Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education)

Impact of a Service Learning Curriculum that Emphasizes Bidirectional Learning on Medical Students' Professional Identity Formation

Introduction

Despite the many known benefits of service learning, little is known about the impact of service learning on medical students' professional identity formation.

Purpose

The objective of our study was to assess the impact of a service learning curriculum that emphasized bidirectional learning on the professional identity of medical students.

Methods

The community-based participatory research (CBPR) conceptual model, a model which emphasizes bidirectional learning between academic and community stakeholders, was utilized as a curricular framework for a required service-learning course at a single institution in North America. All 45 third year medical students enrolled in the course were included. Using a qualitative data analysis framework and the constant comparative method, the two researchers independently reviewed all 45 individual student reflections to identify themes that emerged and to iteratively create a codebook. A thematic analysis of the codes was then undertaken to answer the research question.

Results

Themes from student reflections revealed the following: (1) The process of perspective-taking during bidirectional learning promotes becoming an empathetic physician. Enabling factors are empathy with stakeholders and seeing oneself as a future change agent. (2) The process of perspective-taking and reconciliation of learner/stakeholder beliefs with a goal of unifying around a common mission was expressed in several different ways: Learner pivots from their original belief to stakeholder's beliefBoth learner and stakeholder beliefs are incorporated into the final goalLearner keeps original beliefsEnabling factors are empathy, humility, and discernment.

Conclusion

Bidirectional or reciprocal learning in service learning can promote professional characteristics such as empathy, humility, and discernment.

Engaging Students in a Dialysis Unit: A Pilot Study

BACKGROUND

Seeking to provide early paediatric nephrology exposure to medical students in the United States, we implemented the Kids In Dialysis, Nephrology Exposure and Education (KIDNEE) club. This club served as an educational intervention in which preclinical medical students were paired with paediatric dialysis patients, as patient buddies.

APPROACH

Students were recruited for involvement in the club through the medical school Paediatric Interest Group. For the 2022-2023 academic year, seven first-year students were paired with seven paediatric dialysis patients. Students met with their patient match weekly to play games, watch movies and to act as a friend.

EVALUATION

The evaluation aimed at assessing the feasibility and acceptability of this intervention as well as influence on student interest in paediatric chronic disease and paediatric nephrology. We developed and distributed surveys to patients, unit staff, and students after programme implementation. From October 2022 to April 2023, medical students collectively spent ~173 h in the dialysis unit. Staff and patients/families unanimously reported that they would recommend the KIDNEE club to other families. Students objectively reported an increased interest in paediatric nephrology and chronic disease and subjectively reported an increased understanding of the patient experience.

IMPLICATIONS

The KIDNEE club pilot was both feasible and acceptable for patients/families, staff and students. It holds the potential to increase student interest in the field of paediatric nephrology. As our results are limited by small sample size given the pilot nature of the programme, future studies are needed to assess programme expansion and longitudinal influence on students' career paths.

Contribution of Basic Science Education to the Professional Identity Development of Medical Learners: A Critical Scoping Review

PURPOSE

Professional identity development (PID) has become an important focus of medical education. To date, contributions of basic science education to physician PID have not been broadly explored. This review explores the literature surrounding the contribution of basic science education to the PID of medical learners and interprets findings critically in terms of the landscapes of practice (LoP) framework.

METHOD

In this critical scoping review, the authors searched 12 different databases and professional organization websites from January 1988 to October 2022 for references relating to how, if at all, the basic science component of medical education contributes to the PID of medical learners. The LoP learning theory was chosen as a framework for critically interpreting the identified articles.

RESULTS

Of the 6,674 identified references, 257 met the inclusion criteria. After data extraction, content analysis of recorded key findings was used to ensure all findings were incorporated into the synthesis. Findings aligned with and were critically interpreted in relation to the 3 LoP modes of identification: engagement (engaging in the work of a physician), imagination (imagining oneself becoming a "good doctor"), and alignment (aligning with the practices and expectations of a medical community or specialty). Within each mode of identification, it was possible to see how basic science may support, or catalyze, PID and how basic science may serve as a barrier, or an inhibitor, to PID or contribute to the development of negative aspects of identity development.

CONCLUSIONS

The LoP learning theory suggests that the effect of basic science on physicians' PID is most effective if educators view themselves as guides through interfaces between their scientific disciplines and medicine. Learners need opportunities to be engaged, to imagine how their current learning activities and developing skills will be useful as future physicians, and to feel alignment with medical specialties.

Perceived importance of emotional intelligence for clinical pharmacy practice and suggested improvements: a focus group study of postgraduate pharmacists

BACKGROUND

Emotional intelligence (EI) is a critical set of skills that impacts clinical pharmacists' well-being and positively influences high-level patient-centred care. Describing pharmacists' perceptions may support the integration of EI development approaches into their professional development continuum.

AIM

The aim of this study was to analyse pharmacists' perceptions of the characteristics of emotionally intelligent clinical pharmacists, the importance of EI in clinical practice, and educational models and approaches to enhancing EI.

METHOD

A qualitative study with a focus group methodology was conducted with pharmacy practitioners using a semi-structured guide grounded in the EI competency framework and existing qualitative research methodology practices. Purposive sampling was conducted until information and meaning saturation occurred. The focus group recordings were transcribed and independently coded by two researchers. The conventional content analysis of qualitative data was applied with the inductive thematic approach at its core.

RESULTS

According to the 17 focus group participants, emotionally intelligent clinical pharmacists are perceived as self-confident communicators who control and manage emotions, work well under pressure, and handle every situation effectively. Emotional self-control, self-awareness, awareness of others, tolerance, understanding, and empathy have emerged as key EI competencies required for challenges in clinical practice. EI lectures with reflections from clinical applications, behaviour modelling, and behaviour-changing methods were perceived to be of particular importance for pharmacist education and development programmes.

CONCLUSION

Postgraduate pharmacy practitioners perceived EI competencies as necessary for their professional success and high-quality patient-centred care. They suggested that EI competencies be a focal point in pharmacy professional development programmes.

A scoping review and theory-informed conceptual model of professional identity formation in medical education

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.

Insights into values and emotional wellbeing of medical students in the United Arab Emirates: a cross-sectional study

Objective

To describe the difference in values among medical students from a first-year student' and final year student' perspective. In addition, it is designed to report associations and trends between personal values and overall emotional states.

Methods

This is an analytical cross-sectional study that involved disseminating an online survey via email to first and final year students at the College of Medicine in Mohammed Bin Rashid University (MBRU) in Dubai, United Arab Emirates in December of 2023. The survey encompassed queries on demographics, the Life Values Inventory (LVI) and the Positive and Negative Affect Schedule (PANAS).

