Residency training in the Netherlands is to be restructured over the coming years. To this end a general competence profile for medical specialists has been introduced. This profile is nearly the same as the Canadian CanMEDS 2000 model, which describes seven general areas of medical specialist competence, one of which is professionalism. In order to establish a training programme for residents and their instructors based on this competence, it is necessary to develop a vision that does justice to everyday medical practice. The two most prevailing views of professionalism—as personal, or as a behavioural characteristic—fall short of this. Only when professionalism is understood as reflective professionalism does it encompass the fundamental contextuality of medical treatment. This means that the focus of training and assessment must be shifted to accountability for treatment.
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↵i The CanMEDS roles were updated in 2005 and the definitions of all roles and underlying competences were partly altered. These changes, however, do not influence our stand towards professionalism as a competence, as elaborated in this article.
↵ii Harden and colleagues4 5 use the term “meta-competence” to refer to a competence that can be expressed only via the performance of other competences. However, we prefer the term “second-order competence” in relation to professionalism, in order to underline its reflective and critical character.
Competing interests: None declared.