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Sarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, Krishna LKR. A scoping review and theory-informed conceptual model of professional identity formation in medical education. MEDICAL EDUCATION 2024. [PMID: 38597258 DOI: 10.1111/medu.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues. METHODS A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases. RESULTS A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it. CONCLUSIONS Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.
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Affiliation(s)
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - You Ru Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Suzanne Pei Lin Goh
- Duke-NUS Medical School, National University of Singapore, Singapore
- KK Women's and Children Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Duke-NUS Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, United Kingdom Cancer Research Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore
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Oto T, Matsumoto Y, Iwashita Y, Yoshida R, Taguchi N. A Qualitative Study on the Development of Professionalism Among Japanese Dental Students. Cureus 2024; 16:e51762. [PMID: 38187020 PMCID: PMC10771338 DOI: 10.7759/cureus.51762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Professionalism is believed to vary depending on factors such as era and culture. Therefore, clarifying the meaning of professionalism in each country, region, and workplace is essential. However, how professionalism is cultivated among dental students in Japanese schools has yet to be fully elucidated. Therefore, this study examined whether professionalism among Japanese dental students changes by year. This research will contribute to effective professional education. PARTICIPANTS AND METHODS The participants included six fourth-year dental students and nine fifth-year dental students. Semi-structured interviews were conducted from November 2018 to January 2019, and verbatim transcripts were created from the recorded data. Based on these verbatim transcripts, thematic analysis was utilized to examine and identify professionalism components for each academic year. RESULTS Three themes based on 14 constituent concepts were obtained for fourth-year students. Three themes based on 20 constituent concepts were obtained for fifth-year students. Fourth-year students primarily focused on technical aspects. In contrast, fifth-year students placed greater emphasis on attitude and communication skills. CONCLUSION From fourth-year students, who primarily focus on classroom learning and practical training, to fifth-year students who gain clinical experience, the constituent elements of professionalism became more complex. However, this study did not examine other aspects of healthcare professionalism, such as interprofessional collaboration. A comprehensive education program tailored to the clinical setting is necessary for cultivating professionalism.
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Affiliation(s)
- Takayuki Oto
- Department of General Dental Practices, Kagoshima University Hospital, Kagoshima-shi, JPN
| | - Yuko Matsumoto
- Department of General Dental Practices, Kagoshima University Hospital, Kagoshima-shi, JPN
| | - Yoichiro Iwashita
- Department of Dental Education, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, JPN
| | - Reiko Yoshida
- Department of General Dental Practices, Kagoshima University Hospital, Kagoshima-shi, JPN
| | - Norihiro Taguchi
- Department of Dental Education, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima-shi, JPN
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Walinga CW, Barnhoorn PC, Essers GTJM, Schaepkens SPC, Kramer AWM. 'You are not alone.' An exploratory study on open-topic, guided collaborative reflection sessions during the General Practice placement. BMC MEDICAL EDUCATION 2023; 23:769. [PMID: 37845655 PMCID: PMC10577966 DOI: 10.1186/s12909-023-04756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND To support professional development of medical students faced with challenges of the clinical phase, collaborative reflection sessions (CRSs) are used to share and reflect on workplace experiences. Facilitation of CRSs seems essential to optimise learning and to provide important skills for lifelong learning as a professional. However, little is known about which workplace experiences students share in CRSs without advance guidance on specific topics, and how reflecting on these experiences contributes to students' professional development. Therefore, we explored which workplace experiences students shared, what they learned from reflection on these experiences, and how they perceived the value of CRSs. METHODS We conducted an exploratory study among medical students (N = 99) during their General Practice placement. Students were invited to openly share workplace experiences, without pre-imposed instruction. A thematic analysis was performed on shared experiences and student learning gains. Students' perceptions of CRSs were analysed using descriptive statistics. RESULTS All 99 students volunteered to fill out the questionnaire. We found four themes relating to students' shared experiences: interactions with patients, complex patient care, diagnostic or therapeutic considerations, and dealing with collegial issues. Regarding students' learning gains, we found 6 themes: learning from others or learning from sharing with others, learning about learning, communication skills, self-regulation, determination of position within the healthcare team, and importance of good documentation. Students indicated that they learned from reflection on their own and peer's workplace experiences. Students valued the CRSs as a safe environment in which to share workplace experiences and helpful for their professional development. CONCLUSIONS In the challenging General Practice placement, open-topic, guided CRSs provide a helpful and valued learning environment relevant to professional development and offer opportunities for vicarious learning among peers. CRSs may also be a valuable tool to incorporate into other placements.
