987; Epstein, 1999). Teaching programs should ensure that students are exposed to the wide variety of experiences necessary to encompass knowledge of professionalism. The majority of these encounters will be true clinical situations, but in many instances they can be supplemented with reflection on experience from simulated clinical situations, small group discussions, clinical vignettes, role plays, film and video tape reviews, narratives, portfolios, social media, or directed reading (Cruess & Cruess, 2006).

The experiences used in teaching professionalism should be appropriate to the level of the student (Rudy, 2001). Reflection can be during the experience, on the experience, or after it has occurred, considering how action might differ in similar situations in the future.

Role Modeling

Role models must understand what aspects of professionalism they are modeling and be explicit about what they modeling (Cruess & Cruess, 2006; Wright et al., 1998; Kenny et al., 2003). Faculty development is often required to provide role-models with knowledge of the cognitive base of professionalism (Steinert et al., 2007). The role-modeling of faculty should be assessed and there must be positive or negative consequences to the evaluation (Cruess et al., 2008). Role-models should be supported and good role-models rewarded, poor ones remediated, and those who have demonstrated that they cannot be a good role model removed from teaching.

Both the cognitive base and the behaviors reflective of professional attributes must be evaluated, obviously using different methods. Knowledge can be tested in the traditional ways, including multiple choice questions, essays, short answers etc. It has become clear that professional attitudes and values cannot be reliably evaluated. It is therefore necessary to develop a series of observable behaviors which reflect the attitudes and values of the professional that can be evaluated (Stern, 2005; Hodges et al., 2011). It has also been recognized that only by carrying out multiple observations by multiple observers can reliable and valid results be obtained. Tools have been developed in order to accomplish this, and they should be used to evaluate students, residents, and faculty.

The evaluation of behaviors should be formative as this supports the learning process (Sullivan & Arnold, 2009). Summative evaluation must also be done on students and residents as it is the responsibility of the profession to protect the public from unprofessional practitioners. The professionalism of faculty members must also be assessed (Todhunter et al., 2011). It is a universal complaint of students that they are encouraged to behave professionally but frequently are exposed to unprofessional conduct on the part of their teachers (Brainard & Bilsen, 2007). Assessment of faculty performance offers a possible means of correcting this.

The Environment

The environment in which learning takes place can have a profound positive or negative impact on learning. There are three major components to this environment: the formal, the informal, and the hidden curricula (Hafferty & Franks, 1994; Hafferty, 1998). The formal curriculum consists of the official material contained in the mission statement of an institution and its course objectives. It outlines what the faculty believes they are teaching. The informal curriculum consists of unscripted, unplanned, and highly interpersonal forms of teaching and learning that takes place in classrooms, corridors, elevators - indeed any place where students and faculty have contact. It is here that role models exert their positive or negative influence. Finally, the hidden curriculum functions at the level of the organizational structure and culture of an institution. Allocation of time to certain activities, promotion policies and reward systems, that, for example, rewards research rather than teaching, can have a profound impact on the learning environment. This impact is felt disproportionately in the area of professionalism, which is so heavily dependent upon values. As a part of the establishment of any teaching program on professionalism, all elements of the curriculum must be addressed in order to ensure that they support professional values. 

Faculty Development

Faculty development is fundamental to the establishment of a program of teaching professionalism (Steinert et al., 2007). It promotes institutional agreement on definitions and characteristics of professionalism. It allows the faculty to develop methods of teaching and evaluation and, properly used can lead to substantial changes in the curriculum. Most importantly, it helps to ensure the presence of skilled teachers, group leaders, and hopefully role models.

The McGill Experience

In 1997 McGill instituted the teaching of professionalism and over the next six years, in an incremental fashion, developed a four year program on Physicianship (Cruess & Cruess, 2006; Boudreau et al., 2011; Boudreau et al., 2007). The concept includes the separate but overlapping roles of physicians as healers and as professionals. Through a series of faculty development workshops the faculty agreed upon the definitions to be used and the attributes to be taught and evaluated (Steinert et al., 2007). These became the basis for 1. the selection of students 2. the content of teaching and 3. of the evaluation of students, residents, and faculty.

Student selection

McGill changed its student selection process to one utilizing the multiple mini interview process (MMI) (Razack et al., 2009). The mini-interviews take place in a simulation center using actors. There are 10 stations, with each station designed to demonstrate the presence in the applicant of the behaviors found in a model physician. The purpose is to identify those candidates who already demonstrate the attributes of the healer and the professional and, importantly, to publicly indicate the importance of these attributes. For those students who are granted an interview, the MMI score contributes 70% of the candidate’s final ranking on the admission scale. Unpublished data indicates that the MMI scores correlate with clinical performance during medical school.

There are three major aspects to the undergraduate program; whole class activities on both the healer and the professional; unit specific activities in various departments; and a mentorship program. The faculty first identified those components that were already being taught (ethics, professionalism, narrative medicine, end-of-life care) and added the others as they were developed.

Whole class activities

In the undergraduate curriculum, a longitudinal course on Physicianship that the students are required to pass was developed and implemented (Cruess & Cruess, 2006; Boudreau et al., 2007; Boudreau et al., 2011). It contained two separate but overlapping blocks on the healer and the professional.

Whole class activities include lectures on the nature of professionalism. Of symbolic significance, the first lecture on the first day of class is a didactic session on professionalism which presents the definitions and vocabulary which will be used. This is followed by small group sessions with trained faculty that examines vignettes demonstrating good and poor professional behavior. The objective is to identify the attributes present in each, familiarizing students with the vocabulary and the use of the concept. Ethics lectures are given and are always followed by small group discussions. Communication skills are taught using the Calgary-Cambridge format (Kurtz & Silverman, 1996). The subjects covered in the bloc on the Healer are physician wellness, the perspective of both the doctor and patient in the doctor-patient relationship, working with members of the health care team, and analyzing the nature of suffering. Great emphasis is placed upon reviewing narratives of the experiences of both patients and physicians. Other whole class activities include the introduction to the cadaver as the student’s first patient as well as a body donor service developed by students to show appreciation for the donors of the bodies. There is a white coat ceremony given prior to entry into the clinical years. Palliative care is felt to emphasize the healer role and there are special reflective experiences in this domain with mentors. In the last year students attend seminars with the goal of uniting the healer and professionalism roles. Students are given a fuller exposure to the concept of medicine’s social contract with society and encouraged to reflect on which of the public expectations of the profession they will find difficult to fulfill and how they might overcome these difficulties. These discussions are guided by their mentors (Osler Fellows) who have been with them for all four years.

Unit specific activities

Each department is encouraged to develop unit specific activities on the roles of the healer and the professional. Departmental rounds are devoted to the subject, bedside discussions of conflicts in professionalism take place, and the professionalism of students is assessed on ongoing basis. Of necessity, there is less structure to unit-specific activities than is present in whole class activities, but they are of extreme importance in providing experiences upon which students reflect with their mentors.

Osler Fellows

A mentorship program was established with the mentors being given the title of “Osler Fellows”. They were selected from a list of nominations by students and faculty of those recognized as being outstanding teachers, practitioners and role models. Each Osler Fellow mentors six students throughout their medical school career. They are an important part of the teaching of professionalism as they have a series of mandated activities which must be carried out. A portfolio is instituted, with an emphasis on professionalism, and narratives are produced and reviewed. There are of course a host of unscheduled encounters during which the student and mentor establish a relationship. The Osler Fellows have a dedicated faculty development program to familiarize them with their roles (Steinert et al., 2010).