Results

The survey was completed by 84 students. About half of the participants were final year medical students (45/84; 53.6%) with the majority being females (70/84; 83.3%). Positive emotions were positively correlated to various life values, including belonging, scientific understanding, responsibility, and achievement (p < 0.05). When comparing academic years, the scores of the life value of Achievement showed a significant correlation (p = 0.04), with first-year students' mean (SD) of 12 (2) out of 15 compared to 11 (3) out of 15 for final-year students. Positive Emotions also exhibited a significant correlation (p = 0.006), with first-year students' mean (SD) 40 (5) out of 50 compared to 36 (7) out of 50 for final-year students.

Conclusion

This study adds to medical education research by exploring values and emotions, shedding light on factors shaping students' professional identities. Understanding these dynamics can aid in supporting future healthcare providers and by extension the patients for whom they care.

'I'm looking as white and as straight as possible at all times': a qualitative study exploring the intersectional experiences of BAME LGBTQ+ medical students in the UK

OBJECTIVES

The positive formation of professional identity is considered crucial in how medical students begin to feel and act as clinicians. Although, awareness of how Professional Identity Formation (PIF) may be affected among minoritised groups is increasing, understanding from an intersectional lens remains limited. The aim of this study was to explore the experiences of Black, Asian, Minoritised Ethnic (BAME) and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) medical students in the undergraduate Bachelor of Medicine, Bachelor of Science programme.

DESIGN

Based on the methodology of phenomenography, all medical students identifying as BAME and LGBTQ+ were eligible for participation. Semistructured interviews were conducted with data collection continuing until theoretical saturation was reached. The coding framework was developed independently by the principal researcher and supervisor before being compared to create a shared analytical framework.

SETTING

University College London Medical School (UCLMS) between October 2022 and February 2023.

PARTICIPANTS

Six UCLMS students were recruited, one of whom was in the 'early' years (years 1-3) with the remainder in the 'later' years (years 4-6) RESULTS: Six main themes emerged from the data, which were categorised into three main areas: challenges to intersectionality, benefits to intersectionality and protective factors. Challenges to intersectionality included three themes, 'The BAME identity interacting with the LGBTQ+identity', 'BAME background influencing LGBTQ+identity exploration' and 'no true safe spaces for BAME and LGBTQ+ students to be themselves'. Benefits to intersectionality included 'greater insight into the self' and protective factors included two themes of 'peer support networks' and 'visibility within the university and clinical environments.'

CONCLUSION

By exploring PIF among medical students from an intersectional lens, this study highlights the increased emotional burden faced by those who identify as BAME and LGBTQ+, as they attempt to reconcile both these identities with becoming a future doctor, affecting their sense of belonging socially and within the profession. Despite being based at a single medical school, it highlights the importance of creating a truly inclusive environment through positive role modelling and increased visibility among the BAME, LGBTQ+ community in the undergraduate programme.

Unveiling the impact of interprofessional education on shaping students' interprofessional identity and collaboration perception: a mixed-method study

BACKGROUND

Interprofessional education (IPE) has the potential to shape students' collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students.

METHODS

Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students (N = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson's correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted.

RESULTS

Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p = .02) and interprofessional identity (M = 3.97, t = 4.86; p < .001) after participating in IPE. The positive relationship between collaboration perception and interprofessional identity strengthened after participating in IPE, as evident from the correlation (Time 1: r = .69; p < .001; Time 2: r = .79; p < .001). Furthermore, collaboration perception in Time 1 significantly predicted the variance in interprofessional identity at Time 2 (β = 0.347, p < .001). Qualitative findings indicated that 85.2% of students expressed that IPE played a role in promoting their interprofessional identity and collaboration attitudes.

CONCLUSIONS

Incorporating the IPE program into the curriculum can effectively enhance students' collaboration perception and interprofessional identity, ultimately preparing them for collaborative practice in the healthcare system. By engaging students in interprofessional teamwork, communication, and joint decision-making processes, the IPE program provides a valuable context for students to develop a sense of belonging and commitment to interprofessional collaboration.

"Today, I Say It's Mine!": Professional Identity Construction among Jewish and Arab School Counselors Coping with CSA Disclosure in Israel

School counselors play a crucial role in preventing, disclosing, and intervening in child sexual abuse cases (CSA) and in maintaining safe and protected school environments. However, research on their experiences coping with CSA remains limited. The purpose of the present study was to describe and analyze the coping experiences of Israeli Jewish and Arab school counselors with CSA disclosure, particularly the consequences for their processes of professional identity construction (the ongoing process through which they develop and refine their sense of self in their profession). Semi-structured interviews were conducted with 21 Israeli Jewish and Arab school counselors working in elementary schools (grades 1-6) with significant experience in coping with CSA. Two themes surfaced, reflecting the counselors' professional identity construction: (1) Counselors' professional identity transformation following encounters with CSA among their students; (2) Integrating professional knowledge, attitudes, and engagement behaviors into professional identity. The findings describe a trajectory of transformation and professional development among the counselors, beginning with defining and refining their professional roles and followed by the integration of professional knowledge, attitudes, and behaviors into their professional routines. Arab counselors also highlighted specific sociocultural challenges within this process, relating to the gap between cultural values and role expectations. Implications for future research, policy, and practice are discussed.

The mobilisation of professional identity: A scoping and lexical review

Interprofessional care obliges different healthcare professions to share decision-making and sometimes, practices. Given established hierarchies, it can be difficult to promote interprofessional care, partly because of the need to reshape professional identities. Despite interest in effective interprofessional care, there is limited research on how professional identity can be mobilised to promote it. A scoping review as well as lexical review of academic publications was conducted to address this void. After searching seven academic databases and screening the identified publications, 22 publications met the inclusion criteria. They collectively reported on 22 interventions, most of which were used in healthcare. The scoping review suggested there is some evidence that professional identities can be mobilised. Yet, of the 22 interventions, only ten explicitly targeted professional identity. The most common intervention was a training or development program, followed by workplace redesign. The need for internal motivation to mobilise professional identity was reported as was the impact of external drivers, like extending the scope of practice. Extending these findings, the lexical review demonstrated that, among the 22 publications, the relationship between professional identity and mobilisation did not feature prominently within the discourse. Furthermore, it seems that geography matters-that is, while all the publications spoke of professional identity, they differed by region on how they did this. Given these findings, concentrated scholarship is needed on the relationship between professional identity and interprofessional care, lest interprofessional care programs have limited, sustained effect. Implications for scholars and practitioners are explicated.

Professional values at the beginning of medical school: a quasi-experimental study

BACKGROUND

Teaching professionalism in medical schools is central to medical education and society. We evaluated how medical students view the values of the medical profession on their first day of medical school and the influence of a conference about the competences of this profession on these students' levels of reflection.

METHODS

We studied two groups of medical students who wrote narratives about the values of the medical profession and the influence of the COVID-19 pandemic on these values. The first group wrote the narratives after a conference about the competences of the medical profession (intervention group), and the second group wrote the same narratives after a biochemistry conference (control group). We also compared the levels of reflection of these two groups of students.

