21 – 10 – 2025
Workgroup 1
1. Noordegraaf (2020)
a) Describe what connective professionalism entails using the concepts expertise, autonomy, and
authority.
Connective professionalism refers to a form of professionalism that emphasizes collaboration,
interdependence, and responsiveness across professional boundaries.
Expertise: Instead of relying solely on exclusive, occupation-specific expertise, professionals
in connective professionalism integrate and share knowledge with other experts,
stakeholders, and clients. Expertise becomes situated and relational rather than isolated and
protected.
Autonomy: Professional autonomy is negotiated rather than absolute. Professionals exercise
discretion within networks, organizations, and multidisciplinary teams, balancing their
independent judgment with accountability to others.
Authority: Authority is earned through cooperation and legitimacy rather than through
formal status or monopoly. Professionals gain trust by demonstrating responsiveness,
transparency, and problem-solving capacity within complex systems.
In short, connective professionalism blends professional independence with collaboration and
accountability, reflecting today’s interdependent service environments.
b) How does connective professionalism differ from protective professionalism? Use the concepts
expertise, autonomy, and authority.
Protective professionalism seeks to shield professions from external pressures, while connective
professionalism redefines professionalism as collaborative, adaptive, and outward-looking.
2. Martimianakis et al. (2009) — Four views on professionalism
Martimianakis et al. identify four dominant ways of framing or understanding professionalism in
medical education and practice. In your own words:
Traits and behaviour
Professionalism is a set of personal attributes—such as honesty, integrity, and compassion—that
individuals should possess. It focuses on character and moral behavior.
Role in society
Professionalism is observable conduct. It is defined by how professionals act in practice (e.g.,
showing respect, following ethical rules, maintaining boundaries) and can be assessed or taught
through role-modelling.
Social construct
Professionalism is developed over time as individuals internalize the values and norms of their
profession through socialization, mentorship, and reflection.
Means of social control
Professionalism is socially constructed and embedded in power relations. It should be analyzed
critically—who defines professionalism, whose interests it serves, and how it may reinforce
inequalities or hierarchies.
,3. Waring & Currie (2009) — Five strategies of professionals toward knowledge management
Waring & Currie studied how professionals respond to managerial initiatives (like knowledge
management systems) that may challenge their expertise or autonomy. They identified five
strategies:
Compliance
Professionals accept and follow new systems or managerial demands without resistance. They align
with organizational goals, even if this reduces some autonomy.
Co-optation
Professionals appropriate or reinterpret managerial tools for their own purposes, maintaining some
control while appearing cooperative.
Adaptation
Professionals adjust their practices to fit new systems, finding a middle ground where professional
values and managerial requirements coexist.
Circumvention
Professionals bypass or work around managerial systems, continuing to rely on traditional informal
networks or tacit knowledge.
Resistance
Professionals actively oppose or reject managerial initiatives, defending their professional autonomy
and traditional work practices.
Discuss how shared decision making will affect professionalism. Use the concepts expertise,
autonomy, and authority.
If you practice connective professionalism, this is a form of shared decision making as you engage
multiple actors. In terms of expertise: instead of relying solely on exclusive, occupation-specific
expertise, professionals in connective professionalism integrate and share knowledge with other
experts, stakeholders, and clients. This is a form of shared decision making as you rely on others to
, integrate and share knowledge. Expertise becomes situated and relational rather than isolated and
protected.
In terms of autonomy: it is negotiated rather than absolute. Professionals exercise discretion within
networks, organizations, and multidisciplinary teams, balancing their independent judgment with
accountability to others, and therefore this is another form of shared decision-making, as autonomy
now is “shared” instead of individual. Decisions are made together.
In terms of authority: in connective professionalism it is earned through cooperation and legitimacy
rather than through formal status or monopoly. Professionals gain trust by demonstrating
responsiveness, transparency, and problem-solving capacity within complex systems. This enhances
shared-decision making as it reduces the paternalistic idea.