Postgraduate education

During postgraduate training, residents have several half day recall sessions each year (Snell, 2009). At one of these there is a review of the cognitive base of professionalism as many residents are from diverse backgrounds. It is important to provide a common vocabulary for use in training and practice. The review is followed by small group sessions including residents from different specialties who discuss their experiences of professionalism during residency with an emphasis on how they will meet their responsibilities to society. Residents are involved as group leaders for the undergraduate sessions, participate in the assessment of the professionalism of students and faculty, and sessions are held to assist them in understanding their roles as teachers and role-models. The subjects covered in other half-day sessions that relate to professionalism are ethics, malpractice, risk management, teamwork, communication skills, and their own wellness.

Teaching professionalism requires that each teaching community agree on the cognitive base - a definition of profession, the attributes of the professional, and the relationship of medicine to the society which it serves. These should be taught explicitly. The program should extend throughout the continuum of medical education and passing should be obligatory for progression to the next level. The substance of professionalism must become part of each physician’s identity and be reflected in observable behaviors. Professionalism should be taught as “an Ideal to be pursued” rather than as a set of rules and regulations (Cruess et al., 2000).

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The Oxford Handbook of the History of Education

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20 The Professions and Professional Education

Richard K. Neumann Jr. is the Alexander Bickel Professor of Law at the Maurice A. Deane School of Law, Hofstra University.

Published: 13 June 2019
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Education for a professional career differs fundamentally from other forms of education. A physician, for example, must know more than medical science. To be competent, medical doctors must know how to practice medicine, which Donald Schön called knowing-in-action. At times, professional schools have been stepchildren in universities because they taught skills as well as pure knowledge. In other eras, a medical school or a law school might be one of a university’s crown jewels. Differing degrees of acceptance in universities seem correlated to a profession’s prestige and to a professional school’s ability to generate research and publications. The tensions between trying to satisfy those criteria while simultaneously teaching knowledge-in-action with pure knowledge are essential to the history of professional education. The professions differ from one another in how they have navigated through these tensions, but the differences are variations on more or less the same theme.

Historically the three learned professions were law, medicine, and theology. At times in higher education, theology outshone the other two because many colleges and universities were founded and operated by religious organizations. In modern higher education, however, theology is typically an academic subject like philosophy or literature, and clergy tend to be educated professionally in seminaries. The professions now also include architecture, education, psychotherapy, dentistry, veterinary medicine, engineering, accountancy, and others.

Professional education is subject to some unusual tensions. Those tensions provide the context for a discussion of the history of education in four professions: law, medicine, architecture, and teaching. Law and medicine have long and well-documented educational histories. Architecture is a contrast; it was recognized as a profession later than the other two, and it entered universities from the equivalent of artists’ studios. Primary and secondary school teaching was recognized as a profession even later, and education departments entered universities through a more circuitous route.

A profession is different from other occupations. A professional has a fiduciary obligation to work in the best interests of the client or patient. All professions involve licensure or some other regulation limiting entry to those who can prove knowledge or, in the most rigorous licensure, both knowledge and skill. Business is not a profession. A business person is unlicensed, has no fiduciary obligation to customers, and needs no specialized education. Several of the best known entrepreneurs left college without degrees and may have benefited by doing so.

“Professional school” and “professional education” are not synonymous. The latter is by far the broader concept.

In the United States, a medical school graduate has a doctorate but is not immediately qualified for a license to practice medicine. A year of postdoctoral hospital internship is required before licensure, and additional years of hospital residency are required for specialization. These internships and residencies are the postgraduate medical education, and the institutions that offer them are separately accredited. The Liaison Committee on Medical Education accredits medical schools, and the Accreditation Council for Graduate Medical Education accredits postgraduate internships and residencies.

In many countries, law is studied immediately after secondary school. It is the equivalent of what Americans consider a major subject for a bachelor’s degree. To become licensed in those countries, the graduate must complete a full-time law practice course of a year or more, or its equivalent, taught outside a university, followed by an apprenticeship supervised by the national association of lawyers. There a professional education is the sum of the law degree plus the law practice course plus the apprenticeship.

A profession is based on ways of thinking that remain a mystery to those outside the profession. This is not limited to domain knowledge such as the rules of copyright law or the symptoms of heart diseases. It is also, and perhaps more importantly, the patterns of thought needed to use that knowledge, which Donald Schön called knowing-in-action. To a lay person, the ability to use domain knowledge seems magical. But to a professional it is part of the state of being, so ingrained into the psyche that the professional does not imagine life without it.

Both knowing—and knowing-in-action—are important. Teachers in professional schools often use a phrase that begins “Thinking like. …” “Thinking like a lawyer” is using law and other tools to solve the kinds of problems people bring to lawyers. “Thinking like a doctor” is using medical knowledge to diagnose and treat disease. “Thinking architecturally” is visualizing the resolution of design issues. Preparation for a profession is the acquisition of both knowing and doing.

Domain knowledge in a profession can be—and often is—taught as pure knowledge, without any instruction in how to use that knowledge in professional work. A teacher might stand before a hundred or two hundred students and lecture on human anatomy or the rules of procedural law. A student who listens attentively, takes good notes, and reads the textbook carefully will probably learn a fair amount about anatomy or procedural law. But without more, the student will have no idea how to diagnose disease or plead a case.

A professional’s knowing-in-action cannot fully be explained in words except to someone in the same profession who already understands it. This creates the most difficult educational challenge in all forms of professional education. When Schön talked to students in a variety of professional schools, he found that “in the midst of their education for practice there was a profound sense of mystery … because what the teachers knew how to say the students could not at that point in their experience understand.” 1 In a profession, a student can learn how to think in action only by doing work the student does not know how to do.

The history of professional education can appear incoherent. At one place and time, the learning of a profession might be welcomed into universities and enjoy much prestige there. At another time and place, the opposite may be true. This inconsistency is more apparent than real. University faculties and administrators consider research about and teaching of domain knowledge to be a dignified function of higher education. Historically the opposite has been true of research about and the teaching of knowledge-in-action. Knowledge-in-action can really be taught only through what Schön called “deviant traditions of education for practice—traditions that stand outside or alongside the normative curricula” and that do not reside in lecture halls. 2

Since the late nineteenth century, the most profound change in professional education has been the gradual elevation of knowledge-in-action to a status closer to that of pure knowledge. In medicine, this is the history of the teaching hospital, and the pivotal event was the founding of the Johns Hopkins School of Medicine in Baltimore, the hospital opening in 1888 and the medical school in 1893. In law, it is the history of the law school clinical and other skills courses, and the pivotal event was the creation of the Council on Legal Education for Professional Responsibility, supported financially by the Ford Foundation, beginning in the late 1960s and continuing through the 1970s. In architecture, there was no pivotal event because that profession is also a fine art, where knowledge-in-action has always had primacy.

In any profession, knowledge-in-action is learned experientially on a site where the profession is practiced or in a setting that simulates such a site. In a teaching hospital, the student assists in treatment or treats patients under supervision. Medical education calls this “bedside learning.” In a law school clinic, the student advises and represents a client under a teacher’s guidance. In other law school experiential courses, the student will write legal memos and briefs, negotiate, advise, and do simulated courtroom work, but without an actual client. In an architecture school, the student will create building designs in a design studio.

