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Over 2,300 years ago, Aristotle — Greek philosopher, father of biology, tutor to Alexander the Great — posed a question that still cuts to the heart of what it means to be human: what is the highest good, the best life, any of us can achieve? For him, the answer is not wealth, nor is it fame or pleasure. Aristotle’s answer was eudaimonia — a word we loosely translate as “happiness,” but which means something richer and more demanding than a feeling. Unlike happiness in the modern sense, which is a temporary emotional state, eudaimonia refers to a profound and lasting sense of well-being that comes from living in accordance with our true nature. Call it flourishing. And the path to it, Aristotle argued, ran directly through the cultivation of virtue.

Virtue, for Aristotle, was not a rulebook or a list of commandments. It was character — a stable, ingrained disposition to act well, feel rightly, and choose wisely. What we might call today living with integrity. Acting from conscience. Following your moral compass. Being, in the fullest sense, authentic — not performing goodness for an audience but embodying it so completely that it becomes second nature.

True flourishing, living the best possible life, is not the product of luck or wealth, but a state that must actively be built through the cultivation and habituation of virtue. According to Aristotle, this process involves consistently choosing the middle path, or the “golden mean,” between two extremes, one of deficiency, and one of excess, and training one’s emotions and desires to align with those choices. Courage sits between cowardice and recklessness. Generosity lies between greed and wastefulness. Honesty navigates the space between brutal frankness and hollow flattery. What allows us to find that mean in real situations, with real people, in real time, is practical wisdom – phronesis – the capacity to read a moment and respond well.

It is a philosophy that has informed and influenced Western concepts of morality for millennia. And now, at Roseman University College of Medicine (RUCOM), it is shaping the next generation of physicians.

This is where Aristotle’s framework speaks so directly to medicine. Ethics, in this view, is not a set of abstract principles applied through rational calculation. It is a skill that is developed through practice, reflection, and experience. It doesn’t live in textbooks but instead in the exam room, the hallway conversation, or the moment a physician chooses how to deliver difficult news. And crucially, it is learned by watching. Role models matter enormously in this framework: the attending who pauses to listen, the faculty member who admits uncertainty, and the clinician who treats the custodial staff with the same regard as the department chair. Character is “caught” as much as it is “taught.”

Which is why, at RUCOM, professionalism as flourishing is not a curriculum add-on — it is a culture, tended by every member of the community, from the first foundational science course to the final clinical rotation. RUCOM’s approach to medical professionalism is built on a framework of virtues: character traits that the college has woven into every layer of its curriculum, from the first days of medical school through clinical training and beyond. The framework draws directly from Aristotle’s golden mean, treating each virtue as a balance point between behavioral extremes. In its purest form, it is a character-based education that challenges students, faculty, and staff to not simply behave professionally, but to become professionals.

From Rules to Roots

For much of medical education’s history, discipline has been the foundation of professionalism, with sets of rules to follow and consequences to face when rules are broken. Students, for example, are expected to arrive on time, dress appropriately, and not lie or cheat. The disciplinarian model, as it is sometimes called, defines professionalism largely by its absence: you know unprofessional behavior when you see it, and you act accordingly.

At RUCOM, professionalism is understood as something far larger, drawing instead on two deeper frameworks: the social contract model, which frames physicians as a group that has made a public commitment to patient welfare, patient autonomy, and social justice in exchange for society’s trust through licensure; and the professional identity formation model, which understands professionalism as something developmental that must be thought, felt, and lived, and not just performed. Together, the two models create a single, unifying idea: that the goal of medical professionalism is not compliance. It is flourishing.

“Medicine is fundamentally about human flourishing. The flourishing of patients, of communities, and of ourselves as physicians, faculty educators, and administrative support. We cannot help others flourish if we are not flourishing ourselves,” says Marin Gillis, PhD, LPh, RUCOM’s Senior Executive Dean for Faculty Affairs and Learning Innovation and Professor in the Department of Bioethics, Humanism, and Policy.

