Korean Medical Education Review (의학교육논단)

Yonsei university college of medicine (연세대학교 의과대학)
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Current Status and Directions of Professional Identity Formation in Medical Education

전문직 정체성 형성 및 촉진을 위한 의학교육 현황과 고려점

  • Han, Heeyoung (Southern Illinois University School of Medicine) ;
  • Suh, Boyung (Southern Illinois University School of Medicine)
  • 한희영 (서던일리노이대학교 의과대학 의학교육학과) ;
  • 서보영 (서던일리노이대학교 의과대학 의학교육학과)
  • Received : 2021.04.12
  • Accepted : 2021.06.16
  • Published : 2021.06.30
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Abstract

Professional identity formation (PIF) is an essential concept in professional education. Many scholars have explored conceptual frameworks of PIF and conducted empirical studies to advance an understanding of the construct in medical education. Despite its importance, it is unclear what educational approaches and assessment practices are actually implemented in medical education settings. Therefore, we conducted a literature review of empirical studies reporting educational practices for medical learners' PIF. We searched the Web of Science database using keywords and chose 37 papers for analysis based on inclusion and exclusion criteria. Thematic analysis was conducted. Most empirical papers (92%) were from North America and Western Europe and used qualitative research methods, including mixed methods (99%). The papers reported the use of reflection activities and elective courses for specific purposes, such as art as an educational activity. Patient and healthcare experiences were also found to be a central theme in medical learners' PIF. Through an iterative analysis of the key themes that emerged from the PIF studies, we derived the following key concepts and implications: (1) the importance of creating informal and incidental learning environments, (2) ordinary yet authentic patient experiences, (3) a climate of psychosocial safety in a learning environment embracing individual learners' background and emotional development, and (4) the reconceptualization of PIF education and assessment. In conclusion, research on PIF should be diversified to include various cultural and social contexts. Theoretical frameworks should also be diversified and developed beyond Kegan's developmental framework to accommodate the nonlinear and dynamic nature of PIF.