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Affiliation(s)
- Chris W Walinga
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | | | - Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Centre, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
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Consorti F, Consorti G. Elements and Determinants of Professional Identity During the Pandemic: A Hermeneutic Qualitative Study. TEACHING AND LEARNING IN MEDICINE 2023; 35:422-435. [PMID: 35711162 DOI: 10.1080/10401334.2022.2080068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: The construct of professionalism in undergraduate medical education is a core outcome that is included in the wider concept of professional identity formation. The former is grounded in the more general concept of identity, intended as an internalized set of role expectations. Some have proposed frameworks based on psychological or sociological approaches, but empirical research is still scarce and often limited to the exploration of the role of specific learning activities. The pandemic imposed adaptations that produced an artificial setting for a social experiment, suitable to observe how the deprivation of the social component of a student's life, such as in presence teaching and practical training, unveiled the elements and determinants of the developing identity of medical students. Approach: This research was the extension of a previous phenomenological study about medical students' lived experience of distance learning during the lockdown phase in Italy. We adopted a hermeneutic approach to furtherly deepen the analysis of the phenomenon at stake, in dialogue with the relevant literature. Eight 6th year medical students underwent an in-depth interview, themes were inductively generated and used to identify elements and determinants of the developing identities. Findings: Four themes developed, synthetized in the overarching theme "From crawling to standing on your feet and walking toward an uncertain future". The themes were: "social places and practices that make me feel like a student and a medical student", "toward self-regulation", "an emotional journey", "threats to the identity". The elements of the perceived identity as a medical student were autonomy and learning self-regulation, professional knowledge, competence, and sense of belonging to a community. The determinant factors which influenced the identity as a medical student were living environment, learning spaces and architectures, the social networks, the attendance of the healthcare facilities, the relationship with teachers, the social acknowledgement as a medical student, and as a doctor. Insights: It was possible to identify the generation of both constitutive elements of identity and determinants influencing identity development and this distinction is an added value of the research. According Gilles Deleuze's concept of "empty square" (the sudden lack of an object one used to have at hand: sociality in this case), this research highlighted the ambivalent nature of identity. Individualization and socialization are the "uneven sides" of that same paradoxical object which is identity.
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Affiliation(s)
- Fabrizio Consorti
- Department of Surgical Sciences, University Sapienza of Rome, Rome, Italy
| | - Giacomo Consorti
- Clinical-Based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy, Educational Department of Osteopathy, Istituto Superiore Osteopatia, Milan, Italy
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Barnhoorn PC, Nierkens V, Numans ME, Steinert Y, van Mook WNKA. "What kind of doctor do you want to become?": Clinical supervisors' perceptions of their roles in the professional identity formation of General Practice residents. MEDICAL TEACHER 2023; 45:485-491. [PMID: 36288745 DOI: 10.1080/0142159x.2022.2137395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Supporting the development of a professional identity is a primary objective in postgraduate education. Few empirical studies have explored professional identity formation (PIF) in residency, and little is known about supervisors' perceptions of their roles in residents' PIF. In this study, we sought to understand how supervisors perceive their roles in the PIF of General Practice (GP) residents. MATERIALS AND METHODS Guided by principles of qualitative description, we conducted eight focus groups with 55 supervisors at four General Practice training institutes across the Netherlands. Informed by a conceptual framework of PIF, we performed a thematic analysis of focus group transcripts. RESULTS Three themes related to how GP supervisors described their roles in supporting residents' PIF: supervising with the desired goal of GP training in mind; role modeling and mentoring as key strategies to achieve that goal; and the value of developing bonds of trust to support the process. CONCLUSIONS To our knowledge, this study is the first to explore PIF in GP training from the perspective of clinical supervisors. The identified themes mirror the components of the therapeutic alliance between doctors and patients from a supervisor's perspective and highlight the pivotal roles of the supervisor in a resident's PIF.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne Steinert
- Department of Family Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, and Maastricht UMC + Academy, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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McDonald J, Ryan S, Heeneman S, Hu W. Informed self-assessment during the transition to medical school: a longitudinal narrative study. BMJ Open 2022; 12:e065203. [PMID: 36581430 PMCID: PMC9806099 DOI: 10.1136/bmjopen-2022-065203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To explore how medical students' narratives of informed self-assessment (ISA) change during their first 18 months of study. DESIGN This longitudinal study used student narratives drawn from qualitative interviews and written reflections during the transition to medical school, to examine changes in ISA. Our analysis was informed by Situated Cognition Theory which recognises the impact and interplay of personal and environmental factors in cognition. SETTING To study medicine, first year students need to adapt their self-regulated learning in the context of a new peer group, study demands and educational culture. During this adaptation, students need to seek and interpret available cues to inform their self-assessment. PARTICIPANTS Longitudinal data were collected at five time points over 18 months from a diverse sample of seven first year medical students in an undergraduate medical programme, including 13.5 hours of interviews and 12 written reflections. RESULTS Before and after starting medical school, the participants' self-assessments were informed by environmental influences (exam results and comparison with peers), and personal influences (fear of failure and anxiety about not belonging). Early uncertainty meant self-assessments were overestimated and underestimated.By the end of first year, an enhanced sense of belonging coincided with less fear of failure, less emphasis on exam performance and reduced competition with peers. Self-assessments became increasingly informed by evidence of clinical skills and knowledge gained related to future professional competence. CONCLUSION Influences on medical students' ISAs change during the transition to studying medicine. A greater sense of belonging, and evidence of progress towards clinical competence became more important to self-assessment than comparison with peers and exam performance. Our findings reinforce the importance of formative assessments, opportunities to study and socialise with peers and early clinical experiences during first year. These experiences enhance ISA skills during the transition to medical school.
