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Acad Med. 2014 Jun;89(6):944-50. doi: 10.1097/ACM.0000000000000240.

A tale of two cities: understanding the differences in medical professionalism between two Chinese cultural contexts.

Author information

Dr. Ho is assistant dean for international affairs and professor, Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Dr. Yu is a PhD student, Biomedical Informatics Training Program, Stanford University School of Medicine, Stanford, California. Dr. Pan is professor, Department of Endocrinology and Metabolism, and vice director, Department of Education, Peking Union Medical College Hospital, Beijing, China. Ms. Norris is a research assistant, National Taiwan University College of Medicine, Taipei, Taiwan. Ms. Liang is a research assistant, National Taiwan University College of Medicine, Taipei, Taiwan. Ms. Li is an MD candidate, Peking Union Medical College, Beijing, China. Dr. Hirsh is associate professor Harvard Medical School, Boston, Massachusetts, and Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts.



To compare stakeholders' constructs of medical professionalism in two Chinese cultural contexts.


Between November and December 2011, the authors adopted the nominal group technique (NGT) to elicit professional competencies valued by 97 medical education stakeholders at Peking Union Medical College (PUMC) in Beijing, China. Participants categorized the professional competencies according to an existing framework developed at National Taiwan University College of Medicine (NTUCM) in Taipei, Taiwan; they also modified and developed new categories for the framework. The authors analyzed NGT transcripts to construct a visual medical professionalism framework for PUMC and compared it with that of NTUCM.


The Chinese stakeholders endorsed seven of the eight competencies identified in the Taiwanese framework: clinical competence, communication, ethics, humanism, excellence, accountability, and altruism. For the eighth competency, integrity, the Chinese participants preferred the term "morality." They also added the competencies of teamwork, self-management, health promotion, and economic considerations. Both frameworks differed from typical Western professionalism frameworks in emphasizing morality and the integration of social and personal roles.


The resemblance between the Chinese and Taiwanese frameworks in the prominence of morality and integrity suggests the influence of Confucianism. The exclusively Chinese articulations of teamwork, health promotion, and economic considerations appear to derive from social, political, and economic factors unique to Mainland China. This study demonstrates the dynamic influence of cultural values, social history, and health care systems on the construction of medical professionalism frameworks and calls for further research to adapt global frameworks to fit specific local contexts.

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