Keywords

References

  1. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446-51. https://doi.org/10.1097/ACM.0000000000000427
  2. Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012;87(9):1185-90. https://doi.org/10.1097/acm.0b013e3182604968
  3. Niemi PM. Medical students' professional identity: self-reflection during the preclinical years. Med Educ. 1997;31(6):408-15. https://doi.org/10.1046/j.1365-2923.1997.00697.x
  4. Holden MD, Buck E, Luk J, Ambriz F, Boisaubin EV, Clark MA, et al. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). Acad Med. 2015;90(6):761-7. https://doi.org/10.1097/ACM.0000000000000719
  5. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718-25. https://doi.org/10.1097/ACM.0000000000000700
  6. Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach. 2012;34(9):e641-8. https://doi.org/10.3109/0142159X.2012.687476
  7. Kegan R. The evolving self: problem and process in human development. Cambridge (MA): Harvard University Press; 1982.
  8. Lewin LO, McManamon A, Stein MTO, Chen DT. Minding the form that transforms: using Kegan's model of adult development to understand personal and professional identity formation in medicine. Acad Med. 2019;94(9):1299-304. https://doi.org/10.1097/acm.0000000000002741
  9. Volpe RL, Hopkins M, Haidet P, Wolpaw DR, Adams NE. Is research on professional identity formation biased?: early insights from a scoping review and metasynthesis. Med Educ. 2019;53(2):119-32. https://doi.org/10.1111/medu.13781
  10. Wald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. Acad Med. 2015;90(6):701-6. https://doi.org/10.1097/ACM.0000000000000731
  11. Wyatt TR, Balmer D, Rockich-Winston N, Chow CJ, Richards J, Zaidi Z. 'Whispers and shadows': a critical review of the professional identity literature with respect to minority physicians. Med Educ. 2021;55(2): 148-58. https://doi.org/10.1111/medu.14295
  12. Bearman M, Dawson P. Qualitative synthesis and systematic review in health professions education. Med Educ. 2013;47(3):252-60. https://doi.org/10.1111/medu.12092
  13. Abrams MP, Eckert T, Topping D, Daly KD. Reflective writing on the cadaveric dissection experience: an effective tool to assess the impact of dissection on learning of anatomy, humanism, empathy, well-being, and professional identity formation in medical students. Anat Sci Educ. 2020 Oct 13 [Epub]. https://doi.org/10.1002/ase.2025.
  14. Adema M, Dolmans DH, Raat JA, Scheele F, Jaarsma AD, Helmich E. Social interactions of clerks: the role of engagement, imagination, and alignment as sources for professional identity formation. Acad Med. 2019;94(10):1567-73. https://doi.org/10.1097/acm.0000000000002781
  15. Cunningham H, Taylor D, Desai UA, Quiah SC, Kaplan B, Fei L, et al. Looking back to move forward: first-year medical students' meta-reflections on their narrative portfolio writings. Acad Med. 2018;93(6):888-94. https://doi.org/10.1097/acm.0000000000002102
  16. Sawatsky AP, Nordhues HC, Merry SP, Bashir MU, Hafferty FW. Transformative learning and professional identity formation during international health electives: a qualitative study using grounded theory. Acad Med. 2018;93(9):1381-90. https://doi.org/10.1097/acm.0000000000002230
  17. Shiozawa T, Glauben M, Banzhaf M, Griewatz J, Hirt B, Zipfel S, et al. An insight into professional identity formation: qualitative analyses of two reflection interventions during the dissection course. Anat Sci Educ. 2020;13(3):320-32. https://doi.org/10.1002/ase.1917
  18. Sorrell S, Ibrahim H. First year medical students' perceptions of the impact of wearing scrubs on professional identity: a narrative analysis in the United Arab Emirates. BMJ Open. 2020;10(11):e039357. https://doi.org/10.1136/bmjopen-2020-039357
  19. Stuart E, O'Leary D, Rowntree R, Carey C, O'Rourke L, O'Brien E, et al. 'Challenges in experiential learning during transition to clinical practice: a comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships'. Med Teach. 2020;42(11):1275-82. https://doi.org/10.1080/0142159X.2020.1803250
  20. Wald HS, White J, Reis SP, Esquibel AY, Anthony D. Grappling with complexity: medical students' reflective writings about challenging patient encounters as a window into professional identity formation. Med Teach. 2019;41(2):152-60. https://doi.org/10.1080/0142159x.2018.1475727
  21. Wong A, Trollope-Kumar K. Reflections: an inquiry into medical students' professional identity formation. Med Educ. 2014;48(5):489-501. https://doi.org/10.1111/medu.12382
  22. Chen LYC, Hubinette MM. Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework. Med Teach. 2017;39(8):876-82. https://doi.org/10.1080/0142159X.2017.1317729
  23. Hatem DS, Halpin T. Becoming doctors: examining student narratives to understand the process of professional identity formation within a learning community. J Med Educ Curric Dev. 2019;6:2382120519834546. https://doi.org/10.1177/2382120519834546
  24. Konkin J, Suddards C. Creating stories to live by: caring and professional identity formation in a longitudinal integrated clerkship. Adv Health Sci Educ Theory Pract. 2012;17(4):585-96. https://doi.org/10.1007/s10459-011-9335-y
  25. Nothnagle M, Reis S, Goldman RE, Anandarajah G. Fostering professional formation in residency: development and evaluation of the "forum" seminar series. Teach Learn Med. 2014;26(3):230-8. https://doi.org/10.1080/10401334.2014.910124
  26. De Lasson L, Just E, Stegeager N, Malling B. Professional identity formation in the transition from medical school to working life: a qualitative study of group-coaching courses for junior doctors. BMC Med Educ. 2016;16:165. https://doi.org/10.1186/s12909-016-0684-3