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Affiliation(s)
- Jenny McDonald
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Samantha Ryan
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Sylvia Heeneman
- Department of Pathology, Maastricht University, Maastricht, Netherlands
| | - Wendy Hu
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
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Leep Hunderfund AN, Kumbamu A, O'Brien BC, Starr SR, Dekhtyar M, Gonzalo JD, Rennke S, Ridinger H, Chang A. "Finding My Piece in That Puzzle": A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1804-1815. [PMID: 35797546 DOI: 10.1097/acm.0000000000004799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation. METHOD Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives. RESULTS Most students anticipated enacting one or more systems-related roles as a future physician, categorized as "bottom-up" efforts enacted at a patient or community level (humanist, connector, steward) or "top-down" efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences). CONCLUSIONS This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and director, Learning Environment and Educational Culture, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Ashok Kumbamu
- A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics, Mayo Clinic College of Medicine and Science, and director, Science of Health Care Delivery Education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Michael Dekhtyar
- M. Dekhtyar is research associate, Department of Medical Education, University of Illinois College of Medicine at Chicago; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Stephanie Rennke
- S. Rennke is professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Heather Ridinger
- H. Ridinger is assistant professor of medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Chang
- A. Chang is professor of medicine, Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Sandrone S, Ntonia I. Exploring the identity development of the budding neuroscientist at postgraduate level: a mixed-method study with perspectives from alumni and academics. BMC MEDICAL EDUCATION 2022; 22:746. [PMID: 36307793 PMCID: PMC9615628 DOI: 10.1186/s12909-022-03758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Neuroscience represents one of the most exciting frontiers in scientific research. However, given the recency of neuroscience as a discipline, its inter- and multi-disciplinary nature, the lack of educational research on brain science training, the absence of a national or global benchmark and the numerous neuroscience subfields, the development of the academic neuroscientist identity across career stages remains obfuscated. Neuroscience is not predominantly taught at the undergraduate level but presents as a postgraduate specialism, accepting graduates from a wide range of primary disciplines. METHODS This work represents the first mixed-method study exploring the development of the neuroscientist identity at the postgraduate level at a high-ranking, research-intensive UK University. It combines responses from standardised self-efficacy and professional identity questionnaires and qualitative data from nineteen semi-structured interviews with alumni and academics. RESULTS Key findings on influences, identity transitions, curricular skills and sense of belonging have been discussed. The results obtained can be mapped against the theoretical framework proposed by Laudel and Gläser in 2008, although some minor changes to the model have been suggested. DISCUSSION Implementing active learning strategies and experiential assessments, designing mentoring opportunities and creating spaces for interaction can favour the transition from students to neuroscientists and contribute to an inclusive and diverse neuroscientific community.
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Affiliation(s)
- Stefano Sandrone
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Iro Ntonia
- Centre for Higher Education Research and Scholarship (CHERS), Imperial College London, London, UK
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Barnhoorn PC, Nierkens V, Numans ME, Steinert Y, Kramer AWM, van Mook WNKA. General practice residents’ perspectives on their professional identity formation: a qualitative study. BMJ Open 2022. [PMCID: PMC9301807 DOI: 10.1136/bmjopen-2021-059691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To move beyond professionalism as a measurable competency, medical educators have highlighted the importance of forming a professional identity, in which learners come to ‘think, act, and feel like physicians’. This socialisation process is known as professional identity formation (PIF). Few empirical studies on PIF in residency have been undertaken. None of these studies focused on PIF during the full length of GP training as well as the interplay of concurrent socialising factors. Understanding the socialisation process involved in the development of a resident’s professional identity and the roles of influencing factors and their change over time could add to a more purposeful approach to PIF. Therefore, we aimed to investigate the process of PIF during the full length of General Practice (GP) training and which factors residents perceive as influential. Design A qualitative descriptive study employing focus group interviews. Setting Four GP training institutes across the Netherlands. Participants Ninety-two GP residents in their final training year participated in 12 focus group interviews. Results Study findings indicated that identity formation occurs primarily in the workplace, as residents move from doing to becoming and negotiate perceived norms. A tapestry of interrelated influencing factors—most prominently clinical experiences, clinical supervisors and self-assessments—changed over time and were felt to exert their influence predominantly in the workplace. Conclusions This study provides deeper empirical insights into PIF during GP residency. Doing the work of a GP exerted a pivotal influence on residents’ shift from doing as a GP to thinking, acting and feeling like a GP, that is, becoming a GP. Clinical supervisors are of utmost importance as role models and coaches in creating an environment that supports residents’ PIF. Implications for practice include faculty development initiatives to help supervisors be aware of how they can perform their various roles across different PIF stages.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne Steinert
- Department of Family Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Anneke WM Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Walther NKA van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Darici D, Missler M, Schober A, Masthoff M, Schnittler H, Schmitz M. "Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic. ANATOMICAL SCIENCES EDUCATION 2022; 15:447-463. [PMID: 35274467 DOI: 10.1002/ase.2178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.