RESULTS

Among the 175 medical students entering in the 2022 academic year, 159 agreed to participate in the study (response rate = 90.8%). There were more references to positive than negative models of doctor‒patient relationships experienced by the students (58.5% and 41.5% of responses, respectively). The intervention group referred to a more significant number of values than the control group did. The most cited values were empathy, humility, and ethics; the main competences were technical competence, communication/active listening, and resilience. The students' perspectives of the values of their future profession were strongly and positively influenced by the pandemic experience. The students realized the need for constant updating, basing medical practice on scientific evidence, and employing skills/attitudes such as resilience, flexibility, and collaboration for teamwork. Analysis of the levels of reflection in the narratives showed a predominance of reflections with a higher level in the intervention group and of those with a lower level in the control group.

CONCLUSIONS

Our study showed that medical students, upon entering medical school, already have a view of medical professionalism, although they still need to present a deeper level of self-reflection. A single, planned intervention in medical professionalism can promote self-reflection. The vision of medical professional identity was strongly influenced by the COVID-19 pandemic, positively impacting the formation of a professional identity among the students who decided to enter medical school.

Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula

Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.

Quarantining From Professional Identity: How Did COVID-19 Impact Professional Identity Formation in Undergraduate Medical Education?

Introduction

Professional Identity Formation (PIF) entails the integration of a profession's core values and beliefs with an individual's existing identity and values. Within undergraduate medical education (UGME), the cultivation of PIF is a key objective. The COVID-19 pandemic brought about substantial sociocultural challenges to UGME. Existing explorations into the repercussions of COVID-19 on PIF in UGME have predominantly adopted an individualistic approach. We sought to examine how the COVID-19 pandemic influenced PIF in UGME from a sociocultural perspective. This study aims to provide valuable insights for effectively nurturing PIF in future disruptive scenarios.

Methods

Semi structured interviews were conducted with medical students from the graduating class of 2022 (n = 7) and class of 2023 (n = 13) on their medical education experiences during the pandemic and its impact on their PIF. We used the Transformation in Medical Education (TIME) framework to develop the interview guide. Direct content analysis was used for data analysis.

Results

The COVID-19 pandemic significantly impacted the UGME experience, causing disruptions such as an abrupt shift to online learning, increased social isolation, and limited in-person opportunities. Medical students felt disconnected from peers, educators, and the clinical setting. In the clerkship stage, students recognized knowledge gaps, producing a "late blooming" effect. There was increased awareness for self-care and burnout prevention.

Discussion

Our study suggests that pandemic disruptors delayed PIF owing largely to slower acquisition of skills/knowledge and impaired socialization with the medical community. This highlights the crucial role of sociocultural experiences in developing PIF in UGME. PIF is a dynamic and adaptable process that was preserved during the COVID-19 pandemic.

Competency-based pharmacy education definition: What components need to be defined to implement it?

OBJECTIVES

This study aimed to define the essential elements in the proposed competency-based pharmacy education (CBPE) definition, provide the key defining components of each essential element on the basis of educational theory and evidence, and define how the essential elements meet the identified needs for CBPE.

METHODS

best-practice integrative review was conducted as part of the work of the American Association of Colleges of Pharmacy CBPE Task Force to define the essential elements in the CBPE definition and how these elements fit with the need for CBPE. The definition was compared with other published competency-based education definitions across K-12, higher education, medical education, and veterinary education. Task Force members then met to develop a consensus on the core components of the 5 essential elements in the definition. Next, the Task Force evaluated the fit of CBPE by matching the identified needs, discussed in detail elsewhere, across each of the stakeholder perspectives with the core components of the 5 essential elements in the derived definition of CBPE.

FINDINGS

Upon review of the proposed CBPE definition, the Task Force identified 5 essential elements. These elements include the following: meeting health care and societal needs, outcomes-based curricular model, de-emphasized time, learner-centered culture, and authentic teaching and learning strategies aligned to assessments.

SUMMARY

This article helps to establish a common language for CBPE by defining the essential elements of the core components of the definition, and provides a starting point for further exploration of CBPE.

Professional identity and role perception of Radiographers and Clinical Technologists in Nuclear Medicine - An exploratory qualitative study

INTRODUCTION

An awareness of Professional Identity (PI), an individual's identity in relation to their professional group, and Role Perception (RP), an individual's view of their specific role, may enable safe and effective practice by providing an understanding of professional boundaries, behaviours and activities. This research aimed to explore and gain an understanding of the PI and RP of Radiographers and Clinical Technologists working as Nuclear Medicine Technologists (NMT's).

METHODS

10 NMT's were recruited from a large National Health Service (NHS) Trust. Utilising the established methodology of Qualitative Description, data was obtained using semi-structured interviews and analysed using inductive thematic analysis.

RESULTS

Four themes were identified: "Becoming the Unexpected" which detailed various training pathways; "Caring with Science" which described the NMT's role and defined their PI; "Same View, Different Lens" which portrayed how Radiographers and Clinical Technologists practise as team of NMT's; and "Confirmation of Professional Self" which presented how individuals view their professional status.

CONCLUSION

The study showed that the NMT role is highly specialised, multi-faceted and patient-centred. Their professional status is based on the nature of their role and their university level education and training. They work together under the umbrella title of NMT with a dual professional identity of "provider of care" and "user of science and technology". However, they may have an individual identity of Radiographer or Clinical Technologist that is determined by their training pathway.

IMPLICATIONS FOR PRACTICE

This research has provided valuable understanding of the PI and RP of NMT's. By highlighting the differences in the regulatory status of this workforce, an insight into the future implications in the context of national healthcare planning has been provided, highlighting potentially significant issues that may impact on the manner in which NMT's can practice.

The role of arts-based curricula in professional identity formation: results of a qualitative analysis of learner's written reflections

BACKGROUND

Professional identity formation is an important aspect of medical education that can be difficult to translate into formal curricula. The role of arts and humanities programs in fostering professional identity formation remains understudied. Analyzing learners' written reflections, we explore the relationship between an arts-based course and themes of professional identity formation.

MATERIALS AND METHODS

Two cohorts of learners participated in a 5-day online course featuring visual arts-based group activities. Both cohorts responded to a prompt with written reflections at the beginning and end of the course. Using a thematic analysis method, we qualitatively analyzed one set of reflections from each cohort.

RESULTS

Themes included the nature of the good life; fulfilling, purposeful work; entering the physician role; exploration of emotional experience; and personal growth. Reflections written at the end of the course engaged significantly with art - including literature, poetry, lyrics, and film. One student disclosed a mental illness in their reflection.

CONCLUSIONS

Our qualitative analysis of reflections written during a visual arts-based course found several themes related to professional identity formation. Such arts-based courses can also enrich learners' reflections and provide a space for learners to be vulnerable.