The degree of experiential learning differs from one profession to another. Although the design studio and the teaching hospital are the heart of architectural and medical education, historically in law schools experiential learning barely existed, and even today it is considered at most a supplement to the teaching of domain knowledge. In the United States, which requires no postgraduate law practice instruction or apprenticeship, law school graduates are perhaps the least prepared, among all professionals, to enter practice. Medicine, clinical psychology, architecture, education, dentistry, veterinary medicine, and pharmacy all require far more experiential learning in their professional schools and after graduation.

In some eras and in some places, licensure was not required. Surgery, for example, was routinely performed by barbers. In many countries well into the nineteenth century, anyone could give legal advice, call himself a physician, or design a building. Licensure put an end to that. It also changed professional education, which afterward was required to teach everything necessary for a student to pass a licensing exam.

In countries where the government operates all or nearly all of higher education, quality control at the institutional level is performed by an education ministry or by entities under an education ministry’s supervision. In countries where most institutions of higher learning are privately operated, that function is performed instead by accreditation: a college or university is evaluated by administrators and faculty from other colleges and universities. This is peer review, in which the public typically has only a token role.

Professional school accreditation, however, is not purely peer review. It is usually a joint venture between educators and the relevant profession. Professional school accreditation is different because students there do not receive a general education. Professionals have a vested interest in making sure that graduates are qualified to practice their profession. In this respect, law is the weakest profession in the United States. In architecture, only one of the four members of an accreditation site inspection team will be an educator. The other three will be an architect, an architecture student, and a representative from the licensing authorities. But in law typically five or six members of a seven-person site inspection team will be faculty and administrators at other law schools or universities. Only one will be a lawyer or judge.

In addition to accreditation, quality control comes from professional education itself. Education improves the standard of practice of a profession not just by teaching domain knowledge and knowledge-in-action but also by discovering them. For domain knowledge, medical school laboratories and teaching hospitals produce prodigious amounts of research on diseases and treatments.

Discovering knowledge-in-action is less obvious because it does not lend itself to publication as readily as pure science does. In order to teach students how to practice medicine, true teaching hospitals, beginning with the one at Johns Hopkins, have had to discover what to teach—the most effective forms of diagnostic reasoning, for example. Knowledge-in-action advances through accumulation of incremental insights that usually are not attributable to identifiable authors. Gradually, over long periods of time, education comes to a common understanding, a tacit codification, of which intellectual processes work better than others.

It is a reasonable but unproven hypothesis that the standard of practice—and knowledge about practice—is higher in professions that have permeating experiential learning than in professions that do not. This can happen only where teaching knowledge-in-action is a collective endeavor. Apprenticeship systems, for example, would not do that unless the masters form a community of their own to share insights among themselves. A profession’s standard of practice can rise only if insights are spread throughout the profession. And an insight is only a narrow thought unless discussed by others, studied, and tested empirically.

Despite the spread of knowledge about practice, professional education has had an uneasy relationship with universities. Bologna—along with Paris, the oldest European university—began in the eleventh century primarily as a school for the study of law and grew from that into a university in the modern sense. But professional education has also at times been treated with suspicion or even disdain in universities and dismissed as trade schools. Knowing and being able to do can sometimes have less prestige than simply knowing without activity. Thorstein Veblen wrote that law teachers are like athletic coaches and that a law school “belongs in the modern university no more than a school of fencing or dancing.” 3 A university values its faculty members primarily according to how much publishable knowledge they produce, and educating for a profession—for being able to do as well as know—can appear to be an endeavor that would not produce knowledge for knowledge’s sake.

The same tension can occur inside a professional school. Some parts of the faculty will specialize in teaching domain knowledge, while others will specialize in teaching how to use that knowledge. Those who teach domain knowledge often work with material that can be published in a form that meets university expectations. Those who teach how to use professional knowledge might not be in that position, even though what they teach may be equally rigorous intellectually.

Of the four professions, medicine has the highest prestige in a modern university, architecture has lower status than law, and teaching has the lowest. Because medicine is a science as well as a profession, a medical school faculty as a whole can produce a ready supply of publishable discoveries that faculty members elsewhere in a university, in a chemistry or physics department, for example, will recognize as methodologically rigorous. Architecture is at the opposite end. It is both a profession and a fine art. Because it is a visual field—filled with images rather than words or numbers—it produces relatively few publications of any kind. It does not discover knowledge. It is the most artistically creative profession, and its contribution to knowledge is the built environment we live in. Unlike medicine, law, and even architecture, teaching is often considered a semiprofessional field and has suffered from status anxiety. Moreover, because most people have experienced schooling, many believe that they know what should be taught and how to teach it.

Professions have long histories of educating themselves outside universities. The earliest form of professional education was apprenticeship. As a profession gradually took on the characteristics of a guild, it might regulate apprenticeships, and it might supplement them with explanations delivered orally to groups of apprentices. Or a senior professional might give lectures and charge apprentices a fee for attending. All this might eventually coalesce into a freestanding professional school, one not affiliated with a university.

At the same time universities might have departments, often small ones, teaching some aspect of that profession. Two parallel educational systems would coexist. Because until the early twentieth century, a university education was considered a luxury, as it is still in some countries, a university credential would be associated with higher status in a profession. In some instances a university offered a better education, and in some instances it offered an inferior one.

A freestanding school in linguistics or Asian studies, unaffiliated with a university, would seem anomalous if not impractical. Scholars need a large interdisciplinary library and other shared facilities, and students need to be able to take courses in many different fields. But a university’s professional schools tend to operate separately from the rest of the university even when located on the same campus. They usually have their own libraries; their students rarely take courses in other departments; and their buildings often are not on the university’s campus.

Freestanding professional schools continue to exist, particularly in the United States. Some, such as the Mayo Clinic’s Medical School, are widely respected, and freestanding schools generally provide solid education. But they are fewer now than earlier. A number of freestanding schools have been absorbed into universities, usually after the professional school ran into financial difficulties and the university thought its reputation might be enhanced by adding a law or medical school.

What is now the University of Bologna began in the eleventh century as a place where students gathered to learn law. They did not enroll in a school. Originally there was no school. A student arrived, rented a bed in which to sleep, and sought a tutor. Later, feeling exploited by tutors and landlords who charged too much and delivered too little, students organized and threatened to move to some other town and hire tutors there unless rents fell to reasonable levels and tutors charged less and taught more.

Lackadaisical teaching outraged students, each of whom paid a tutor individually and felt cheated if the tutor’s instruction was insufficiently rigorous. Students collectively agreed on regulations they expected all tutors to obey, and a disobedient tutor would be boycotted. According to Charles Homer Haskins:

The professor was put under bond to live up to a minute set of regulations which guaranteed his students the worth of the money paid by each. We read in the earliest [student] statutes (1317) that a professor might not be absent without leave, even a single day, and if he desired to leave town he had to make a deposit to ensure his return. If he failed to secure an audience of five for a regular lecture, he was fined as if absent. … He must begin with the bell and quit within one minute after the next bell. He was not allowed to skip a chapter in his commentary or postpone a difficulty to the end of the hour, and he was obliged to cover ground systematically, so much in each specific term of the year. No one might spend the whole year on introduction and bibliography. 4

Eventually the tutors themselves organized and formed colleges and faculties, which affiliated with each other and coalesced into a university as theology, medicine, and other subjects were added. The tutors had the upper hand because they were permanent and students have always been transient.

