The Professionalism subcommittee of Japan Society for Medical Education has been examining a diverse range of issues related to medical professionalism education for approximately the past 20 years. In July 2015, the committee formulated and presented a draft on “ The Attributes and Competencies of Physicians: An Exploration of Professionalism” Based on this, we have been conducting educational activities on professionalism education, but we had not documented this draft. We are now re-presenting the draft here with minor lexical corrections and additional notes. The professionalism of physicians is delineated in seven attributes and competencies :1. Sense of mission and responsibility towards society2. Practice of patient-centered health care3. Demonstration of integrity and justice4. Acceptance of diverse values and sharing of fundamental values5. Fulfilling roles as leaders/members in organizations and teams6. Pursuit of excellence and lifelong learning7. Self-management and career developmentThis document is presented with the expectation that it will contribute to future discussions on professionalism education.

Due to the importance of developing physicians' competencies to utilize information, science, and technology, the 2022 revision of the Model Core Curriculum for Medical Education newly established guidelines for qualities and competencies, which it refers to as "Competencies to utilize information, science, and technology." The Model Core Curriculum outlines these qualities as "understanding the ever-developing information society and practicing medical research and treatment while utilizing information, science and technology such as artificial intelligence." The guidelines are organized by the three perspectives of "ethical viewpoints and rules for dealing with information, science and technology," "principles of information, science and technology necessary for medicine and its surrounding society," and "utilization of information, science and technology in the medical field." The objectives of the course were set from the three perspectives of "ethics and rules for dealing with information, science and technology," "principles of information, science and technology necessary for medicine and the society surrounding it," and "utilization of information, science and technology in medical practice." We looked back on the process of formulating these qualities and competencies, which will become increasingly important, and discussed their future prospects.

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.

In the revised Core Curriculum, professionalism is listed as one of the basic qualities and abilities required of physicians. The definition of professionalism and related learning objectives (1. trust, 2. compassion, 3. liberal arts, and 4. bioethics) are also presented. However, the Core Curriculum does not explain why these objectives were listed. Therefore, some of them are difficult to understand or differ from what has been discussed in previous meetings of the current subcommittee (and previous committees). To properly and effectively advance professionalism education, it is necessary to confirm the contents of the revised Core Curriculum that are insufficient or inappropriate. It is also necessary to deepen the discussion for the next revision of the Core Curriculum. A symposium was held for this purpose. The main points of each lecture are presented within this report.

With the enactment of the amended Anti-Discrimination Act, which mandates the provision of reasonable accommodations, the urgent task for all health professional education institutions is to establish a support system for students with developmental disabilities. On the other hand, they are also required to fulfill their social accountability through quality assurance in education, such as the implementation of outcome-based education curriculum. In order to consider how to balance reasonable accommodations for students with developmental disabilities, quality assurance in education, and social accountability in undergraduate medical education, Professionalism Subcommittee held a workshop on April 22, 2023. The participants engaged in active discussions during the workshop.　Through a post-workshop survey, educational needs and challenges in supporting students with developmental disabilities were clarified, providing insights for future Subcommittee activities.

Significant event analysis (SEA) is a method of reflecting on the cause of things in a semi-structural manner and utilizing the analysis in the planning of subsequent improvement measures. SEA can be applied to a wide variety of events. In the field of medicine, it is widely used as a tool for promoting patient safety by medical teams in nations such as the United Kingdom. In Japan, the subjects of SEA mainly reflect on their own behavior (reflection) to learn from their experience. Unlike the results of observations done by third parties, the results of self-reflection cannot be denie by the subjects. Therefore, this method is particularly suitable for events in which the actor has been greatly moved emotionally.　The first paper presents an individual SEA method that utilizes individual reflection to improve behavior, the second paper introduces a group SEA method to share lessons learned from individual reflections.

Professionalism is the (right) way of being/doing things as a member of a particular profession. Evaluating legitimacy (right/wrong) of one’s behavior or the behavior of others is a moral judgement. Thus, professionalism is a set of desirable moral characteristics of a particular profession. The education of professionalism firstly promotes learning a set of desirable moral characteristics required in a profession. Secondly, it promotes the resolution of conflict with someone who has different moral characteristics. In this article, a possible learning strategy to promote these learning objectives will be explained based on the emerging knowledge of the science of human morality.

　The 18th term Ethics & Professionalism Committee started to visualize the final outcome of medical professionalism education in FY 2014. Contributions from 7 small groups in the workshop organized by the committee, accumulated knowledge on professionalism , and the outcome in career development education proposed by the Women Physician Career Education Committee were combined to produce the first draft. Public opinions were invited, and a consensus meeting was held to revise it. This draft consists of 7 sub-domains of medical professionalism:

　1. Relationship with patients and ordinary citizens

　2. Commitment to societal mission

　3. Morality expected of physicians

　4. Accepting various values and consideration of fairness

　5. Role as leaders/members of organizations and teams

　6. Pursuit of excellence and continuing professional development

　7. Self-control and career development

Further revision through society-wide discussion will be continued.

　Bushido is the so-called identity of the people of Japan, which was "invented" during the "official nationalism" movement in the Meiji era when the state of Japan pursued a policy of increasing wealth and military power. After the defeat of the second world war, nationalistic Bushido almost disappeared, while Nitobe's Bushido has been revived after a long absence. However, Nitobe's Bushido was originally described in English to explain peculiar conduct by samurai worriers, such as hara-kiri (self-immolation by disembowelment) and kataki-uchi (redress) .

　Descriptions of Bushido were written mostly in the Meiji Era as a professional code for the worrier class of samurai. Nitobe's Bushido is one of them, in which he focused heavily on Care/harm, Fairness/cheating, Loyalty/betrayal, and Authority/subversion among the moral intuitions of human beings. On the other hand, Care/harm, Fairness/cheating, and Liberty/oppression are the moral intuitions expected of physicians. This difference is large enough to potentially lead to serious ethical misconduct if physicians act the under Bushido code of professional ethics.