PRACTICE POINTS

(five short bullets conveying the main points) Arts-based courses can support learners' professional identity formationReflection themes related to professional identity formation included entering the physician role, fulfilling clinical work, and personal growthAt the end of the course, learners' reflections included significant engagement with artReflective writing in small, arts-based learning communities can provide space for learners to be vulnerableThe Role of Arts-Based Curricula in Professional Identity Formation: Results of A Qualitative Analysis of Learner's Written Reflections.

Professional Identity of Pakistani Veterinary Students: Conceptualization and Negotiation

Most work on the professional identity of veterinary and medical professionals has been conceptualized in the US and Europe. It reports professional identity formation to be highly individualized, triggered by experiences of identity distress, and identity negotiation strategies to be generally focused around personal reflection. However, within Asia, important sociocultural differences exist that might influence professional identity and its development. Societal values may take precedence over individual ones, and some cultures consider the veterinary profession as stigmatized. With this background, we seek to understand professional identity and its construction in Pakistani veterinary students. We selected five students through purposive sampling and invited them for narrative interviews. Social identity theory and Maslow's theory of hierarchy of needs predominantly contributed to the theoretical framework, which together with principles of social phenomenology and narrative analysis informed qualitative analysis of the transcribed interviews using an in-depth approach. We found that students' professional identity was predominantly socially constructed, though their sense of their identity was not very well developed. Role models, social stigma, professional socialization in clinical settings, gender, and to some extent, cultural interpretations of religious messages seemed to mediate professional identity development. Students responded differently to their understanding of professional stigma, making sense of stigma through strategies such as denial or internalization. Since Pakistani veterinary students experience social and personal values differently compared with those from predominantly individualistic cultures, identity formation through reflecting on personal values may be less effective than strategies that emphasize social learning and beliefs.

Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education

The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners' abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula may be unintentionally overlooking who learners are becoming (i.e., the formation of their professional identities). Integrating professional identity formation (PIF) into curricula has the potential to positively influence professionalism, well-being, and inclusivity; however, issues related to the definition, assessment, and operationalization of PIF have made it difficult to embed this curricular imperative into CBME. This paper aims to outline a path towards the reconciliation of PIF and CBME to better support the development of physicians that are best suited to meet the needs of society. To begin to reconcile CBME and PIF, this paper defines three contradictions that must and can be resolved, namely: (1) CBME attends to behavioral outcomes whereas PIF attends to developmental processes; (2) CBME emphasizes standardization whereas PIF emphasizes individualization; (3) CBME organizes assessment around observed competence whereas the assessment of PIF is inherently more holistic. Subsequently, the authors identify curricular opportunities to address these contradictions, such as incorporating process-based outcomes into curricula, recognizing the individualized and contextualized nature of competence, and incorporating guided self-assessment into coaching and mentorship programs. In addition, the authors highlight future research directions related to each contradiction with the goal of reconciling 'doing' and 'being' in medical education.

Reluctant heroes: New doctors negotiating their identities dialogically on social media

BACKGROUND

Ensuring that students transition smoothly into the identity of a doctor is a perpetual challenge for medical curricula. Developing professional identity, according to cultural-historical activity theory, requires negotiation of dialectic tensions between individual agency and the structuring influence of institutions. We posed the research question: How do medical interns, other clinicians and institutions dialogically construct their interacting identities?

METHODS

Our qualitative methodology was rooted in dialogism, Bakhtin's cultural-historical theory that accounts for how language mediates learning and identity. Reasoning that the COVID pandemic would accentuate and expose pre-existing tensions, we monitored feeds into the Twitter microblogging platform during medical students' accelerated entry to practice; identified relevant posts from graduating students, other clinicians and institutional representatives; and kept an audit trail of chains of dialogue. Sullivan's dialogic methodology and Gee's heuristics guided a reflexive, linguistic analysis.

RESULTS

There was a gradient of power and affect. Institutional representatives used metaphors of heroism to celebrate 'their graduates', implicitly according a heroic identity to themselves as well. Interns, meanwhile, identified themselves as incapable, vulnerable and fearful because the institutions from which they had graduated had not taught them to practise. Senior doctors' posts were ambivalent: Some identified with institutions, maintaining hierarchical distance between themselves and interns; others, along with residents, acknowledged interns' distress, expressing empathy, support and encouragement, which constructed an identity of collegial solidarity.

CONCLUSIONS

The dialogue exposed hierarchical distance between institutions and the graduates they educated, which constructed mutually contradictory identities. Powerful institutions strengthened their identities by projecting positive affects onto interns who, by contrast, had fragile identities and sometimes strongly negative affects. We speculate that this polarisation may be contributing to the poor morale of doctors in training and propose that, to maintain the vitality of medical education, institutions should seek to reconcile their projected identities with the lived identities of graduates.

Professional Identity Formation of Basic Science Medical Educators: A Qualitative Study of Identity Supports and Threats

PURPOSE

Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators.

METHOD

A qualitative descriptive study was conducted with a purposive sample of 58 BSME from 7 allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted.

RESULTS

Factors shaping PIF were grouped into 3 broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued.

CONCLUSIONS

This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.

A Pilot Study of Art Museum-Based Small Group Learning for Pre-Health Students

Introduction

Health professions educators are increasingly recognizing the fundamental role the arts and humanities play in professional identity formation; however, few reports exist of programs designed specifically for pre-health professional students.

Methods

We designed and delivered four, 2.5-h sessions for pre-health professions students at a local museum in partnership with museum educators. Participants were invited to respond to a follow-up survey asking about their perceived insights from and importance of the session. We used descriptive statistics and thematic content analysis for quantitative and qualitative data, respectively.

Results

Ten of the participants responded to the survey (n=10/23, response rate=43%) and all supported the integration of such an experience in their pre-health curriculum. The qualitative analysis of responses to the open-ended item about any insights gained from participation in the program revealed three themes: cultivation of the health professional, personal growth, and awareness and appreciation of multiple perspectives.

Discussion

Participants who responded to our survey drew meaningful connections to the relevance of these sessions to their development as future professionals.

Developing medical professionalism in care of gender nonconforming patients: Reflections of second-year medical students after a curricular experience with gender nonconforming people and allies

INTRODUCTION

Negative healthcare experiences persist for gender nonconforming individuals. Clinician-related factors, including lack of comfort with gender nonconforming persons and unexamined personal biases, present barriers to equitable and affirming healthcare. We explored the effects of contact with gender nonconforming individuals in preclinical medical education through a structured curricular intervention designed to build medical and humanistic knowledge and stimulate the development of medical professionalism surrounding the care of gender nonconforming individuals.

METHODS

A curricular module (didactic prework, time-synchronous online panel discussion, and post-event written reflection) was implemented in a second-year preclinical course in a large multi-campus Midwestern medical school. The module was based on pedagogical foundations of contact theory and reflective writing. Post-event written reflections were investigated using thematic analysis.