“Law is for the bad man,” said Oliver Wendell Holmes, and the Bologna students’ regulations were for the bad tutors. There were also very good ones, for example, Pepo, who was called “the bright and shining light of Bologna,” and Irnerius, who, according to Haskins, was “the teacher who gave Bologna its reputation.” 5

Students did not gather at Bologna to become lawyers. They gathered to learn law, which is not the same thing. Before the social and behavioral sciences were created, learning law was important to understanding the world in which one lived. Law is primarily enforceable rules, and educated people knew the rules. This was true in Europe well into the nineteenth century, before law became more modern, intricate, and specialized. Educated people knew law even without studying it in school. In a letter to Balzac, Stendhal could say that while writing The Charterhouse of Parma , the first great French novel, “in order to acquire the correct tone I read every morning two or three pages of the Code civil ,” which we know as the Napoleonic Code and with which Stendhal would be familiar as it set out his rights and obligations as a citizen of a civil society. 6 Some law students in early universities became lawyers, but we know not how many. It could have been a small percentage.

Only as an academic subject could law be the core from which a great university grew. As an academic subject, law was studied just for the sake of knowing it. If a student wanted to do something with it—to practice law by using it as a tool to solve problems—the student would have to learn the doing elsewhere. A student could learn law in a university and then apprentice with a lawyer. That might not, however, have been the most common route. Families wealthy enough to afford the luxury of a university education might not wish a son—and they were all sons—to enter the trade of lawyering.

Through the middle of the nineteenth century, the study of law in universities tended to follow two models. One started in Bologna. In Continental Europe, law was—and still is—an undergraduate degree, part of a general liberal education. To an American observer, this resembles an undergraduate student’s major field. Today a European undergraduate law degree does not qualify its holder to obtain a law license. For that, postgraduate preparation, typically outside a university, is necessary. At the undergraduate level, law was and still is studied by future lawyers together with prospective higher-level civil servants and business executives, among others.

That was the historical model and is still the current model in the civil law countries of Continental Europe and its former colonies. Britain evolved toward the Continental model of an undergraduate law degree followed by postgraduate preparation for licensure. But the United States gradually developed university law schools , graduation from which would qualify a graduate to take the bar examination and be licensed without postgraduate preparation.

In the mid-nineteenth century, most American lawyers had been educated as Lincoln had been, by reading law while working as an apprentice in a lawyer’s office. During and after the Jacksonian era, popular sentiment held that educated elites should not control professions and that anyone should be able to practice law if literate enough to read it and memorize some of it. The very few university law schools were small departments with tiny full-time faculties. An elite lawyer in a cosmopolitan northeastern city might have attended a university law school, but as a substitute for a liberal arts education and to obtain a credential largely proving that the lawyer came from a family wealthy enough to support him as a gentleman student.

This changed beginning at 1870 at Harvard, where Christopher Columbus Langdell became dean of a small law faculty of only three full-time teachers. Over the following two decades, he led the school in developing all but one of the characteristics that define an American law school today: a three-year degree preceded by undergraduate study in a field other than law; teaching Socratically from a casebook; the law library’s role as the center of the law school; and an academic faculty with little experience or interest in practicing law. The one defining characteristic that did not begin in this period was the teaching of knowledge-in-action. The only skill taught in a Langdellian law school was that of reading and analyzing judicial opinions, which is a small part of the practice of law.

Although putting a lawyer’s entire education under university control might seem like an advance, it was also a limitation. Partly because universities are comfortable teaching knowledge and uncomfortable teaching knowledge-in-action, U.S. law schools taught only law as knowledge until the development of clinical, legal writing, and other skills beginning in the 1970s. A 1928 report on American legal education for the Carnegie Foundation for the Advancement of Teaching observed, “There is probably no other practical calling the preparation for which is so unrelievedly academic as that which is provided for American lawyers by most American law schools,” especially as compared to schools of medicine, architecture, dentistry, and engineering. To some extent, this is still true today. A recent study of over two thousand U.S. lawyers identified twenty-six capabilities essential to the practice of law, only three of which are part of the required curriculum in most U.S. law schools. 7

Although the United States shares the common law heritage with other English-speaking countries, legal education outside North America evolved in the opposite direction. Even before Europe’s Bologna Process began in the 1990s, English legal education had come to resemble the Continental European model in overall structure, although English law is so fundamentally different from European civil law in both content and analytical methods that individual courses and subjects cannot be taught in the same way in a common law system as in a civil law system.

The English legal profession is divided into solicitors, who are primarily office lawyers, and barristers, who are courtroom advocates. Most solicitors and barristers have law degrees, but a law degree is not actually required. An aspirant can instead get a degree in some other field and then take a one-year conversion course. To become a solicitor, a graduate takes a one-year legal practice course followed by a two-year apprentice-like traineeship working under supervision in a solicitor’s office. To become a barrister, a graduate takes a one-year professional training course followed by a one-year pupilage similar to a solicitor’s traineeship. The courses are heavily regulated by the solicitors’ and barristers’ professional organizations.

Thus in England five years are needed to become a barrister, and six years in most cases to become a solicitor—all of that time spent learning law and how to practice it. But in the United States, it takes a minimum of seven years to become a lawyer, longer than virtually anywhere else in the world. In spite of that, an American lawyer has spent much less time than a European lawyer studying law and lawyering. Only three years of the American seven are spent in a law school. Before that a student is required to spend four years studying something other than law—anything, in fact, that the student happens to choose. Neither the law school nor the licensing authorities care what it is.

This uniquely American requirement of a four-year, non-law degree preceding law study began at Langdell’s Harvard because he preferred to be surrounded with men (women were not permitted) who were cultured and had a classical education of the kind that made one capable of reading Virgil in Latin. But the requirement spread throughout American legal education for a different reason. It was not believed that four years of non-law study were thought necessary to sharpen every mind. The only minds at issue were those of immigrants and the children of immigrants, especially Jews. The goal was to exclude by more than doubling the cost of a legal education and, for those not excluded by cost, to inculcate the supposed superior values to be found in an Anglo-Saxon college environment.

Socratic teaching from casebooks, perhaps the most distinguishing feature of U.S. legal education since 1870, has had little influence beyond North America. Outside the common law family of nations, it is irrelevant because civil law and other legal systems do not create law through judicial precedent. Even within the common law world—countries whose law is descended from English precedents—Socratic casebook teaching has had only limited acceptance.

European legal education spread internationally through colonial empires in Latin America, Africa, and large portions of Asia. In almost every instance, the colonizing nation’s law became the colony’s law, and local lawyers were educated according to the colonizer’s methods, often in the colonizer’s home country. “In Singapore and Malaysia, for example, nearly every lawyer was trained in England.” 8 Before he became a revolutionary, Gandhi practiced law in South Africa and India. He learned law in England, argued in court in the style of an English barrister, and wore English-style suits rather than the bare loincloth of his later years of civil disobedience and insurrection.