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Affiliation(s)
- Dogus Darici
- Institute of Anatomy and Molecular Neurobiology, Westfälische Wilhelms-University, Münster, Germany
| | - Markus Missler
- Institute of Anatomy and Molecular Neurobiology, Westfälische Wilhelms-University, Münster, Germany
| | - Anna Schober
- Institute of Anatomy and Molecular Neurobiology, Westfälische Wilhelms-University, Münster, Germany
| | - Max Masthoff
- Institute of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Hans Schnittler
- Institute of Anatomy and Vascular Biology, Westfälische Wilhelms-University, Münster, Germany
| | - Martina Schmitz
- Institute of Anatomy and Vascular Biology, Westfälische Wilhelms-University, Münster, Germany
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Kang YJ, Hwang JS, Lin Y, Lee HJ, Han SY, Kim DH. Exploring the preconception of the first year of medical students on medicine before entering medical school. KOREAN JOURNAL OF MEDICAL EDUCATION 2021; 33:369-379. [PMID: 34875153 PMCID: PMC8655364 DOI: 10.3946/kjme.2021.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE First-year students can form a preconception based on life experiences before entering college and identifying learners' existing characteristics can be useful foundation data for curriculum development. This study examines what preconceptions freshman students had about medicine before entering medical school. METHODS A total of 110 first-year students were asked about what preconceptions they had about "medicine". A total of 1,124 data were used in the content analysis method. RESULTS The results were extracted into 5, and 12 twelve categories. On the theme of "scientific discipline", the knowledge students had about general health was based on scant expertise and little evidence. Students perceived medicine as Western and scientific, considering Korean traditional medicine as unscientific. Students believed that "medical practice" should be a "disease treatment" and "patient-centered" approach rather than a "social responsibility". In "the role of the doctor", students were concerned about the doctor's being financially stable on the positive side, and about the high-intensity workload on the negative side. In "medical education", students believed that studying medicine would be "hard and difficult" because of the "importance of memorizing" and "extensive study load". In "specialty stereotype", students had biases that were mostly concentrated on "psychiatry" and "surgery". CONCLUSION Perception of "medicine" has been revealed to a varied range of themes, but some have been inaccurate or unrealistic. These prejudices and groundless beliefs have a gap with the learning outcomes that students should achieve in the curriculum, and these preconceptions seem to have been influenced by South Korea's unique cultural context.
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Affiliation(s)
- Ye Ji Kang
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Jun Soo Hwang
- Hanyang University College of Medicine, Seoul, Korea
| | - Yanyan Lin
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
| | - Hyo Jeong Lee
- Department of Education, Sangmyung University College of Education, Seoul, Korea
| | - Sang Yun Han
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Hwan Kim
- Department of Medical Education, Hanyang University College of Medicine, Seoul, Korea
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Philippon AL, Truchot J, De Suremain N, Renaud MC, Petit A, Baron GL, Freund Y. Medical students' perception of simulation-based assessment in emergency and paediatric medicine: a focus group study. BMC MEDICAL EDUCATION 2021; 21:586. [PMID: 34798890 PMCID: PMC8605506 DOI: 10.1186/s12909-021-02957-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/24/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although simulation-based assessment (SBA) is being implemented in numerous medical education systems, it is still rarely used for undergraduate medical students in France. Objective structured clinical examinations (OSCEs) will be integrated into the national medical curriculum in 2021. In 2016 and 2017, we created a mannequin SBA to validate medical students' technical and psychometric skills during their emergency medicine and paediatric placements. The aim of our study was to determine medical students' perceptions of SBA. METHODS We followed the grounded theory framework to conduct a qualitative study. A total of 215 students participated in either a paediatric or an emergency medicine simulation-based course with a final assessment. Among the 215 participants, we randomly selected forty students to constitute the focus groups. In the end, 30 students were interviewed. Data were coded and analysed by two independent investigators within the activity theory framework. RESULTS The analyses found four consensual themes. First, the students perceived that success in the SBA provided them with self-confidence and willingness to participate in their hospital placements (1). They considered SBA to have high face validity (2), and they reported changes in their practice after its implementation (3). Nevertheless, they found that SBA did not help with their final high-stakes assessments (4). They discussed three other themes without reaching consensus: stress, equity, and the structure of SBA. After an analysis with activity theory, we found that students' perceptions of SBA underlined the contradictions between two systems of training: hospital and medical. We hypothesise that a specific role and place for SBA should be defined between these two activity systems. CONCLUSION The students perceived that SBA would increase self-confidence in their hospital placements and emphasise the general skills required in their future professional environment. However, they also reported that the assessment method might be biased and stressful. Our results concerning a preimplementation mannequin SBA and OSCE could provide valuable insight for new programme design and aid in improving existing programmes. Indeed, SBA seems to have a role and place between hospital placements and medical schools.