RESULTS

Analysis of 355 written reflections revealed three major themes (moments of insight, topics of confusion, connections to professional identity formation) and eight sub-themes. The findings demonstrated emerging gender professionalism and the importance of contact in professional development.

DISCUSSION

Contact with gender nonconforming people and the use of written reflections can encourage self-examination and foster professional identity formation among preclinical medical students. Modeling gender-affirming approaches may help counteract negative cultural messages about gender nonconforming people, aiding development of inclusive future physicians.

Reevaluating Core Elements of Emotional Intelligence in Professional Identity Formation for Inclusion in Pharmacy Education

OBJECTIVES

The objectives of this review are to (1) analyze the core concepts of emotional intelligence self-perception, self-expression, interpersonal relationships, decision-making skills, and stress management and their role in professional identity formation, and (2) investigate the methods and strategies to incorporate emotional intelligence in pharmacy education.

FINDINGS

A literature review of emotional intelligence in health care education was conducted by searching the electronic databases PubMed, Google Scholar, ProQuest, and ERIC. The following search terms were included: emotional intelligence, emotional quotient, in association with professional identity formation, pharmacy curriculum, pharmacy cocurriculum, entrustable professional activities, medicine, and nursing. Only full-length, free-access, English-text articles were included. Twenty articles addressed the inclusion and/or assessment of core elements of emotional intelligence in pharmacy education. Commonly taught, cultivated, and assessed core elements include self-awareness, empathy, and interdisciplinary relationships. Assessment tools used to evaluate emotional intelligence in pharmacy education are subjective, qualitative, and semiquantitative, and may include pre and postcourse surveys, event surveys, and questionnaires.

SUMMARY

The pharmacy literature is scarce on how best to analyze emotional intelligence and the role it plays in the pharmacist's education and practice. A comprehensive integration of emotional intelligence into the pharmacy curriculum is a challenging task and requires additional in-depth discussions on how best to incorporate it in the pharmacist's professional identity formation. The Academy will benefit from re-engaging its constituents in addressing the gaps of emotional intelligence in the professional curriculum in preparation for the Accreditation Council for Pharmacy Education 2025 standards.

A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems Science

Background and Purpose

Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students' HSS knowledge and attitudes concerning health system citizenship.

Methods

This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey.

Results

Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher).

Discussion

There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.

Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa

The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.

Professional Identity and Motivation for Medical School in First-Year Medical Students: A Cross-sectional Study

Background

Professional identity formation (PIF) is a life-long process, starting even before professional education. High levels of motivation for medical school are essential for effective learning and academic success. Both are key factors in future physicians' professional and personal development, and according to self-determination theory, professional identity (PI) and students' levels of motivation could be closely linked. Therefore, we sought to investigate whether PI and strength of motivation for medical school are associated in new medical students.

Methods

In a cross-sectional survey, all new medical students in Munich, Germany, were asked to complete the Macleod Clark Professional Identity Scale (MCPIS-9) and the Strength of Motivation for Medical School-Revised questionnaire (SMMS-R) as well as to provide information about age, gender, and waiting time before starting medical school.

Results

Eight hundred eleven out of 918 new medical students participated in the survey. A positive correlation between the MCPIS-9 and the SMMS-R (p < 0.001) was found. Female students showed higher scores in the SMMS-R (p < 0.05) and the SMMS-R-subscale Readiness to Start (p < 0.001). The amount of waiting semesters showed a positive correlation with the total SMMS-R score (p < 0.01) as well as with the subscales Readiness to Start and Persistence (both p < 0.001).

Discussion

We found an association between PI and strength of motivation for medical school in a large cohort of new medical students. Female gender and more waiting semesters were associated with higher levels of self-perceived motivation and higher scores on the SMMS-R-subscale Readiness to Start. More research is needed to better understand this topic to further improve medical education.

Goal co-construction and dialogue in an internal medicine longitudinal coaching programme

BACKGROUND

Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships.

METHODS

This was a qualitative study using interpretive description methodology. Eight internal medicine coach-resident dyads consented to audiotaping coaching meetings over a 1-year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co-construction as a sensitising concept.

RESULTS

Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals.

CONCLUSIONS

In analysing goal development in the coach-resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage-specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co-regulation and reflection on both clinical competencies and professional identity formation.

Development of professional identity among dental students - A qualitative study

PURPOSE

The study explored dental students' perception of their professional identity (PI) development at a newly established dental college with a problem-based learning (PBL) curriculum.

METHODS

Qualitative methods based on focus groups were used for data collection. The conceptual framework of the study was informed by a subject-centered sociocultural approach to PI development. Purposive sampling was used to collect data from five focus groups of undergraduate dental students to gain a deeper understanding of their PI development in a PBL environment.

RESULTS

Out of a total of 38 dental students in years 2 and 3, 34 students (89.47%) participated in the focus groups. A theory-driven thematic analysis was used to dissect the views and experiences of the participants to explore factors contributing to PI development in the early years of the program. At an individual level, PBL was seen to be appropriate for PI development. However, some participants placed more emphasis on practical training in operative dental skills. Relational sources especially role modeling by the PBL facilitators and faculty staff were identified as a key factor to nurture PI development. Mixed views were observed on the value of PBL to enhance team-working skills. The participants also identified challenges of PBL and provided recommendations on further improvements to enhance the learning experiences of the students.

CONCLUSIONS

This study provided useful insights into a PBL curriculum at a newly established dental institution. The findings underscore the value of PBL in developing PI and also highlight the challenges of implementing PBL in a socio-cultural context and pedagogical implications for further program improvement.

Potential of Volunteering in Formal and Informal Medical Education-A Theory-Driven Cross-Sectional Study with Example of the COVID-19 Pandemic

Students' volunteering is an effective way to manage health crises, including pandemics. Due to the limited capacity of the healthcare system at the time of the COVID-19 outbreak, the engagement of students in volunteering services seemed invaluable. Based on different teaching-learning theories, in this survey study, we aimed to evaluate the potential of the volunteering service project launched by the Poznan University of Medical Sciences during the COVID-19 pandemic as a learning opportunity for undergraduate healthcare students. The results indicate the potential of involving students in volunteering activities for educational purposes, as well as other values, including attitudes and professional identity development, which could be difficult to realize using traditional teaching methods. However, stimulating students' reflectiveness seems necessary to reach its full educational effectiveness. Medical teachers should provide students with more opportunities for volunteering and service learning and consider making these a constant element of the curriculum beyond the COVID-19 pandemic.

