In Reply.—This letter makes some interesting comments that deserve further consideration. The authors note that in their home country of Turkey, ethics and professionalism education during pathology and laboratory medicine residency training is not standardized or organized. Their assessment is not all that surprising, because professionalism education during pathology residency could also generally be improved not only in the United States, but also in many other countries, where limited survey data have shown that education in ethics and professionalism is too often heterogenous or even nonexistent.1,2  All too often, residents are expected to learn professionalism through day-to-day exposure “to various good and bad examples,” as noted by the authors; that is, through the hidden curriculum.3  Thus, it is heartening to see that our recent article4  has served as a stimulus for the development of a more formal educational effort in professionalism. One of the intents of our article4  was to achieve this exact goal, and we thank the authors for the feedback and comments on their experience.

No less important, however, is that the authors raise a profound, philosophical question related to professionalism that deserves further comment. What defines professionalism in cultures outside of the Western/Eurocentric-dominated literature that has, for the most part, defined and framed many of our ideas of ethics and professionalism in pathology and medicine?58  Are there alternative paradigms for viewing professionalism in pathology? What can different cultures learn from each other about educating residents in professionalism? The authors note that they “devised a variation of the 5 case scenarios…better tailored for our population and work environments” that were initially presented in our paper.4  The authors also noted that cultural differences probably played a role in some of the responses and findings in their study, but they only allude to what those differences might have been. Unfortunately, we do not have the revised cases for comparison, so it is difficult to assess in more detail any potential cultural, social, or religious differences that might have played a role in the findings noted in their study.

More formal and in-depth cross-cultural and multinational studies from the Middle East, Asia, South America, Africa, etc, examining these potential differences and perspectives in medical professionalism are needed if we, as medical educators, are going to more fully understand what it means to be a professional as well as to better assess and remediate unprofessional behavior.59  This author suspects that such studies in professionalism will reveal more similarities than differences, but that the differences will prove enlightening and meaningful, and will potentially serve to enhance the professional underpinnings of our specialty.

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