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Affiliation(s)
- Anne-Laure Philippon
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 83, bd de l'hôpital, 75013, Paris, France.
- Sorbonne Université, Paris, France.
- Department of Learning Sciences, EDA Laboratory, Université Sorbonne Paris Cité, Paris, France.
| | - Jennifer Truchot
- Department of Learning Sciences, EDA Laboratory, Université Sorbonne Paris Cité, Paris, France
- Emergency Department, SMUR, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - Nathalie De Suremain
- Emergency Department, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - Arnaud Petit
- Sorbonne Université, Paris, France
- Department of Pediatric Hematology-Oncology, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Georges-Louis Baron
- Department of Learning Sciences, EDA Laboratory, Université Sorbonne Paris Cité, Paris, France
| | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 83, bd de l'hôpital, 75013, Paris, France
- Sorbonne Université, Paris, France
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13
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Abstract
BACKGROUND Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF. METHODS A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data. RESULTS A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF. DISCUSSION PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.
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Myers SE, Bender NR, Seidel MA, Weinstock RS. Diabetes SPECIAL (Students Providing Education on Chronic Illness and Lifestyle): a novel preclinical medical student elective. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:312-315. [PMID: 33349906 PMCID: PMC8505564 DOI: 10.1007/s40037-020-00641-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Traditional medical student curricula limit substantial clinical experiences until the third and fourth years of medical school. This delay in valuable experiences hinders the ability of some medical students to choose a specialty to pursue, delays the formation of meaningful longitudinal mentorship relationships, and limits the development of important clinical acumen. Furthermore, the use of medical students in preclinical years may help to improve patient care and outcomes. APPROACH The novel preclinical Diabetes SPECIAL (Students Providing Education on Chronic Illness and Lifestyle) elective was designed to introduce first year medical students to the field of endocrinology, promote the development of a professional identity, improve medical student communication skills, and raise awareness of the complexities of managing patients living with diabetes mellitus. Furthermore, and novel to this experience, was to measure the impact of this elective on patient outcomes. EVALUATION Students attended patient appointments, communicated with their assigned patients regularly, relayed important health information to the attending endocrinologist, and attended monthly didactic sessions. The elective outcomes were evaluated via completed surveys by patients, students, and attending physicians as well as medical record review for pre- and post-elective hemoglobin A1C levels. REFLECTION Students, faculty, and patients who participated in this elective generally reported having a positive experience. Seven out of 10 patients had a reduction in their hemoglobin A1C levels. The outcomes from the pilot of this novel preclinical elective support the importance of early clinical exposure in medical student training and highlight potential positive impacts on both medical student education and patient outcomes.
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Affiliation(s)
- Sarah E Myers
- Department of Medicine: Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Nicholas R Bender
- Department of Medicine: Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Marina A Seidel
- Department of Medicine: Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ruth S Weinstock
- Department of Medicine: Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY, USA
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15
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van Buuren A, Yaseen W, Veinot P, Mylopoulos M, Law M. Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation. MEDICAL TEACHER 2021; 43:538-545. [PMID: 33529540 DOI: 10.1080/0142159x.2021.1874326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND While there is increasing effort among medical schools to recruit diverse students, there is a paucity of research into the unique experiences of these students during their transition to medicine. This study explored how experiences during medical school orientation influence students' transition into the medical profession. METHODS Semi-structured interviews were conducted (April-August 2019) with 16 first-year Canadian medical students. We applied descriptive thematic analysis using a constant comparative approach. Verbatim transcripts were coded and analyzed to elucidate themes. RESULTS Participants highlighted the importance of social orientation during their transition into medical school and noted experiencing complex social pressures during this time. They shared how incoming students were introduced to the dominant medical professional identity during orientation. Participants noted tensions during this period, many of which revolved around the dominant identity and their past, present and future selves. CONCLUSIONS Longstanding issues of diversity and inclusion in medicine manifest from day one of medical school. While orientation may be intended as a transition period to welcome students into the profession, it is a crucial period for medical schools to intentionally establish a commitment to an inclusive culture. Waiting to do so after identity formation has already begun is a missed opportunity.