After independence, a former colony’s legal education might gradually evolve into something more accurately reflecting local cultural norms. In some instances, however, this happened not at all. Although Hong Kong is now part of China and answerable to the Chinese Communist Party, courts in Hong Kong operate exactly as English courts do, Hong Kong statutes closely resemble those enacted at Westminster, and the two Hong Kong law schools are based on English models. Indonesia, on the other hand, has gone its own way, and little of Dutch legal education remains. A colonizer’s law and legal education tended to persist after independence because the period of decolonization coincided with the beginning of world modernization in industrial commerce and individual rights, for which European law had well-established norms.

Even in countries that were not formally colonized, such as Siam (now Thailand), modernizing a local legal system often meant adopting large aspects of European law, including European legal education. Japan, which was never colonized, imported American and British legal education methods during the post–World War II U.S. occupation, and recent reforms have been modeled on current practices in American law schools. 9

Internationally over the past half-century, the most significant U.S. influence on legal education has been the spread of experiential teaching. In the United States, the Council on Legal Education and Professional Responsibility provided financial support in the 1970s to U.S. law schools that opened teaching clinics. In the 1990s, when former Soviet-bloc countries were converting their legal systems to conform to non-Soviet norms, American clinicians began to help law schools in those countries to set up their own clinics. This has since spread to Western Europe, Africa, Asia, and Latin America.

Nowhere, however, not even in the United States, have clinics acquired the role that teaching hospitals have in medical education. In law everywhere, pregraduate education focuses less on knowledge-in-action than in any other profession. And although the United States originated clinical education, American lawyers are admitted to practice with less experiential learning than in many other countries.

During the Middle Ages, the Islamic world was far more advanced than Europe in the sciences, including medicine. The idea of a hospital, for example, originated in Baghdad in the eighth century. 10 A hospital is essential to medical learning and education because only there can experienced physicians and surgeons share techniques and learn from each other while the inexperienced can learn from their elders’ examples. By the time of the European Renaissance, however, Islamic countries were no longer the world leader in medicine.

Beginning in the twelfth and thirteenth centuries, medicine in Europe was taught in universities or freestanding medical schools at Bologna, Montpellier, Oxford, and Paris, among other places. But most physicians and surgeons learned their work as apprentices. These were primitive learning experiences because no professional organizations or governments supervised them. The master passed on to the apprentice less knowledge than ignorance.

The first American medical school was opened by the College of Philadelphia (now the University of Pennsylvania) in 1765. Kings College (now Columbia University) opened its medical school in 1767, and Harvard followed in 1783. But an American who wanted medical school training would rather, if his family could afford it, study in Europe. Before the Johns Hopkins School of Medicine and its teaching hospital opened, European medical education was incomparably better than anything in America. But that was irrelevant for large portions of the U.S. population. They were treated by physicians and surgeons who had not learned any of their medicine in a school.

For many centuries, the basic issue was whether school training would drive out apprenticeship as acceptable education. In each country where that happened, the basic issue then became the relationship between the academic teaching of domain knowledge and the practical teaching of clinical knowledge.

Today the first and second years of American medical education primarily cover a basic science curriculum in large classrooms. The third year is often called the year on the wards because it is spent in clinical rotations in bedside learning mostly in a teaching hospital. In the fourth year, students complete their rotations and take some electives. The student is then awarded an M.D. degree and begins postgraduate medical education in internships and residencies. In other countries, medical education is roughly similar but not identical to this.

In the United States, William Osler and Abraham Flexner were the two central figures in creating this form of education. Today—more than a hundred years after their initial impact—their names appear more often than those of any other individuals in searches of current issues of American medical journals. Osler was not a lecture-hall teacher. And Flexner was not even a physician or a surgeon; he had no medical training at all, but rather was an educational reformer of colleges and universities.

In Europe, students had been taught in hospitals to varying degrees according to the place and the era. Hospital teaching had been common in Germany, Britain, and France at least since the eighteenth century, and there is evidence that it had occurred well before that. In the best American medical schools, it was happening by the mid-nineteenth century. But it was not bedside learning as we understand the concept today.

Usually the student simply watched the teacher practice medicine. The teacher might hold rounds, strolling through wards followed by dozens of students, who crowded each other to get a view of what the teacher might be doing or to hear something of whatever conversation the teacher might be engaged in. He might ignore them, or he—always a he —might deliver a spontaneous mini-lecture, using the patient as a prop. This was not learning by doing. It was learning by watching and listening. It might amount to a lecture with a demonstration, as illustrated in Thomas Eakins’s paintings The Gross Clinic and The Agnew Clinic . The surgeon-professor operates on a patient and explains what he is doing while students sit in galleries watching and listening.

The single most important event in the history of medical education, and perhaps all professional education, was the founding of the Johns Hopkins School of Medicine and its teaching hospital in Baltimore. The hospital opened in 1888 and the medical school in 1893. The hospital opened first because it was the intellectual center of the medical school. Bedside learning was not to be an afterthought to classroom learning. Instead classroom learning’s purpose was to get the student to the bedside, where clinical thinking could be learned.

Before Hopkins, American medical education was inferior to the European in almost every respect. After Hopkins—and after what Flexner did on the basis of Hopkins—that was no longer true. American medical education improved dramatically, and it became extraordinarily expensive. Maintaining a teaching hospital is a staggering expense. Less so but still costly are the laboratories in which students work out the basic science introduced in classrooms.

Hopkins was a clean break in at least three ways. First, although a Hopkins clinical teacher might start by practicing medicine while students observed, quickly the student would begin diagnosing and treating while the teacher watched and critiqued. The student would learn how to do by doing. Something like this had happened in some places and times in Europe, but it was infrequent if not rare, and it was not institutionalized as the entire clinical experience for every student.

Second, before Hopkins the hospitals where students were present had not been true teaching hospitals. Mostly they were hospitals that happened to permit teaching on the premises. The Johns Hopkins hospital, however, was designed specifically for teaching and learning. Students were its reason for being.

Third, a hospital that allowed teaching on the premises had been only loosely connected with or at most an appendage to a medical school. But the Hopkins hospital was the centerpiece of the medical school. The curriculum was organized around the hospital.

The catalyst was Osler, a Canadian who had been teaching at the University of Pennsylvania and was appointed the hospital’s physician in chief. The wards were his classroom, and his goal was to ingrain in students what he called “clinical wisdom.” He wrote, “The natural method of teaching the student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end.” Osler wrote The Principles and Practice of Medicine , “the first great textbook of modern medicine” and in its time “the dominant medical textbook in the English-speaking world.” He became a world-famous physician whose diagnoses patients would travel great distances to obtain. But he did not consider those to be his most valuable achievements. Instead he wrote, “I desire no other epitaph than the statement that I taught medical students in the wards.” 11

Flexner, a theorist in learning and teaching, saw to it that every American medical school would either convert to Osler’s model or cease to exist. The Carnegie Foundation for the Advancement of Teaching commissioned him to investigate the quality of medical education. His book-length report to the Foundation in 1910 is one of the most influential documents in American higher education.