  27. Kline CC, Park SE, Godolphin WJ, Towle A. Professional identity formation: a role for patients as mentors. Acad Med. 2020;95(10):1578-86. https://doi.org/10.1097/ACM.0000000000003561
  28. Parsons AS, Kon RH, Plews-Ogan M, Gusic ME. You can have both: coaching to promote clinical competency and professional identity formation. Perspect Med Educ. 2021;10(1):57-63. https://doi.org/10.1007/s40037-020-00612-1
  29. Reis SP, Wald HS. Contemplating medicine during the Third Reich: scaffolding professional identity formation for medical students. Acad Med. 2015;90(6):770-3. https://doi.org/10.1097/ACM.0000000000000716
  30. Schei E, Knoop HS, Gismervik MN, Mylopoulos M, Boudreau JD. Stretching the comfort zone: using early clinical contact to influence professional identity formation in medical students. J Med Educ Curric Dev. 2019;6:2382120519843875. https://doi.org/10.1177/2382120519843875
  31. Tien L, Wyatt TR, Tews M, Kleinheksel AJ. Simulation as a tool to promote professional identity formation and patient ownership in medical students. Simul Gaming. 2019;50(6):711-24. https://doi.org/10.1177/1046878119869038
  32. Green MJ. Comics and medicine: peering into the process of professional identity formation. Acad Med. 2015;90(6):774-9. https://doi.org/10.1097/ACM.0000000000000703
  33. Joseph K, Bader K, Wilson S, Walker M, Stephens M, Varpio L. Unmasking identity dissonance: exploring medical students' professional identity formation through mask making. Perspect Med Educ. 2017;6(2):99-107. https://doi.org/10.1007/s40037-017-0339-z
  34. Rabow MW, Evans CN, Remen RN. Professional formation and deformation: repression of personal values and qualities in medical education. Fam Med. 2013;45(1):13-8.
  35. Stephens MB. Behind the mask: identity formation and team building. Ann Fam Med. 2019;17(6):561. https://doi.org/10.1370/afm.2447
  36. Hawking M, Kim J, Jih M, Hu C, Yoon JD. "Can virtue be taught?": a content analysis of medical students' opinions of the professional and ethical challenges to their professional identity formation. BMC Med Educ. 2020;20(1):380. https://doi.org/10.1186/s12909-020-02313-z
  37. Helmich E, Yeh HM, Kalet A, Al-Eraky M. Becoming a doctor in different cultures: toward a cross-cultural approach to supporting professional identity formation in medicine. Acad Med. 2017;92(1):58-62. https://doi.org/10.1097/ACM.0000000000001432
  38. Matthews R, Smith-Han K, Nicholson H. From physiotherapy to the army: negotiating previously developed professional identities in mature medical students. Adv Health Sci Educ Theory Pract. 2020;25(3):607-27. https://doi.org/10.1007/s10459-019-09942-0
  39. Van den Broek S, Querido S, Wijnen-Meijer M, van Dijk M, Ten Cate O. Social identification with the medical profession in the transition from student to practitioner. Teach Learn Med. 2020;32(3):271-81. https://doi.org/10.1080/10401334.2020.1723593
  40. Adams J, Ari M, Cleeves M, Gong J. Reflective writing as a window on medical students' professional identity development in a longitudinal integrated clerkship. Teach Learn Med. 2020;32(2):117-25. https://doi.org/10.1080/10401334.2019.1687303
  41. Sawatsky AP, Huffman BM, Hafferty FW. Coaching versus competency to facilitate professional identity formation. Acad Med. 2020;95(10): 1511-4. https://doi.org/10.1097/ACM.0000000000003144
  42. Yardley S, Kinston R, Lefroy J, Gay S, McKinley RK. 'What do we do, doctor?': transitions of identity and responsibility: a narrative analysis. Adv Health Sci Educ Theory Pract. 2020;25(4):825-43. https://doi.org/10.1007/s10459-020-09959-w
  43. Jarvis-Selinger S, MacNeil KA, Costello GR, Lee K, Holmes CL. Understanding professional identity formation in early clerkship: a novel framework. Acad Med. 2019;94(10):1574-80. https://doi.org/10.1097/acm.0000000000002835
  44. Pratt MG, Rockmann KW, Kaufmann JB. Constructing professional identity: the role of work and identity learning cycles in the customization of identity among medical residents. Acad Manag J. 2006;49(2):235-62. https://doi.org/10.5465/AMJ.2006.20786060
  45. Helmich E, Yeh HM, Yeh CC, de Vries J, Fu-Chang Tsai D, Dornan T. Emotional learning and identity development in medicine: a cross-cultural qualitative study comparing Taiwanese and Dutch medical undergraduates. Acad Med. 2017;92(6):853-9. https://doi.org/10.1097/ACM.0000000000001658
  46. Sawatsky AP, Santivasi WL, Nordhues HC, Vaa BE, Ratelle JT, Beckman TJ, et al. Autonomy and professional identity formation in residency training: a qualitative study. Med Educ. 2020;54(7):616-27. https://doi.org/10.1111/medu.14073
  47. Kay D, Berry A, Coles NA. What experiences in medical school trigger professional identity development? Teach Learn Med. 2019;31(1):17-25. https://doi.org/10.1080/10401334.2018.1444487
  48. Conway-Hicks S, de Groot JM. Living in two worlds: becoming and being a doctor among those who identify with "not from an advantaged background". Curr Probl Pediatr Adolesc Health Care. 2019;49(4):92-101. https://doi.org/10.1016/j.cppeds.2019.03.006
  49. Wyatt TR, Rockich-Winston N, Taylor TR, White D. What does context have to do with anything?: a study of professional identity formation in physician-trainees considered underrepresented in medicine. Acad Med. 2020;95(10):1587-93. https://doi.org/10.1097/ACM.0000000000003192
  50. Han H. Interprofessional education in medical education: can we break the silos? Korean Med Educ Rev. 2017;19(1):1-9. https://doi.org/10.17496/kmer.2017.19.1.1