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Affiliation(s)
- Asia van Buuren
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wid Yaseen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Paula Veinot
- Independent Research Consultant, Halifax, Canada
| | - Maria Mylopoulos
- Temerty Faculty of Medicine and Wilson Centre, University of Toronto, Toronto, Canada
| | - Marcus Law
- Department of Family and Community Medicine, and MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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16
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Wyatt TR, Kleinheksel AJ, Tews M. Linking Patient Care Ownership and Professional Identity Formation through Simulation. TEACHING AND LEARNING IN MEDICINE 2021; 33:164-172. [PMID: 33840311 DOI: 10.1080/10401334.2020.1813583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The link between ownership of patient care and professional identity formation (PIF) has not been formally established, yet PIF researchers frequently cite clinical experiences as powerful contributions to PIF. Hypothesis: Using clinical simulation, this study aimed to explore the relationship between patient care ownership and the cognitive processes involved in the creation of a professional identity. Methods: In 2018-2019, 189 third-year students participated in a simulation in which they were placed in the role of a physician treating a patient in respiratory distress. Data were collected from 12 focus groups (n = 84; 44% of the third-year class), each lasting 15-25 minute. Students were asked four questions designed to identify moments when they felt like a physician and experienced feelings of ownership. Each focus group was transcribed and analyzed for the presence of known elements that contribute to feelings of psychological ownership, and then inductively for how students related their feelings of ownership to their professional identity. Results: When students were asked to take ownership of their patient's care, they underwent a three-step process: (1) experiencing disorientation, (2) reconceptualizing roles and responsibilities, and (3) reorientation to professional goals. Patient care ownership was disorienting because it marked a departure from the clinical roles the students had previously experienced. While disoriented, students engaged in a process of reflection during which they asked themselves who they were, who they were becoming, and who they needed to become to effectively serve in the role of a physician. This process prompted students to realize the limitations of their clinical reasoning abilities and that the role of a physician requires new ways of thinking. Conclusions: This study advances a conceptual model of PIF that identifies patient care ownership as a catalyst in developing a professional identity. Assuming responsibility for patients places students into an unfamiliar role, which opens a channel for students to access new perspectives in their development as physicians.
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Affiliation(s)
- Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - A J Kleinheksel
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Tews
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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17
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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. MEDICAL EDUCATION 2021; 55:148-158. [PMID: 33448459 DOI: 10.1111/medu.14295] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Professional identity formation (PIF) is a growing area of research in medical education. However, it is unclear whether the present research base is suitable for understanding PIF in physicians considered to be under-represented in medicine (URM). This meta-ethnography examined the qualitative PIF literature from 2012 to 2019 to assess its capacity to shine light on the experiences of minoritised physicians. METHODS Data were gathered using a search of six well-known medical education journals for the term 'professional identit*' in titles, keywords, abstracts and subheadings, delineated with the date range of 2012-2019. All non-relevant abstracts were removed and papers were then further reduced to those that focused only on learners' experiences. This left 67 articles in the final dataset, which were analysed using a collaborative approach among a team of researchers. The team members used their professional expertise as qualitative researchers and personal experiences as minoritised individuals to synthesise and interpret the PIF literature. RESULTS Four conceptual categories were identified as impacting PIF: Individual versus Sociocultural Influences; the Formal versus the Hidden Curriculum; Institutional versus Societal Values; and Negotiation of Identity versus Dissonance in Identity. However, a major gap was identified; only one study explored experiences of PIF in URM physicians and there was an almost complete absence of critical stances used to study PIF. Combined, these findings suggest that PIF research is building on existing theories without questioning their validity with reference to minoritised physicians. CONCLUSIONS From a post-colonial perspective, the fact that race and ethnicity have been largely absent, invisible or considered irrelevant within PIF research is problematic. A new line of inquiry is needed, one that uses alternative frameworks, such as critical theory, to account for the ways in which power and domination influence PIF for URM physicians in order to foreground how larger sociohistorical issues influence and shape the identities of minoritised physicians.
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Affiliation(s)
- Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta, Georgia, USA
| | - Dorene Balmer
- Department of Paediatrics, Children's Hospital of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Rockich-Winston
- Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta, Georgia, USA
| | - Candace J Chow
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joslyn Richards
- Educational Innovation Institute, Medical College of Georgia, Augusta, Georgia, USA
| | - Zareen Zaidi
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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18
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Bynum WE, Varpio L, Lagoo J, Teunissen PW. 'I'm unworthy of being in this space': The origins of shame in medical students. MEDICAL EDUCATION 2021; 55:185-197. [PMID: 32790934 DOI: 10.1111/medu.14354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Shame results from a negative global self-evaluation and can have devastating effects. Shame research has focused primarily on graduate medical education, yet medical students are also susceptible to its occurrence and negative effects. This study explores the development of shame in medical students by asking: how does shame originate in medical students? and what events trigger and factors influence the development of shame in medical students? METHODS The study was conducted using hermeneutic phenomenology, which seeks to describe a phenomenon, convey its meaning and examine the contextual factors that influence it. Data were collected via a written reflection, semi-structured interview and debriefing session. It was analysed in accordance with Ajjawi and Higgs' six steps of hermeneutic analysis: immersion, understanding, abstraction, synthesis, illumination and integration. RESULTS Data analysis yielded structural elements of students' shame experiences that were conceptualised through the metaphor of fire. Shame triggers were the specific events that sparked shame reactions, including interpersonal interactions (eg, receiving mistreatment) and learning (eg, low test scores). Shame promoters were the factors and characteristics that fuelled shame reactions, including those related to the individual (eg, underrepresentation), environment (eg, institutional expectations) and person-environment interaction (eg, comparisons to others). The authors present three illustrative narratives to depict how these elements can interact to lead to shame in medical students. CONCLUSIONS This qualitative examination of shame in medical students reveals complex, deep-seated aspects of medical students' emotional reactions as they navigate the learning environment. The authors posit that medical training environments may be combustible, or possessing inherent risk, for shame. Educators, leaders and institutions can mitigate this risk and contain damaging shame reactions by (a) instilling a true sense of belonging and inclusivity in medical learning environments, (b) facilitating growth mindsets in medical trainees and (c) eliminating intentional shaming in medical education.