Flexner held every American and Canadian medical school to the Hopkins standard, and he named the ones that failed that standard and explained in detail how they failed it. He wrote—and this is the most widely quoted passage in his report—that in the best medical schools “the student no longer merely watches, listens, memorizes; he does . His own activities in the laboratory and in the clinic are the main factors in his instruction and discipline. An education in medicine nowadays [in 1910] involves both learning and learning how; the student cannot effectively know, unless he knows how.” 12

On the Flexner report’s publication, a New York Times headline read “Factories for the Making of Ignorant Doctors; Carnegie Foundation’s Startling Report That Incompetent Physicians Are Manufactured by Wholesale in This Country.” The public was so shocked that a credible medical school became impossible without a teaching hospital on the Hopkins model. Every medical school in North America either acquired one or merged with another school that had one or closed for good. Some freestanding medical schools were absorbed into universities. Many perished.

It was at this point that medical education truly entered the American university both physically and intellectually. American universities were re-creating themselves on the German model as centers of both learning and research. The concept of a true teaching hospital was a substantial intellectual achievement and afterward lent itself to research as well as learning because every part of the practice of medicine was available for empirical analysis. Medical schools became the benchmark against which other professions’ schools were measured.

After Flexner’s 1910 report, the Carnegie Foundation for the Advancement of Teaching sent him to Europe to evaluate medical education there. He delivered that report in 1912, concluding that no true medical school existed in England because no institution provided a complete medical education, combining the academic with the clinical. 13 Oxford and Cambridge taught only the domain knowledge that American medical schools call basic science. Students graduated with a bachelor’s degree in medicine and then got clinical experience through what amounted to an apprenticeship in a hospital unaffiliated with a university. As apprenticeships, these positions were quite good. But they were only apprenticeships; their learning was by osmosis rather than the result of teaching.

In France, Flexner found that all the medical schools were in universities and had dedicated wards in charity hospitals, but “the French medical school is nowhere conceived as an organic whole.” 14 The academic faculty on university campuses and the clinical faculty in the distant charity wards ignored each other and did nothing to coordinate their curricula and teaching. Flexner was impressed with the clinical teaching, but he felt that the French hospital teaching methods relied too much on having students observe and imitate what their teachers did rather than giving them responsibility and critiquing what they did.

Flexner found the German method of clinical instruction to be a demonstrative lecture in which the teacher described a medical problem and a correct way to solve it. Some of these lectures included exercises in which students performed tasks in the classroom rather than with the patients on the wards. The student was not learning “how to unravel the puzzle that the patient presents.” 15 German clinical teaching had once been more individualized and closer to the Hopkins model but deteriorated in the late nineteenth century under the pressure of rapidly increasing enrollments.

In all three countries, Flexner saw little adherence to the pedagogical self-discipline necessary for the student to gain knowledge-in-action, expressed thus by C. M. Jackson in 1913: “Never tell a student anything he can observe for himself; never draw a conclusion or solve a problem which he can be led to reason for himself; and never do anything for him that he can do himself.” 16

Through formal and informal colonization and example, European concepts of medicine and medical education spread throughout the world. A colonizing power would typically establish its own health care systems and require professionals to meet its licensing and educational requirements. In countries that hadn’t been colonized formally, missionaries might establish standards through example when they founded hospitals and schools. China, for instance, had twenty-six medical schools in 1916, and thirteen of them were run by missionaries. 17

In American teaching hospitals, the learning environment has eroded over recent decades. The intimate teaching of Osler’s Hopkins is becoming more difficult to find. It has not disappeared, as similar teaching did in Germany toward the end of the nineteenth century. But the declines have been strikingly similar in the two countries and eras. In Germany it happened when enrollment exploded and outstripped faculty resources. In the United States, managed care and shrinking government spending have diverted clinical faculty members into generating revenue through faculty practice plans. Many of them now teach little or not at all.

Architecture

Just as medicine is both a profession and a science, architecture is both a profession and a fine art. Both the profession and the art are learned in the design studio, where students plan buildings, are critiqued in their work, and learn how to think architecturally. An architecture school is organized around its design studio, and architectural education’s values and practices are studio values and practices. The history of architectural education is essentially the history of the French atelier and its evolution into the design studio.

A studio teacher assigns a problem by specifying a site and the type of building the student must design for it. The student sits at a design table and thinks by drawing. Lawyers think in words, engineers think in numbers, and architects think in pictures. In the design studio, the student might work for long periods in silence. The teacher might occasionally watch for a while and then move on to watch other students, conversing little. Or the teacher might ask the student a few questions or make some brief comments. Or the teacher might comment visually by drawing something related to the student’s design while the student watches. The two will have communicated with each other much more than the few words might suggest.

The design studio resembles an art class in which many students are drawing the same model. In fact the design studio and the art class have a common ancestor. In 1816 the Ecole des Beaux-Arts in Paris was created from the merger of the Académie d’Architecture, founded in 1671, and the Académie de Peinture et de Sculpture, founded in 1648.

Henceforward painting, sculpture, and architecture were “taught as one discipline,” 18 and architectural education began to take its modern form. In regard to architecture, learning in the Ecole was learning in an atelier , where students shared space with a patron , a master architect approved by the Ecole. There students critiqued each others’ work, and the master might deliver judgments, either helpful or destructive.

Beginning in the mid-nineteenth century, a few American architects who had studied in France began teaching in their own ateliers in the United States. By the turn of the twentieth century, formal education in a degree-granting architecture school was the common credential of a young American architect. When American universities opened architecture schools, they hired atelier -trained faculty, who renamed the atelier the design studio, adapted its practices to a university setting, and created side courses to supplement the studio and prepare students for it.

In England, architectural education followed a different path. Sir Christopher Wren, the architect of St. Paul’s Cathedral, was appointed surveyor-general of the Royal Works in 1669, and he treated the Works “not just as an organisation for erecting and maintaining buildings but also as a school of architecture and of building in its broader sense, wherein all manner of skills and aptitudes might be nurtured and developed.” One carpenter gradually took on greater responsibility and, after showing some promise, learned architecture by assisting and eventually became an architect himself. A joiner did the same thing. So did an apprentice plasterer.

Outside the Works, an aspirant could enter into apprenticeship or pupilage with an architect. An apprentice paid for instruction with labor, and a pupil paid with money. By 1819 two-thirds of the architects in England had learned in pupilage. Other routes existed as well. Uneducated but talented people might enter through crafts, as builders might start to design the structures they built. At the opposite extreme, educated and creative members of the upper classes might practice architecture based on “the Renaissance belief that the arts of painting, sculpture, and architecture were simply three branches of the same art of design ( desegno ) and that transfer across them was therefore easy.” 19

Atelier learning did not enter this characteristically English chaos the same way it entered American architecture, which energetically emulated French methods. But the concept of architecture as art had been well established in England, and it is difficult to learn any art without a studio. Eventually licensure required formal training in architecture schools, which educated not only in classrooms but also in studios.

Architectural education’s history is less complex than that of other professions because the core issues were more quickly resolved. Schools did not need to defeat apprenticeships. They absorbed them, as with the Ecole and the atelier . And it was not difficult to determine the allocation of resources between the teaching of knowledge and the teaching of knowledge-in-action. In the arts a person who knows an art but cannot do it is a spectator.

