Becoming clinical supervisors: identity learnings from a registrar faculty development program

A Critical Review of Professional Identity Formation Interventions in Medical Education

PURPOSE

Professional identity formation (PIF) can be defined as the integration of the knowledge, skills, values, and behaviors of a profession with one's preexisting identity and values. Several different, and sometimes conflicting, conceptualizations and theories about PIF populate the literature; applying these different theories in PIF curricula and pedagogic strategies can profoundly impact the PIF of future physicians. The authors conducted a critical review of the recent literature on PIF interventions in medical education to explore the conceptualizations of and theoretical approaches to PIF that underlie them.

METHOD

The authors searched articles on PIF educational interventions published in 5 major medical education journals between 2010 and March 2021. The articles' context and findings were extracted, analyzed, and summarized to identify conceptualizations and theoretical approaches to PIF.

RESULTS

The authors identified 43 studies examining medical education interventions aimed at influencing PIF. The majority of the studies (n = 31) focused on undergraduate medical education. Reflective writing and the use of narrative reflections were the dominant modes of student activity in PIF interventions, supporting the dominant individualist approach to PIF. Less commonly PIF was understood as a socialization process or as an active process with both individually and socially focused influences.

CONCLUSIONS

Relying on reflective writing as the intervention of choice to impact PIF feeds the dominant individualist perspective on PIF. An unintended consequence of this individualist orientation is that cultural problems embedded in the profession can become burdens for individual physicians to personally bear. Future education and research into PIF should account for theoretical preferences and the impact of these preferences.

Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators

Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities.

An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations.

This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.

Widening how we see the impact of culture on learning, practice and identity development in clinical environments

As part of this State of the Science series on Self, Society and Situation, we focus on how we might see the situation of the workplace as a learning environment in the future. Research to date into how health professionals learn while working in clinical workplace environments has mostly focused on the supervisor-trainee relationship or on the interaction between the affordances of a workplace and the receptiveness of trainees. However, the wider environment has not received as much focus-though frequently mentioned, it is seldom investigated. We suggest there is a need to embrace the wider institution factors, recognise and acknowledge an organisation's values and culture as they impact on clinical learning in order to work with these, not around them or ignore them, to make what may be tacit visible through reflection and observation and to embrace a range of perspectives on culture.