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Affiliation(s)
- William E Bynum
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Lara Varpio
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Janaka Lagoo
- Duke Family Medicine Residency Program, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Dickinson BL, Gibson K, VanDerKolk K, Greene J, Rosu CA, Navedo DD, Porter-Stransky KA, Graves LE. "It is this very knowledge that makes us doctors": an applied thematic analysis of how medical students perceive the relevance of biomedical science knowledge to clinical medicine. BMC MEDICAL EDUCATION 2020; 20:356. [PMID: 33046061 PMCID: PMC7552568 DOI: 10.1186/s12909-020-02251-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intensive study of the biomedical sciences remains a core component of undergraduate medical education with medical students often completing up to 2 years of biomedical science training prior to entering clerkships. While it is generally accepted that biomedical science knowledge is essential for clinical practice because it forms the basis of clinical reasoning and decision-making, whether medical students perceive an expanded role for their biomedical science knowledge remains to be examined. METHODS We conducted a qualitative research study to explore how medical students in the first clerkship year perceived the relevance of biomedical science knowledge to clinical medicine during this pivotal time as they begin their transition from students to physicians. To identify previously unidentified perspectives and insights, we asked students to write brief essays in response to the prompt: How is biomedical science knowledge relevant to clinical medicine? Ten codes and four themes were interpreted through an applied thematic analysis of students' essays. RESULTS Analysis of students' essays revealed novel perspectives previously unidentified by survey studies and focus groups. Specifically, students perceived their biomedical science knowledge as contributory to the development of adaptive expertise and professional identity formation, both viewed as essential developmental milestones for medical students. CONCLUSIONS The results of this study have important implications for ongoing curricular reform efforts to improve the structure, content, delivery, and assessment of the undergraduate medical curriculum. Identifying the explicit and tacit elements of the formal, informal, and hidden curriculum that enable biomedical science knowledge to contribute to the development of adaptive expertise and professional identity formation will enable the purposeful design of innovations to support the acquisition of these critical educational outcomes.
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Affiliation(s)
- Bonny L Dickinson
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, USA.
| | - Kristine Gibson
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kristi VanDerKolk
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jeffrey Greene
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Claudia A Rosu
- Center for Interprofessional Studies and Innovation at Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Deborah D Navedo
- Massachusetts General Hospital, Learning Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Kirsten A Porter-Stransky
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa E Graves
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, USA
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Kline CC, Park SE, Godolphin WJ, Towle A. Professional Identity Formation: A Role for Patients as Mentors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1578-1586. [PMID: 32618605 DOI: 10.1097/acm.0000000000003561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Medical education should foster professional identity formation, but there is much to be learned about how to support learners in developing their professional identity. This study examined the role that patients can play in supporting professional identity development during the University of British Columbia Interprofessional Health Mentors Program (HMP), a longitudinal preclinical elective in which patients, or their caregivers, act as mentors and educate students about their lived experience of a chronic condition or disability. METHOD The authors interviewed 18 medical residents in 2016, 3 to 4 years after they completed the HMP. Professional identity was explored by asking participants how the HMP had influenced their ideas about the ideal physician and the kind of doctor they aspire to become. The authors analyzed the data using the identify status paradigm as a conceptual framework. RESULTS The authors identified 7 themes: patient as more than disease, patient as autonomous, patient as expert, doctor as partner, doctor as collaborator, self-aware doctor, and empathic doctor. They found firm commitments to patient partnership, interprofessional collaboration, and holistic care for patients rooted in the exploration of professional values that was prompted by patient mentors during HMP. CONCLUSIONS Patient mentors can help medical students begin to construct their professional identity during the preclinical period by supporting exploration of and commitment to the professional values that society expects of physicians.