In the United States, the history of education for the profession of teaching is a progression from normal schools to teachers colleges to university postgraduate education departments. Normal schools were the earliest American institutions preparing enrollees for careers as teachers in primary and secondary education. Massachusetts founded the first normal school in 1839; later in the century normal schools were established throughout the United States. They filled a pressing need as local governments created and expanded public school systems. A normal school might have a one-, two-, or three-year curriculum, in some places longer, and “students dropped in and out … as the institutions served their needs and interests” in a profession where hiring was often at the whim of local officials who understood little about education. A normal school preparation was not generally a requirement for career employment, and it was never true that most teachers had attended a normal school. 20

In the first half of the twentieth century, normal schools evolved into teachers colleges granting four-year bachelor’s degrees, typically under state sponsorship. Some teachers colleges grew into universities. For example, a normal school founded in Tempe, Arizona, in 1885 became Tempe State Teachers College in 1925, Arizona State College in 1945, and Arizona State University in 1958. It now has over eighty thousand students on four campuses, its own medical and law schools, as well as a graduate school of education.

While normal schools were becoming colleges, a bachelor’s degree was becoming a prerequisite to employment as a primary or secondary school teacher. A bachelor’s program would cover the subject—math or history, for example—that the student would teach after graduation. In a postgraduate education department, a teacher would earn a master’s degree in the skill of teaching. Typically a school district would hire a person with a bachelor’s degree to teach in a primary or secondary school, and that person would subsequently earn a master’s degree. By 1986 this had passed the threshold to becoming normative: more than half the primary and secondary school teachers in the United States had master’s degrees.

Since at least the 1980s, American schools of education—which include colleges and departments of education in universities—have been vehemently criticized and demeaned, an easy target blamed for supposedly poor teacher preparation and low student achievement. David Labaree argues that this critique has impacted the caliber of students and faculty attracted to the schools, the way the public has responded to the schools’ research and teaching, and the schools’ influence on K–12 education. Moreover schools of education have faced a daunting challenge in preparing teachers, since teaching is a complex process requiring its practitioners to motivate “cognitive, moral, and behavioral change in a group of involuntary and frequently resistant clients.” In their efforts to find legitimacy and status, schools of education found common ground with other nonelite professional schools like those of nursing and social work. 21

This scapegoating of American education schools emerged as part of a nationwide angst about schooling that had been growing during the 1960s and 1970s. In 1983 the federal government issued A Nation at Risk: The Imperative for Educational Reform , a scathing report declaring, among other things, that teacher preparation programs needed substantial improvement. Some reforms were tried. One approach was to push for alternatives to university-based teacher preparation programs, as for example, placing scientists and mathematicians directly in schools without training in pedagogy. Another approach was to develop professional development schools, strong partnerships between universities and schools, to strengthen the preparation of teachers. Modeled after medical schools’ teaching hospitals, this concept, proposed by prominent associations like the Holmes Group (composed of deans of education) and the Carnegie Task Force on Teaching, focused on both content and pedagogy and included recommendations to raise teacher standards, develop career ladders, and establish accountability measures. Consistent among the reform efforts was the idea that the status of teaching should be raised to the level of law and medicine. 22

In other countries, twentieth-century educational reform efforts similarly affected teacher preparation institutions. In England in the 1980s and 1990s, the push was to improve the quality of teaching through contradictory means, by both centralizing and decentralizing control of schools. Control was centralized with a national curriculum and national assessment on student achievement at the same time that control was decentralized with efforts to empower schools in decision-making. The result was incoherent and poorly conceived reform efforts in teacher preparation. Control was similarly at issue in Japan, where teacher education reform efforts from the 1950s through the 1980s pitted the Ministry of Education against the powerful Japan Teachers Union. After a protracted struggle, the government in the late 1980s succeeded in gaining greater authority in the certification of teachers and other matters concerning teaching and teacher education. Reforms in teacher education were not at the forefront in younger countries that achieved independence as late as the mid-twentieth century. In Indonesia, for example, which became fully independent in 1949, the national focus was on expanding access to elementary schools, and this effort only began in the late 1960s. By the 1980s and 1990s, the effort to increase educational access moved to secondary and higher education institutions. In this context, the issue of improving teacher preparation programs did not receive close scrutiny until the 1990s. Since then, issues of teacher quality, low pay, and the reduction of teaching appointments due to budget cuts have negatively impacted teacher preparation programs. 23

Donald A. Schön, “Educating the Reflective Legal Practitioner,” Clinical Law Review 2 (1995): 231, 249.

Donald A. Schön, Educating the Reflective Practitioner: Toward a New Design for Teaching and Learning in the Professions (1987; repr. San Francisco: Jossey-Bass, 1990) , 15.

Thorstein Veblen, The Higher Learning in America (1918; repr. Stanford, CA: Academic Reprints, 1954), 211.

Charles Homer Haskins, The Rise of Universities (New York: Henry Holt, 1923), 15.

To the Happy Few: Selected Letters of Stendhal , trans. Norman Cameron (London: John Lehmann, 1952), 371.

Alfred Z. Reed, Present-Day Law Schools in the United States and Canada , Bulletin No. 21 (New York: Carnegie Foundation for the Advancement of Teaching, 1928), 215; Marjorie M. Shultz and Sheldon Zedeck, “Predicting Lawyer Effectiveness: Broadening the Basis for Law School Admission Decisions,” Law & Social Inquiry 36 (2011): 620.

Bruce A. Lasky and M. R. K. Prasad, “The Clinical Movement in Southeast Asia and India,” in The Global Clinical Movement: Educating Lawyers for Social Justice , ed. Frank S. Bloch (New York: Oxford University Press, 2011), 37.

Malee Pruekpongsawalee, “Thammasat Clinical Education and the Delivery of Legal Services: A Historical and Personal Perspective,” in Educating for Justice around the World , ed. Louise G. Trubek and Jeremy Cooper (Brookfield, VT: Ashgate, 1999), 118, 120; Shigeo Miyagawa, Takao Suami, Peter A. Joy, and Charles D. Weisselberg, “Japan’s New Clinical Programs: A Study of Light and Shadow,” in Bloch, The Global Clinical Movement , 105–108.

Sami Hamarneh, “Medical Practice and Education in Medieval Islam,” in The History of Medical Education , ed. C. D. O’Malley (Berkeley: University of California Press, 1970) , 39, 40.

Quoted in W. R. Bett, Osler: The Man and the Legend (London: Heinemann, 1951), 74; Michael Bliss, William Osler: A Life in Medicine (New York: Oxford University Press, 1999) , ix, 191; Gert H. Brieger, “Clinical Teaching and Clinical Science in American Medicine, 1900–1950,” Clio Medica 21 (1987–1988): 47, 49.

Abraham Flexner, Medical Education in the United States and Canada , Bulletin No. 4 (New York: Carnegie Foundation for the Advancement of Teaching, 1910) , 53, emphasis in original.

Abraham Flexner, Medical Education in Europe , Bulletin No. 6 (New York: Carnegie Foundation for the Advancement of Teaching, 1912) , 192.

Ibid., 231.

Ibid., 179, 167.

C. M. Jackson, “On the Improvement of Medical Teaching” in Medical Education and Research , ed. J. McKeen Cattell (New York: Science Press, 1913), 92.

Pierre Huard, “Medical Education in South-East Asia (Excluding Japan),” in O’Malley, The History of Medical Education , 367, 373.

Peter Collins, “Architectural Criteria and French Traditions,” AIA Journal 46, no. 2 (August 1966): 67, 70.