 

 

RUCOM’s Twelve Virtues

At the heart of RUCOM’s character-based model are its twelve virtues, each mapped to the college’s core medical educational program objectives: adaptability, beneficence, compassion, conscientiousness, critical thinking, curiosity, discernment, excellence, fair-mindedness, humility, integrity, and respect. According to Shadi “Soph” Heidarifar, PhD, MA, Assistant Professor of Bioethics, a philosopher-bioethicist who wrote her doctoral dissertation on character-based education, these virtues are not abstract ideals. Rather, each is defined in concrete, behavioral terms and situated as a mean between two extremes.

“These twelve are not the only virtues,” said Dr. Heidarifar, “but they give us something concrete to build on.” And once you begin thinking in terms of virtues, the excess/mean/deficiency model becomes a practical tool for calibration – a way to assess not just what a student knows, but who they are becoming.

Take respect. RUCOM defines it as demonstrating regard for patients, families, peers, collaborators, faculty, staff, and self in all professional environments, and embracing shared decision-making that honors patient preferences and values. In terms of the golden mean, the deficiency of respect is disrespect or disdain, which can include speaking over others, dismissing viewpoints, and using condescending language. The excess is obsequiousness, such as avoiding difficult conversations, over-yielding to others’ opinions, and neglecting to advocate for one’s own perspective. The mean is the physician who listens attentively, engages in genuine dialogue, fosters collaboration, and still advocates clearly when the patient’s wellbeing requires it.

This same framework applies across all six physician roles the RUCOM curriculum develops: Communicator, Collaborator, Leader, Advocate, Scholar/Educator, and Medical Expert. A respectful leader, for instance, neither disregards team input nor hesitates indefinitely out of excessive deference. A respectful medical expert neither cherry-picks evidence nor uncritically accepts every patient’s self-diagnosis. The golden mean is not a fixed point but a target that skilled practitioners must learn to locate in each clinical encounter.

“The twelve virtues are not rules, but ways of being and becoming that enable flourishing,” Dr. Gillis explains. “When we practice respect, curiosity, compassion, and all the other virtues, we create the conditions where students, faculty, administration, patients, and families can thrive.”

A Curriculum Built Around Character

What makes RUCOM’s approach unique is not just its philosophical coherence, but the purposeful way that character formation is embedded into every layer of students’ medical educational experience. Instead of treating professionalism as a single course or subject in the curriculum or a checkbox in a clerkship evaluation, RUCOM has adopted a strategy of integrating and “microdosing” virtue-focused moments into everyday learning.

Judy Hanrahan, JD, MA, Associate Dean of Faculty Affairs, offers an example of microdosing. In their clinical preparation coursework, students are guided to describe complex patients in person-centered, humanistic language, and to avoid terms like “difficult patient” or “non-compliant,” which reduces a person into a behavioral category. “This simple shift in language,” notes Professor Hanrahan, “reflects a deep commitment to the virtue of respect, and it reinforces the habit of seeing a whole person before a diagnosis or a label.”

Faculty in the Department of Bioethics, Humanism, and Policy, including Becky Jayakumar, PharmD, BCIDP, BCPA, who holds a dual position in Roseman’s colleges of Medicine and Pharmacy, have created integrated Roadrunner Learning Community sessions and foundational phase lectures drawing virtues into clinical dilemmas, such as the complex ethics of antibiotic prescribing, where a physician must balance integrity, beneficence, critical thinking, and discernment, often under time pressure. A weekly professionalism curriculum, including coursework on physicians as advocates, gives students structured opportunities to explore the values of medicine alongside its science.

Fundamentally, professional identity formation at RUCOM goes beyond what a student knows or does. It encompasses what a student feels. Thinking like a physician, acting like a physician, feeling like a physician – these three dimensions of professional selfhood are understood as inseparable.

“A student who can recite the social contract of medicine but has not yet internalized its values is not yet fully formed as a professional,” explains Professor Hanrahan. “The curriculum is designed to close that gap by encouraging self-reflection, helping students learn the profession’s language and values, and engaging deeply with the ethical and human side of care, including self-care.”

Flourishing as a Faculty Value

One of the most compelling aspects of RUCOM’s professionalism initiative is its insistence that character-based education cannot be limited to students. The same framework of virtues also applies to faculty, staff, and administration. The Professionalism Campaign, titled “Flourishing Together,” which launches in July, is structured around the idea that a community dedicated to the flourishing of its students must also be committed to the flourishing of its educators, staff, and administration. It is a college-wide campaign led by College of Medicine’s, Office of Access, Opportunity, and Collaboration, Office of Student Affairs., and Office of Faculty Affairs and Learning Innovation (OFALI).