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Affiliation(s)
- Cathy C Kline
- C.C. Kline is research coordinator, Patient and Community Partnership for Education, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0003-2254-0721
| | - So Eyun Park
- S. Park is a family medicine resident, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-0088-8527
| | - William J Godolphin
- W.J. Godolphin is professor emeritus, Department of Pathology and Laboratory Medicine, Faculty of Medicine, and codirector, Patient and Community Partnership for Education, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0003-0113-1339
| | - Angela Towle
- A. Towle is associate professor, Department of Medicine, Faculty of Medicine, and codirector, Patient and Community Partnership for Education, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-7164-0959
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Adams J, Ari M, Cleeves M, Gong J. Reflective Writing as a Window on Medical Students' Professional Identity Development in a Longitudinal Integrated Clerkship. TEACHING AND LEARNING IN MEDICINE 2020; 32:117-125. [PMID: 31729253 DOI: 10.1080/10401334.2019.1687303] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Integral to the formation of a professional identity is the concept of professional identity construction, an essential part of becoming a competent physician. In this framework, identity is dynamic and shaped by experiences and relationships. Minimal work has addressed the impact that clinical care settings and relationships with patients have in the construction of professional identity for medical students. This study explores how patient interactions and intentional curriculum design support professional identity construction in students participating in a longitudinal integrated clerkship focused on care for the underserved. Approach: This qualitative analysis investigated students' professional identity construction as detailed in 45 reflective essays from 15 students while enrolled in an 11-month longitudinal integrated clerkship (LIC) in a safety-net hospital system. Researchers used an inductive analytic approach. Findings: Students provided rich and complex descriptions of their experiences. Six themes emerged: care for the underserved; therapeutic alliance; humility and gratitude; altruism; resilience; and aspirations. Insights: Professional identity construction was observable through students' reflective essays. Student interactions with patients provided rich material for professional identity construction, and role models in patient care enhanced this process. This study suggests that clinical learning in a safety-net hospital system, coupled with an LIC curriculum that prioritizes continuity with vulnerable patients, faculty role models, and ongoing reflection, supported the professional identity construction of students as patient-centered caregivers providing equitable care and advocacy for the underserved, described here as an Equity Identity.
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Affiliation(s)
- Jennifer Adams
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Mim Ari
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Michelle Cleeves
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Jennifer Gong
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
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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. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1299-1304. [PMID: 31460919 DOI: 10.1097/acm.0000000000002741] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The formation of a physician's professional identity is a dynamic process shaped by and intertwined with the development of that person's larger adult identity. Constructive-developmentalist Robert Kegan's model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities.When people use a particular lens to construct meaning, Kegan describes them as being "subject" to that lens: The lens "has them," and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan's lenses that are relevant to medical educators are called instrumental-focused on rules and rewards; socialized-attending to social norms and expectations; self-authoring-seeking to build internal values; and self-transforming-seeing gaps in one's closely held value systems and being open to those of others.When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan's model can help educators provide more effective support to groups of learners as well as individuals, support learners' transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.
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Affiliation(s)
- Linda Orkin Lewin
- L.O. Lewin is professor of pediatrics, Emory University, Atlanta, Georgia; ORCID: http://orcid.org/0000-0001-6028-3960. A. McManamon is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. M.T.O. Stein is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. D.T. Chen is associate professor of biomedical ethics, public health sciences, and psychiatry and neurobehavioral sciences, and director of the iTHRIV Scholars curriculum, University of Virginia, Charlottesville, Virginia; ORCID: http://orcid.org/0000-0003-1081-1053
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Reimer D, Russell R, Khallouq BB, Kauffman C, Hernandez C, Cendán J, Castiglioni A. Pre-clerkship medical students' perceptions of medical professionalism. BMC MEDICAL EDUCATION 2019; 19:239. [PMID: 31262283 PMCID: PMC6604300 DOI: 10.1186/s12909-019-1629-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/23/2019] [Indexed: 05/30/2023]
Abstract
BACKGROUND Professionalism instruction and assessment is a core component of medical education, and essential for professional identity formation (PIF). Thus, understanding the socialization of medical students to the values of the profession (i.e., medical professionalism), and how these may evolve, warrants continued understanding. METHODS The purpose of this study was to examine and compare pre-clerkship (first and second year) medical students' perceptions of professionalism. First and second year medical students participate in this study. This was a two-phase mixed-methods cohort study conducted across two academic years (2014-2015 and 2015-2016). In Phase I, first and second year medical students participated in a nominal group technique (NGT) session. NGT data was analyzed qualitatively to generate a card-sorting exercise of professionalism attributes for Phase II. In Phase II, data from the sorting task was analyzed using Principle Component Analysis (PCA). RESULTS The PCA for first year students derived a 7-factor solution. Factors (i.e., professionalism domains) identified were: Self-management and patient-centeredness, ethics and professional reputation, dependability, self-awareness and self-improvement, image, proficiency and lifelong learning and integrity. The PCA for second year students derived a 5-factor solution; factors identified were: "Good Doctor" attributes, responsibility, ethics, innovation and self-improvement and unbiased. CONCLUSIONS Identification and organization of attributes into an overarching professionalism mental model provide a window into the active reconstruction of students' professional identity during the nascent stages of medical education. M1 professionalism domains were more consistent with the conventional professional image of the physician (e.g. Ethics and Professional reputation, Dependability, Integrity), whereas, M2 domains reflected a more global view (e.g., "Good Doctor" attributes, Responsibility, Ethics). This study provides a lens into the dynamic nature of students' PIF and encourages educators to evaluate PIF pedagogy at their own institutions.
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Affiliation(s)
| | | | - Bertha Ben Khallouq
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Christine Kauffman
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Caridad Hernandez
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Juan Cendán
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
| | - Analia Castiglioni
- College of Medicine, University of Central Florida, 6850 lake Nona Blvd, Orlando, FL 32827 USA
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