"Every day that I stay at home, it's another day blaming myself for not being at #Frontline"-Understanding medical students' sacrifices during COVID-19 Pandemic

COVID-19 struck the world and stretched the healthcare system and professionals. Medical students engaged in the pandemic effort, making personal and professional sacrifices. However, the impact of these sacrifices on students` professional development is still unknown. We applied constructivist grounded theory to individual audio diaries (total time = 5h38 min) and interviews (total time = 11h57min) performed with 18 last-year medical students during the first wave of COVID-19 pandemic in Brazil. The perspective of making sacrifices caused initial emotional distress in medical students, followed by a negotiation process revolving around three themes: predisposition to sacrifice, sense of competence, and sense of belonging. This negotiation process led to three response patterns: Pattern A: "No sense of duty"-the sacrifice was perceived as meaningless, and students showed intense anger and a desire to flee; Pattern B: "Sense of duty with hesitation to act"-the sacrifice was acknowledged as legitime, but students felt unprepared to contribute, leading to feelings of frustration and shame; and, Pattern C: "Sense of duty with readiness to act"-the engagement with the sacrifice was perceived as an opportunity to grow as a doctor, leading to fulfillment and proudness. Students ready to engage with the COVID-19 effort experienced identity consonance, reinforcing their professional identities. Students who felt incompetent or found the sacrifice meaningless experienced identity dissonance, which led to emotional suffering and the consideration of abandoning the course. Monitoring students' emotional reactions when facing professional challenges creates opportunities to problematize the role of sacrifice in the medical profession and scaffold professional identity development.

Assessing student reflections of significant professional identity experiences

INTRODUCTION

Professional identity formation (PIF) is an essential component of pharmacy education. A student-focused holistic approach can be introduced through exposure to a variety of curricular and co-curricular activities. It is essential for students to not only participate in these activities but also to reflect on their actions and thoughts about those activities. The objective of this study was to better understand the experiences students identify as significant in their PIF.

METHODS

A mixed methods approach with qualitative thematic analysis was conducted for first-year (P1) and second-year (P2) student pharmacist end-of-year reflections to understand the types and impact of various experiences on PIF. Students identified which experience was most impactful; additional analysis based on this identification was conducted.

RESULTS

A review of 151 student reflections led to coding and analysis of 453 experiences. Co-curricular experiences were identified most frequently in both P1 and P2 groups (59.8% and 56.4%, respectively). Curricular experiences were more likely to be mentioned by P1 students than P2 students (28.8% vs. 9.8%, P < .001). P2 students were more likely to identify experiential rotations (17.9% vs. 6.4%, P < .001) or work (13.7% vs. 9.1, P < .001). Other experiences were cited less frequently but were ranked as most impactful by students. Students often identified experiences that allowed them to apply skills and knowledge and opportunities to attend seminars and lectures.

CONCLUSIONS

When reflecting on experiences and their impact on PIF, student pharmacists discussed a variety of experiences but identified co-curricular opportunities most frequently as impactful.

Assessing professional identity formation (PIF) amongst medical students in Oncology and Palliative Medicine postings: a SEBA guided scoping review

BACKGROUND

Introduction to a multi-professional team who are working and caring for the dying, and facing complex moral and ethical dilemmas during Oncology and Palliative Medicine postings influence a medical student's professional identity formation (PIF). However, limited appreciation of PIF, inadequate assessments and insufficient support jeopardise this opportunity to shape how medical students think, feel and act as future physicians. To address this gap, a systematic scoping review (SSR) of PIF assessment methods is proposed.

METHODS

A Systematic Evidence-based Approach (SEBA) guided SSR of assessments of PIF in medical schools published between 1st January 2000 and 31st December 2021 in PubMed, Embase, ERIC and Scopus databases was carried out. Included articles were concurrently content and thematically analysed using SEBA's Split Approach and the themes and categories identified were combined using SEBA's Jigsaw Perspective. The review hinged on the following questions: "what is known about the assessment of professional identity formation amongst medical students?", "what are the theories and principles guiding the assessment of professional identity formation amongst medical students?", "what factors influence PIF in medical students?", "what are the tools used to assess PIF in medical students?", and "what considerations impact the implementation of PIF assessment tools amongst medical students?".

RESULTS

Two thousand four hundred thirty six abstracts were reviewed, 602 full-text articles were evaluated, and 88 articles were included. The 3 domains identified were 1) theories, 2) assessment, and 3) implementation in assessing PIF. Differing attention to the different aspects of the PIF process impairs evaluations, jeopardise timely and appropriate support of medical students and hinder effective implementation of PIF assessments.

CONCLUSION

The Krishna-Pisupati model combines current theories and concepts of PIF to provide a more holistic perspective of the PIF process. Under the aegis of this model, Palliative Care and Oncology postings are envisaged as Communities of Practice influencing self-concepts of personhood and identity and shaping how medical students see their roles and responsibilities as future physicians. These insights allow the forwarding of nine recommendations to improve assessments of PIF and shape the design of a PIF-specific tool that can direct timely and personalized support of medical students.

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.

Re-thinking "I"dentity in medical education: genealogy and the possibilities of being and becoming

Professional identity formation has emerged as a key topic for medical education research, with contributions from perspectives of psychological development and socialization opening up needed conversations in the field. Yet mainstream training practices may have the unintended effects of educating for a physician typology that may be too narrow to account for the complexity of learners' personal identities. Alternative approaches, such as Foucauldian genealogy, offer ways to empirically investigate how the legitimate contours of being and becoming have come to be as they are, how they shape professional identities, and to which degree their borders may be made more inclusive. Drawing upon an example of the contemporary practice of competency-based medical education in the Canadian context, this paper considers how genealogy's methodological tools of critical distancing, the dispositif, and problematization may help reveal how educational practices shape the identities of physicians-in-training in ways both intended and unintended. From this perspective it becomes apparent that any attempt to explore professional identity is incomplete without also considering that a trainee's evolving sense of self is inexorably bound up with forces of knowledge, power, and ethics that shape them into becoming certain kinds of physician subjects rather than others. In mapping this terrain, a genealogical approach determines how we reached the now in which we find ourselves and how we might transform it, such that we may shift the possibilities afforded to health professionals to establish professional identities aligned with their personal identities in ways that maximize inclusivity and minimize marginalization.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

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.

Medical students' self-evaluation of character, and method of character education

BACKGROUND

As medical doctors must have a strong sense of ethics, character education is particularly important for them compared with other professions. This follow-up study aimed to establish the foundation for developing a character education program in medical schools by (1) conducting a survey among medical students on the self-assessment of one's character based on eight qualities (service and sacrifice, empathy and communication, care and respect, honesty and humility, responsibility and calling, collaboration and magnanimity, creativity and positivity, patience and leadership), the perceived importance of character, and satisfaction with character education at medical school, and (2) analyzing the usefulness of learning methods for acquiring character elements. It also aimed at verifying the (3) gender differences in self-evaluation of character elements, and (4) academic-year differences in the survey items.

METHODS

Medical students' perceptions were identified through a questionnaire survey among 856 medical students from five South Korean medical schools. The questionnaire comprised items on the achievement level of the character element, importance of character in the medical curriculum, satisfaction with character education in medical schools, and the learning method's degree of helpfulness. Descriptive statistics, t-test, and one-way ANOVA were used to compare responses.