Looking from a protective professionalism viewpoint: how will shared decision-making affect
professionalism of physicians in a consultation room?
Expertise: SDM can doubt the expertise of the physician.
Expertise is seen to be solely belonging to professional, and thus they have the proper expertise to
make a decision. They determine the decision.
Autonomy: three types (clinical (=deciding treatments; individual level), political (=deciding policies;
group level), economical (=deciding fees, bonuses, budgets etc; group level)).
- Clinical autonomy is also called professional discretion; freedom to deviate from guidelines
and protocols. Physician has freedom to deviate from protocols because of individual
characteristics.
- Clinical autonomy is fixed within physician; they have autonomy to choose.
o SDM threatens clinical autonomy, by allowing the patient to be involved in decisions
about clinical situations, treatments etc. judgement of patient is incorporated.
- Economical autonomy: treatment choice by patient in SDM influences fees etc. so it
influences, but does not limit the economical autonomy itself.
- Political autonomy: policies may change on higher level because of patient engagement (e.g.
types of treatment they choose). But the political autonomy itself is not limited.
- So, only clinical autonomy is threatened in SDM, not political and economical!
Authority: SDM challenges (dependent on situation) the authority position of physician, because
patient is also expected to be given a voice in decisions. Authority is something that is fixed;
physician has it, and it is given to them by society.
In the protective professionalism viewpoint, the physician has a more paternalistic role. This inhibits
shared decision making, as the authority lies more with the physician and there is little room for
negotiation with the patient. For example, the patient may say what their symptoms are, and based
on that the physician comes to a conclusion and prescribes the patient something, without
considering their input.
Looking from a connective professionalism viewpoint: how will shared decision-making affect
professionalism of physicians in a consultation room?
In this case, the patient would be more involved in the consultation, as from this viewpoint, the
authority is shared/not a given but has to be earned, expertise is not exclusive but dependent on
context and is shared, and autonomy is negotiated and based on trust and collaboration. In other
Workgroup 1
1. Noordegraaf (2020)
a) Describe what connective professionalism entails using the concepts expertise, autonomy, and
authority.
Connective professionalism refers to a form of professionalism that emphasizes collaboration,
interdependence, and responsiveness across professional boundaries.
Expertise: Instead of relying solely on exclusive, occupation-specific expertise, professionals
in connective professionalism integrate and share knowledge with other experts,
stakeholders, and clients. Expertise becomes situated and relational rather than isolated and
protected.
Autonomy: Professional autonomy is negotiated rather than absolute. Professionals exercise
discretion within networks, organizations, and multidisciplinary teams, balancing their
independent judgment with accountability to others.
Authority: Authority is earned through cooperation and legitimacy rather than through
formal status or monopoly. Professionals gain trust by demonstrating responsiveness,
transparency, and problem-solving capacity within complex systems.
In short, connective professionalism blends professional independence with collaboration and
accountability, reflecting today’s interdependent service environments.
b) How does connective professionalism differ from protective professionalism? Use the concepts
expertise, autonomy, and authority.
Protective professionalism seeks to shield professions from external pressures, while connective
professionalism redefines professionalism as collaborative, adaptive, and outward-looking.
2. Martimianakis et al. (2009) — Four views on professionalism
Martimianakis et al. identify four dominant ways of framing or understanding professionalism in
medical education and practice. In your own words:
Traits and behaviour
Professionalism is a set of personal attributes—such as honesty, integrity, and compassion—that
individuals should possess. It focuses on character and moral behavior.
Role in society
Professionalism is observable conduct. It is defined by how professionals act in practice (e.g.,
showing respect, following ethical rules, maintaining boundaries) and can be assessed or taught
through role-modelling.
Social construct
Professionalism is developed over time as individuals internalize the values and norms of their
profession through socialization, mentorship, and reflection.
