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Trustworthiness is the cornerstone professional virtue in the practice of medicine. The authors' goals for this Invited Commentary were to provide an account of the professional virtue of trustworthiness and its historical origins as well as to suggest how trustworthiness in a professional curriculum can be taught and assessed. They identified 2 components of trustworthiness that originate in the work of John Gregory (1724-1773) and Thomas Percival (1740-1804), who invented the ethical concept of medicine as a profession. The first is intellectual trust, the commitment to scientific and clinical excellence. The second is moral trust, the primary commitment of physicians and health care organizations to promote and protect the interest of patients while keeping individual and group interests secondary. Teaching should focus first on the mastery and understanding of the conceptual vocabulary of intellectual and moral trust through a range of formats, including modeling by faculty on how they respect and treat patients and learners. Assessment should be behaviorally based and articulated in increasing, observable, and integrated levels of mastery through training. Medical educators and academic leaders also share the responsibility to inculcate and sustain an organizational culture of professionalism that is respectful, critically self-appraising, accountable, and committed to its learners and to the promotion of physician well-being. These proposals can be used by medical educators and academic leaders to assist learners to become and remain trustworthy physicians.

BACKGROUND Measurement of the quality of team processes in medical education, particularly in classroom-based teaching settings, has been limited by a lack of measurement instruments. Therefore, the purpose of this study was to develop and test an instrument to measure the quality of team interactions. METHOD The authors created 30 items and reduced these to 18 items using factor analysis. They distributed the scale to 309 second-year medical students (RR = 95%) in a course that used teams and measured internal consistency, validity, and differences in scores between teams. RESULTS Cronbach's alpha for the scale was 0.97. Team ratings were variable, with a mean score of 95.7 (SD 8.5) out of 108. Team Performance Scale (TPS) scores correlated inversely with the spread of peer evaluation scores (r = -0.38, P = .003). Differences between teams were statistically significant (P < .001, eta = 0.33). CONCLUSIONS The TPS was short, had evidence of reliability and validity, and exhibited the capacity to distinguish between teams. This instrument can provide a measure of the quality of team interactions. More work is needed to provide further evidence of validity and generalizability.

PURPOSE Although medical ethics research is frequently published in medical journals, little is known about the prepublication review such articles receive. The authors sought to describe the prepublication review of medical ethics research at major medical journals and medical ethics journals. They also sought to compare the ethics backgrounds of editors at both journal types and editors' attitudes concerning the training necessary for reviewers of ethics research. METHOD In November 2006, the authors distributed a 19-item survey via the Internet and mail to editors of major medical journals, specialty medical journals, and medical ethics journals. The survey collected data on the use of peer review, importance of peer review, ethics training of editors, and editors' attitudes regarding the appropriate training for reviewers. Multiple-choice and open-response questions measured peer review use characteristics, and questions weighted with a five-point scale measured editor attitudes. RESULTS Medical journals and medical ethics journals almost always peer reviewed articles examining topics in medical ethics and considered this review important to enhancing the quality of published ethics research. However, medical journals were less likely to have an editor with advanced training in ethics as compared with medical ethics journals (7% versus 100%, P < .001), and their editors viewed specialized training in ethics as less important for a reviewer than did medical ethics journal editors (2.56 versus 3.88, P = .035). CONCLUSIONS Physicians should be aware that ethics articles in prominent medical journals may not have been appropriately reviewed by a reviewer with specialized training in ethics.