RESULTS

The importance of eight-character qualities had high average scores, whereas the average scores for satisfaction with character education and achievement level were comparatively low. For the question on each learning method's helpfulness in gaining the eight-character qualities, the score of team-based learning activities was the highest, followed by club activities, relationships with peers, role modeling of professors, and course study. Regarding satisfaction with character education, male students gave higher scores than female students, manifesting a statistically significant difference. Regarding the importance of the character element in medical education, statistically significant differences existed based on academic year.

CONCLUSION

Medical students' perceptions of character education varied according to gender and academic year. They regarded character education highly but were unsatisfied with the current character education at medical schools. Thus, diverse character education curricula must be developed and implemented along with extra-curricular character programs. An effective approach to implementing character education can be discovered by verifying the differences in students' perceptions based on the character education courses in medical schools.

Research on the influencing factors of fatigue and professional identity among CDC workers in China: an online cross-sectional study

OBJECTIVE

This study aimed to investigate the status quo and the influencing factors of fatigue and professional identity among the Centers for Disease Control and Prevention (CDC) workers in China during the pandemic.

DESIGN

A cross-sectional design.

SETTING

CDC workers employed by the Liaoning CDC system were enrolled (administrative staffs were excluded).

PARTICIPANTS

1020 CDC workers.

PRIMARY OUTCOME MEASURES

Fatigue scores and professional identity scores.

SECONDARY OUTCOME MEASURES

Postcompetency scores, respect scores, occupational stress scores, resilience scores and self-efficacy scores.

RESULTS

The average scores of fatigue and professional identity were 8.23, 38.88, respectively. Factors including perceived public respect (β=-0.129, p<0.01), resilience (β=-0.104, p<0.05) and self-efficacy (β=-0.22, p<0.01) were negatively associated with fatigue. Educational background (bachelor vs junior college or below) (β=0.105, p<0.01), (master or above vs junior college or below) (β=0.092, p<0.05), workplace (county vs district) (β=0.067, p<0.05), (city vs district) (β=0.085, p<0.05), fighting the COVID-19 on the front line (β=0.059, p<0.05) and occupational stress (β=0.166, p<0.01) were positively correlated with fatigue. Educational background (bachelor vs junior college or below) (β=-0.097, p<0.01), (master or above vs junior college or below) (β=-0.114, p<0.01), workplace (city vs district) (β=-0.114, p<0.01), fighting the COVID-19 on the front line (β=-0.047, p<0.05) and occupational stress (β=-0.105, p<0.01) were negatively associated with professional identity. Factors including postcompetency (β=0.362, p<0.01), perceived public respect (general vs low) (β=0.219, p<0.01), (high vs low) (β=0.288, p<0.01), resilience (β=0.097, p<0.05) and self-efficacy (β=0.113, p<0.01) were positively connected with professional identity.

CONCLUSION

The fatigue among the CDC workers was at a higher level. The level of professional identity was high, and administrators should take measures to alleviate fatigue and maintain professional identity. In addition, methods aiming to attenuate occupational stress, and improve resilience and self-efficacy should be immediately put into action.

The Role for Simulation in Professional Identity Formation in Medical Students

INTRODUCTION

Authentic clinical experiences and reflection are critical for medical student professional identity formation (PIF). Individualized learning plans and competency-based education accelerate time to graduation, thus creating more demand for students to gain PIF experiences early in medical education. This pilot study investigated student professional identity experiences related to participation in a clinical simulation during the first week of medical school.

METHODS

All first-year medical students at an academic health center participated in a clinically relevant simulation-based orientation to medical school (SOMS). Participants completed evaluation surveys measuring PIF-related experiences during the SOMS.

RESULTS

All participants completed the survey (N = 186). Students agreed that the SOMS helped them feel what it is like to be a doctor (90%) and transition to the role of student-physician (91%). Student comments about the SOMS-reflected PIF-related processes, such as building a sense of a community of practice among their peers in their roles as a healthcare team. Students also valued the opportunity to engage in reflection about their roles as student-physicians.

CONCLUSIONS

Simulation experiences can be used as a trigger for self-reflection to assist in medical student professional identity development as early as the first weeks of medical school. Simulation exercises may improve PIF and could further enhance medical student PIF by adding them longitudinally into the curriculum.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

Does a measure of Medical Professional Identity Formation predict communication skills performance?

OBJECTIVE

To validate an approach to measuring professional identity formation (PIF), we explore if the Professional Identity Essay (PIE), a stage score measure of medical professional identity (PI), predicts clinical communication skills.

METHODS

Students completed the PIE during medical school orientation and a 3-case Objective Structured Clinical Exam (OSCE) where standardized patients reliably assessed communication skills in 5 domains. Using mediation analyses, relationships between PIE stage scores and communication skills were explored.

RESULTS

For the 351 (89%) consenting students, controlling for individual characteristics, there were increases in patient counseling (6.5%, p<0.01), information gathering (4.3%, p = 0.01), organization and management (4.1%, p = 0.02), patient assessment (3.6%, p = 0.04), and relationship development (3.5%, p = 0.03) skills for every half stage increase in PIE score. The communication skills of lower socio-economic status (SES) students are indirectly impacted by their slightly higher PIE stage scores.

CONCLUSION

Higher PIE stage scores are associated with higher communication skills and lower SES.

PRACTICE IMPLICATIONS

PIE predicts critical clinical skills and identifies how SES and other characteristics indirectly impact future clinical performance, providing validity evidence for using PIE as a tool in longitudinal formative academic coaching, program and curriculum evaluation, and research.

The physician healer track: educating the hearts and the minds of future physicians

Calls to reform medical education recommend explicit training in professional identity formation to promote the development of humanistic, compassionate physicians. The authors report their experience offering The Physician Healer Track, a 500-contact-hour curricula integrated over 4 years, focusing on self-awareness, reflection, being-with-suffering, communication and professional identity development. The voluntary scholarly-concentration program comprises 4 years of monthly dinner meetings with faculty mentors, a two-month preceptorship in the first year, a one-month immersion course in MS4 and one elective. Training in mindfulness, cognitive behavioral therapy, nonviolent communication, motivational interviewing, spirituality in healthcare, wellness, equanimity, and 'being with suffering' is reinforced across all 4 years. Community building and reflection are integral to the training both in the monthly sessions and the immersion courses. Enrollment has grown from 26 students in the first year (11% of class) to a total of 258 students across our first 6 years (average of 20-26% of each class). Graduates in our first two cohorts of PHT have exceeded the numbers in the eight other scholarly concentrations offered at UTMB. Among students participating in the summer preceptorship, there has been less than 1% attrition. In serial assessments, students report continued growth in personal development, professional development, and the ability to empathize. Offering PHT has resulted in the growth of training for our medical residents, faculty, physical therapy students and the creation of a student healer association. Despite the demands on student's time, they are voluntarily participating in a challenging program of integrated training with the intention of keeping them connected to their humanity during the rigors of medical school training.