Means of social control
Professionalism is socially constructed and embedded in power relations. It should be analyzed
critically—who defines professionalism, whose interests it serves, and how it may reinforce
inequalities or hierarchies.
,3. Waring & Currie (2009) — Five strategies of professionals toward knowledge management
Waring & Currie studied how professionals respond to managerial initiatives (like knowledge
management systems) that may challenge their expertise or autonomy. They identified five
strategies:
Compliance
Professionals accept and follow new systems or managerial demands without resistance. They align
with organizational goals, even if this reduces some autonomy.
Co-optation
Professionals appropriate or reinterpret managerial tools for their own purposes, maintaining some
control while appearing cooperative.
Adaptation
Professionals adjust their practices to fit new systems, finding a middle ground where professional
values and managerial requirements coexist.
Circumvention
Professionals bypass or work around managerial systems, continuing to rely on traditional informal
networks or tacit knowledge.
Resistance
Professionals actively oppose or reject managerial initiatives, defending their professional autonomy
and traditional work practices.
Discuss how shared decision making will affect professionalism. Use the concepts expertise,
autonomy, and authority.
If you practice connective professionalism, this is a form of shared decision making as you engage
multiple actors. In terms of expertise: instead of relying solely on exclusive, occupation-specific
expertise, professionals in connective professionalism integrate and share knowledge with other
experts, stakeholders, and clients. This is a form of shared decision making as you rely on others to
, integrate and share knowledge. Expertise becomes situated and relational rather than isolated and
protected.
In terms of autonomy: it is negotiated rather than absolute. Professionals exercise discretion within
networks, organizations, and multidisciplinary teams, balancing their independent judgment with
accountability to others, and therefore this is another form of shared decision-making, as autonomy
now is “shared” instead of individual. Decisions are made together.
In terms of authority: in connective professionalism it is earned through cooperation and legitimacy
rather than through formal status or monopoly. Professionals gain trust by demonstrating
responsiveness, transparency, and problem-solving capacity within complex systems. This enhances
shared-decision making as it reduces the paternalistic idea.
Looking from a protective professionalism viewpoint: how will shared decision-making affect
professionalism of physicians in a consultation room?
Expertise: SDM can doubt the expertise of the physician.
Expertise is seen to be solely belonging to professional, and thus they have the proper expertise to
make a decision. They determine the decision.
Autonomy: three types (clinical (=deciding treatments; individual level), political (=deciding policies;
group level), economical (=deciding fees, bonuses, budgets etc; group level)).
- Clinical autonomy is also called professional discretion; freedom to deviate from guidelines
and protocols. Physician has freedom to deviate from protocols because of individual
characteristics.
- Clinical autonomy is fixed within physician; they have autonomy to choose.
o SDM threatens clinical autonomy, by allowing the patient to be involved in decisions
about clinical situations, treatments etc. judgement of patient is incorporated.
- Economical autonomy: treatment choice by patient in SDM influences fees etc. so it
influences, but does not limit the economical autonomy itself.
- Political autonomy: policies may change on higher level because of patient engagement (e.g.
types of treatment they choose). But the political autonomy itself is not limited.
- So, only clinical autonomy is threatened in SDM, not political and economical!
Authority: SDM challenges (dependent on situation) the authority position of physician, because
patient is also expected to be given a voice in decisions. Authority is something that is fixed;
physician has it, and it is given to them by society.
In the protective professionalism viewpoint, the physician has a more paternalistic role. This inhibits
shared decision making, as the authority lies more with the physician and there is little room for
negotiation with the patient. For example, the patient may say what their symptoms are, and based
on that the physician comes to a conclusion and prescribes the patient something, without
considering their input.
Looking from a connective professionalism viewpoint: how will shared decision-making affect
professionalism of physicians in a consultation room?
In this case, the patient would be more involved in the consultation, as from this viewpoint, the
authority is shared/not a given but has to be earned, expertise is not exclusive but dependent on
context and is shared, and autonomy is negotiated and based on trust and collaboration. In other