Mark Crinson and Jules Lubbock, Architecture, Art or Profession? Three Hundred Years of Architectural Education in Britain (New York: Manchester University Press, 1994), 7, 20.

James W. Fraser, Preparing America’s Teachers: A History (New York: Teachers College Press, 2007) , 47, 59, 115.

David Labaree, The Trouble with Ed Schools (New Haven, CT: Yale University Press, 2004 , 3–13).

Alison Rutter, “Purpose and Vision of Professional Development Schools,” Teachers College Record 113, no. 14 (2011): 289–305.

Meg Maguire and Stephen J. Ball, “Teacher Education and Education Policy in England,” in Teacher Education in Industrialized Nations: Issues in Changing Social Contexts , ed. Nobuo K. Shimahara and Ivan Z. Holowinsky (New York: Garland, 1995), 225–254; Nobuo K. Shimahara, “Teacher Education Reform in Japan: Ideological and Control Issues,” in Shimahara and Holowinsky, Teacher Education in Industrialized Nations , 155–193; T. Raka Joni, “Indonesia,” in Teacher Education in the Asia-Pacific Region: A Comparative Study , ed. Paul Morris and John Williamson (New York: Falmer Press, 2000), 75–106.

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The New Professionalism: An Exploration of Vocational Education and Training Teachers in England

First Online: 01 January 2014
pp 1099–1124

Cite this chapter

define the concepts of professionalism in education and training

James Avis 4 &
Kevin Orr 4

Part of the book series: Springer International Handbooks of Education ((SIHE))

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In the current conjuncture important themes surrounding models of professional learning are those that stress the significance of practice-based workplace learning as well as the salience of on-going CPD. There is some articulation between this work and conceptualisations of a new professionalism that seeks to overcome the ‘elitism’ of earlier forms. There is also a link with a critique of impoverished conceptualisations of professionalism rooted within audit, performativity and standards. These newer forms seek to develop models of accountability that engage with the broader community and are characterised by democratic relations. Notions such as dialogic and ecological, or indeed models of preferred professionalism capture these ideas, as do discussions of hybrid inter-professionalism. The chapter interrogates these notions together with their significance for conceptualisations of professional learning. In addition it problematises conceptualisations of the ‘new’ professionalism. It could be argued Thatcherism interrupted all sorts of radical projects, amongst which were those orientated towards the development of emancipatory and dialogic models of teacher practice. These practices could be construed as embodying forms of dialogic and collective professional learning, that in some ways anticipated current debates. The chapter concludes by arguing that these approaches can only take us so far and that they need to be aligned to a radical transformative politics to fulfil their potential. For without such a stance they can easily be appropriated by forms of conservative modernisation.

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Work-based Learning in Teacher Education: A Scottish Perspective

The policy context of teachers’ workplace learning: the case for research-based professionalism in teacher education in england, framing workplace learning.

English Further Education nestles between the end of compulsory schooling and degree level study, and has been orientated towards the provision of non-advanced vocational/technical and general education, as well as adult and community education. It has never been an easily definable sector – characterised by diversity, shifting boundaries and is delivered not only within FE colleges but by a variety of providers. FE provision can range from basics skills to degree level work, with providers being marked by their particular histories as well as their local and regional contexts.

Inevitably, there will be some schoolteachers who are dual professionals.

It is important at this stage to introduce a caveat concerning the breadth of this chapter, particularly in relation to what one reviewer referred to as ‘the elephant in the room’, namely the affordances for learning of web-based resources. These are clearly significant and could constitute a chapter in their own right. If we were to address these questions with the seriousness they deserve we would have found ourselves engaging with Italian workerism and the manner in such arguments are played out in current theoretical discussions (see for example, Cederström and Fleming 2012 ; Peters and Bulut 2011 ; Berardi 2009 ; Virno 2008 ).

Grace ( 1987 ) cites White to illustrate the way in which teachers and local autonomy were conceived as a bulwark against socialism in the UK in the 1920s/1930s. “If parliament still controlled the content of education, the socialists would change the regulations… they would be able to introduce curricula more in line with socialist ideas. To forestall this it was no longer in the interests of the conservatives to keep curriculum policy in the hands of the state… if they could devise a workable system of non-statutory control the conservatives had everything to gain and nothing to lose by taking curricula out of the politicians hands.” (White cited in Grace 1987 , p. 207). Interestingly it was under a Conservative government that a national curriculum was introduced in 1988, some 100 years after the UKs continental rivals.

Lingard et al. ( 2008 ) refer to this as a, “duality of policy [is] informed, arguably, by the state seeking to regulate different class interests and concerns. One set of strategies is designed to satisfy the possessive individualism of the advantaged, providing them with the positional goods to secure their relative advantage in the spaces of the mobile global economy. While another set of strategies that are creating an integrated and collaborative Children’s Service is designed to provide ‘wrap around’ care and 14–19 vocational training to secure adaptation of disadvantaged children and families to the changing demands of local labour in its place. Thus we are possibly seeing a new correspondence between class structure, educational provision and differing local and global labour markets”. (Lingard et al. 2008b , p. 14)

Five outcomes are embedded in Every Child Matters;

being healthy: enjoying good physical and mental health and living a healthy lifestyle

staying safe: being protected from harm and neglect

enjoying and achieving: getting the most out of life and developing the skills for adulthood

making a positive contribution: being involved with the community and society and not engaging in anti-social or offending behaviour

economic well-being: not being prevented by economic disadvantage from achieving their full potential in life. (DfES 2003 , pp. 6–7)

Y outh Matters commenting upon four key challenges states these as being:

how to engage more young people in positive activities and empower them to shape the services they receive;

how to encourage more young people to volunteer and become involved in their communities

how to provide better information, advice and guidance to young people to help them make informed choices about their lives; and

how to provide better and more personalised intensive support for each young person who have serious problems or get into trouble. (DfES 2005 , p. 5)

Billett writes, “finding means to legitimately and authoritatively recognise skills acquired through work hold the prospect of providing just arrangements for these otherwise disadvantaged workers as well as those requiring recognition throughout their working life”. [my emphasis] ( 2005 , p. 944)

Bourdieu describes habitus as a person’s set of individual dispositions and behaviour; it is ‘a product of the incorporation of objective necessity’ or having a ‘feel for the game’ ( 1990 , p. 11). This understanding sees learning as a situated social practice that leads to change in the individual and which may be seen in the use of language and the making of professional judgements.

Abbott, A. (1988). The system of professions: An essay on the division of expert labour . Chicago: University of Chicago Press.

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Avis, J., Orr, K. (2014). The New Professionalism: An Exploration of Vocational Education and Training Teachers in England. In: Billett, S., Harteis, C., Gruber, H. (eds) International Handbook of Research in Professional and Practice-based Learning. Springer International Handbooks of Education. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8902-8_40

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A contemporary definition of professionalism in education Considering the above, differences in needs and understandings led to lack of consensus in the meaning of professionalism (Fox, 1992; Hargreaves and Goodson, 1996; Freidson, 1994). Contemporary meanings of professionalism highlight the influence of social, political and
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Colley, H. (2011). Learning to labour with feeling: Class, gender and emotion in childcare education and training. In Marxism and education: Renewing the dialogue, pedagogy, and culture (Marxism and education). New York: Palgrave. Google Scholar Crook, D. (2008). Some historical perspectives on professionalism.