MPRO: A Professionalism Curriculum to Enhance the Professional Identity Formation of University Premedical Students

Limited opportunities exist for university premedical students to gain exposure to the realities of clinical practice through physician shadowing or through a formal curriculum. Medical Professionalism and Observership utilizes didactics, reflective writing, small- and large- group discussions, and clinical observerships to enhance the process of professional identity formation during a critical developmental window of late- adolescence. The pilot semester included a sample of 135 students, all in their sophomore, junior, or senior years of study at Rice University. Students were selected through an application process and paired with physicians at Houston Methodist Hospital based on specialty preference and availability. Students were required to participate in biweekly lectures and discussions and to submit a weekly reflection on topics discussed in the course and their shadowing experiences. Student evaluations were administered to survey changes in students' knowledge and perceptions of the curriculum. Selected reflections were read for evidence of professional identity formation. Lectures increased students' exposure to core competencies within the medical profession and influenced their desire to become physicians. Reflective writings demonstrated integration of these core competencies into the professional identity of students. Structured reflection and didactics, when coupled with physician shadowing, appear to promote integration of the values, beliefs, and attitudes of medical professionalism. Future studies should seek to demonstrate how such a curriculum affects professional identity formation through established measures, and to assess whether such a curriculum may influence students' preparedness for medical training and practice as they progress along their careers.

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

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.

Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations

PURPOSE

The American Medical Association's Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment.

METHOD

Authors performed a single-institution qualitative study using transcribed phone interviews with eligible Vanderbilt residency program directors, associate program directors, and core faculty. Participants described observations of successful residents within each HSS domain. Two researchers independently coded, discussed, and reconciled deidentified transcripts using inductive-deductive approaches to identify themes.

RESULTS

Seventeen faculty participated across specialties (17/39, 45%). Faculty responses emphasize precurricular experiences including professional degrees, work experience, extracurriculars, and medical school exposure. Importantly, successful residents exhibit foundational core workforce characteristics including growth mindset, curiosity, and a desire to learn about systems. GME faculty identified HSS domain-specific skills, noting distinctions among learning environments. Outcomes resulting from residents' application of HSS concepts include delivering high-quality, person-centered care and systems improvements.

CONCLUSIONS

Descriptions of successful practice within HSS domains highlight preparatory experiences and core workforce characteristics and outline entry-level HSS behaviors. Conceptualized in a logic model framework, these findings describe key inputs, learning activities, outputs, and outcomes for systems-prepared entering residents bridging the UME-GME transition.

Fostering the development of professional identity within healthcare education-interdisciplinary innovation

INTRODUCTION

Historical theories on development of professionalism are no longer sufficient in modern radiation therapy or radiography curricula with the focus moving from 'virtues-based professionalism' to 'professional identity formation'. Professional identity formation is a new concept that is described as a transformative journey from being a layperson to 'becoming' a professional. Knowledge, values, and behaviours are transformative and unique to each individual. The overall aim is to produce a consensus statement outlining evidence based programme initiatives to support healthcare students' professional identity formation.

METHODS

'Think tank' methodology was used for individual and final combined group reflective tasks to enable the creation of an evidenced based consensus statement. Participants discussed their personal views and beliefs regarding the process of Professional Identity Formation for teaching, learning, assessment, and evaluation. Discussions were recorded, transcribed, and analysed using thematic analysis from an interpretivist perspective. 'Think Tank' participants were asked to attend masterclasses to gain a greater understanding of professional identity formation from leading experts before the final combined 'Think Tanks'.

RESULTS

Faculty and students across all Disciplines (N22) within the school of medicine attended the 'Think Tank' sessions.

DISCUSSION

During each student's transformative process of professional identity formation, healthcare educators need to create evidence based pedagogic opportunities to support them. It is no longer sufficient to leave to chance within a 'hidden' or 'informal' curriculum. Professional identity is more than a set of learned behaviours that are assessed within the clinical environment.

CONCLUSION

The development of this consensus statement is an innovative educational strategy that will ultimately enhance the education of professionalism in the clinical environment for radiographers and radiation therapists. Through seeking an understanding of the educational needs of students and faculty, the multidisciplinary team were able to create a tailored approach to professional identity formation within the institution. This student-faculty partnership is unique and beneficial to all parties involved and is an effective method of seeking a shared understanding.

Mechanisms involved in the formation of professional identity by medical students

BACKGROUND

Despite in-depth discussions regarding professional identity of doctors, there is still a gap in our understanding of how this professional identity actually evolves.

OBJECTIVE

To outline some major mechanisms involved in formation of medical students' professional identity.

METHODS

A qualitative study based on thematic analysis. 296 diary entries, written by eight medical students as part of the three-year course 'Becoming a Physician,' were reviewed. The course, conducted in small groups, gradually exposes students to the clinical field, and emphasizes awareness to marginalized populations, and interpersonal communication skills.

RESULTS

Following the social constructivist learning theory, where learners individually and socially construct meaning attributed to their experiences, we identified three major mechanisms based on students' written reflections. These include linking current experiences to past; comparing different types or aspects of knowledge, doctors or medicine; and future perspective taking.

CONCLUSIONS

This study sheds light on the possible mechanisms used by medical students in forming their professional identity prior to their clinical training. Knowing these mechanisms can help medical educators better understand and support their students in formation of their professional identities. Conducting reflective writing could serve as an effective tool for learners to comprehend the meanings of their experiences.

Preliminary study of the relationship between career choice motivation and understanding of professionalism in newly enrolled medical students in China: a cross-sectional study

OBJECTIVES

Early professionalism education for first-year students is important for generating sound knowledge and attitudes towards medical professionalism. Of the many factors affecting professionalism and professional identity formation in medical students, career choice motivation is an understudied one. This study aimed to explore the relationship between the career choice motivations of first-year medical students and their understanding of professionalism.

SETTINGS AND PARTICIPANTS

A cross-sectional survey of 940 first-year clinical medicine students was conducted at China Medical University in September 2017 to explore students' motivation to study medicine and its relationship with students' understanding of professionalism. Demographics, career choice motivation and professionalism were obtained through paper questionnaires. Logistic regression analysis was used to analyse the association between career choice motivation and understanding of professionalism while controlling for potential demographic confounders.

RESULTS

The most common career choice motivations for first-year medical students (N=843) were interested in the health sciences, income and social status and advocating altruism. The most mentioned subdimensions of professionalism were accountability, pursuit of excellence and compassion. There were significant differences in the understanding of professionalism among students with different career choice motivations.

CONCLUSION

First-year medical students with different motivations to study medicine also have different understandings of professionalism. Medical educators can explore motivations to learning medicine as a new entry point to providing professionalism education for newly enrolled medical students.