“You can’t give what you don’t have. If you’re burned out, disconnected, and depleted, you can’t help students flourish. This initiative is for all of us,” said Dr. Gillis.

Partnering with the prestigious , OFALI leads faculty workshops that explore questions such as: What does human flourishing mean, and how does virtue ethics support it? What blocks my own thriving? What do my students and colleagues need from me to flourish? How do I recognize and name flourishing when it is happening around me?

“The student who can acknowledge struggle without shame learns more honestly,” Dr. Gillis notes. “The clinician who can sit with their own imperfection without self-destruction remains present for others. The professor who can teach with humility and learn from a colleague in another discipline grows as an educator and a person.”

For staff and administrative team members, the message is equally clear: their flourishing is not secondary to the mission – it is integral to it. When every member of the RUCOM community is supported in practicing the virtues, the effects radiate outward: to students, to patients, to families, and to the broader Southern Nevada community RUCOM serves.

The Tree in the Garden

Gretchen Keys, EdD, MLS, RRT, Assistant Dean of Faculty and Staff Advancement, has a flair for design. As the Professionalism as Flourishing Campaign took shape, a visual metaphor came to her: a tree. It was an image that felt true to everything RUCOM was trying to say: organic, relational, and alive with the possibility of growth.

The roots of the tree represent the college’s foundational virtues: humility, excellence, and respect. From those roots rises the trunk — compassion — the quality strong enough to bear everything above it and honest enough to turn inward as well as outward. The canopy comprises the full range of virtues that become visible in professional practice: discernment, curiosity, critical thinking, adaptability, fair-mindedness, conscientiousness, beneficence, and integrity.

The tree does not grow in ideal conditions. Like all trees, it weathers drought and storms. What matters, as Dr. Keys and the Campaign Committee frame it, is that the community tends the garden together. That means basic sciences faculty and clinical faculty working in concert — weaving professionalism not only into clinical practice but into foundational coursework from the very start — because when the whole faculty pulls in the same direction, students feel it. “Flourishing is contagious,” the campaign’s core messaging reads. “When you tend your own growth, it helps others thrive. When you support someone else’s flourishing, yours deepens.”

This vision has practical consequences for how professionalism is assessed and cultivated at the RUCOM. Instead of relying primarily on a disciplinary model, the college embeds assessment into the curriculum itself, into its Medical Student Promotion and Review Committee (MedSPARC), Learning Environment and Professionalism (LEAP) committee, and into its admissions process. A culture of professionalism, the college believes, cannot be imposed from the outside. It must be grown from within.

“This is one of the main reasons I came to Roseman,” said Dr. Gillis. “Dean Greer gave me both the authority and the responsibility to place moral competence at the core of a medical school curriculum and indeed in the College infrastructure itself, and that kind of bold, innovative mission to reimagine medical education as a whole drew me here.”

Why It Matters for Medicine

The stakes of getting this right are high. Medicine’s social contract – the implicit promise that physicians will act in service of patient welfare, respect persons and their autonomy, and promote social justice in exchange for society’s trust – depends on a profession comprised of physicians of genuine character, not just technical skill. The virtues RUCOM cultivates are precisely those that make that contract credible: integrity that ensures honesty even when it is difficult; humility that keeps a physician open to learning and to the patient’s own knowledge of their body; compassion that sustains engagement even in the most demanding encounters.

There is also a practical, institutional argument. As Dr. Gillis shares, flourishing people provide better care, make fewer errors, stay longer in their roles, and recruit others who share their values. A character-based culture is not just an aspirational goal; it is a strategic investment in the quality and sustainability of the institution itself.

Aristotle understood that virtue is not a gift but a practice. It is something developed through habit, through community, and through the sustained effort to find the right response in each particular situation. RUCOM has taken that ancient insight and built a medical education around it. The golden mean is not a compromise. It is the mark of wisdom in a profession that lives in the space between knowledge and uncertainty, between protocol and compassion, and between the textbook and the human being in the exam room.