Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians

Investigating the status and influencing factors of professional identity formation among Chinese medical interns: a mixed methods study

BACKGROUND

Professional Identity Formation (PIF) involves a movement through a series of conceptually distinct developmental stages. Kegan's theory of PIF is divided into 6 phases (stages 0-5). It is believed that students undergo stages 2-4 (imperial, interpersonal, institutional) during medical education. Currently, the PIF of medical interns is being extensively studied. However, few studies on Chinese interns. Social-ecological theory (STC) suggests that an individual's behavior and development are shaped by his or her multilevel interactions with the environment, so it's necessary to explore the mechanisms of interns' PIF within Chinese socio-cultural settings.

AIM

This study assesses the PIF status of Chinese medical interns and investigates interactions between multidimensional influencing factors underlining the process of PIF.

METHODS

This is a convergent mixed methods case study and consists of two parallel parts. The quantitative research involved a cross-sectional survey using online questionnaires on PIF, job burnout, and resilience. Four stage-specific scales (SASs) and a development scale (DS) were used to quantify the complexity and divergent processes of PIF. In the qualitative research, authors arranged semi-structured face-to-face interviews with medical interns. Data collection and analysis were conducted simultaneously. The model of Reciprocal Determinism is used as theoretical framework until data saturation was achieved.

RESULTS

A total of 1054 responses were considered valid. Interns' score of stage 4-specific attribute scale (SAS-4) scoring significantly higher than other SASs. Gender, higher family income, receiving scholarships, having continuous mentor guidance, and having clear career plans were identified factors that influences different stages of intern's PIF. Seven themes that influence PIF were identified from the qualitative research. The interplays between personal, behavioral, and environmental factors are bidirectional and complex. The Balancing of these complex relationships is identified as a crucial factor in PIF.

CONCLUSION

This study illustrates that Chinese medical interns were at stage 4 according to Kegan's model. Additionally, the reciprocal interactions between personal, behavioral, and environmental aspects can serve as potential mechanisms for PIF.

Professional identity formation: Who am I? Where am I going?

Background

Professional identity formation (PIF) is an ongoing journey where individuals internalize the characteristics, values, and behaviors of the medical profession. This concept, deeply rooted in medical tradition, has gained attention in recent decades, shifting from a passive to a more intentional process. Theories of PIF draw from theories of personal identity formation and moral reasoning.

Aims

The purpose of this paper is to describe the development of a didactic on PIF presented at the 2024 Society for Academic Emergency Medicine annual conference.

Materials & Methods

The didactic was developed through literature review, expert consultation, and iterative discussions within a team of educators and was attended by approximately 20 participants.

Results

Through interactive exercises, reflective tools, and literature-based insights, participants were prompted to explore their own PIF journeys.

Discussion & Conclusion

This session emphasized the importance of fostering a holistic understanding of medical training and integrated personal development with broader societal and moral expectations as well as supported the ongoing evolution of professional identity.

Investigating the Relationship between Burnout, Workload, and Imposter Syndrome for Mental Health Nurses in the UK

This study investigated the interrelationship between burnout, workload, and imposter syndrome among mental health nurses within the UK. Understanding their connections is crucial given the detrimental effects of these factors on workplace well-being. Despite extensive research on imposter syndrome in various healthcare professions, its exploration within nursing has been limited. This study aimed to address this gap by examining the relationships between these variables in a sample of registered mental health nurses. Correlational analyses revealed moderate to high levels of burnout, workload, and imposter syndrome among participants. While a significant positive correlation was found between burnout and workload, no significant associations were observed between burnout and imposter syndrome, or workload and imposter syndrome. These findings are discussed within the context of existing literature, and potential implications for future research are explored.

Investigating feelings of imposterism in first-year medical student narratives

INTRODUCTION

Imposter phenomenon (IP), feeling as if a person does not belong, has been reported in medical students at various rates. In medical literature, this phenomenon has often been defined as a 'syndrome', but other studies have described it as a dynamic experience that can have various impacts on different people at different time points. Although studies have linked IP with other phenomena such as burnout in residents and physicians, no studies have examined its aetiology nor how these feelings are experienced by medical students.

METHODS

With the use of social identity theory as a framework, the authors analysed 233 reflective essays for elements of IP across eight cohorts of medical students from two institutions. Students responded to a prompt that asked: 'What was one part of your identity that you thought you would have to change in order to become a physician?' Included reflections were analysed using the framework method.

RESULTS

Elements of IP were identified in 121 reflections (52%) and were categorised into three major themes: (1) Comparing oneself to an idealised image of a medical student, (2) Comparing oneself to an idealised image of a physician and (3) Concerns about presentation of self to others. Each theme contained two or more sub-themes. Commonly, students discussed how their own personality traits, experiences, backgrounds and identities cast doubt on their sense of belonging in medicine.

DISCUSSION

The results of this study were consistent across both institutions, suggesting that imposter feelings are common among all first-year medical students. However, the extent of the impact of these feelings on their identity formation depends on the individual lived experiences of students and the context in which these feelings arise. Encouraging reflective journaling and sharing of stories from all stages of education can normalise imposter feelings during the development of the professional identity as a physician.

Association between non-academic activities and professional identity formation of Indonesian medical students: a nationwide cross-sectional study

PURPOSE

This study explores the association between student involvement in non-academic activities (NAA) and the stages of professional identity formation (PIF) among Indonesian medical students.

METHODS

This cross-sectional survey was distributed to students in 50 medical schools, across both preclinical and clinical students in years 2-6. Respondents completed a Developmental Scale (DS) questionnaire to assess PIF and self-reported the number of hours spent on different NAA. Descriptive and bivariate analyses were performed; multiple linear regression was utilized to predict PIF.

RESULTS

Indonesian medical students reported a median of 13 NAA hours and a median DS score of 5.07 on a scale of 7. NAA hours were significantly different across sex groups, years of study, university regions, and institution types. Female participants spent significantly more hours on NAA than male students and PIF was predicted by the number of hours spent on research and competition-related activities. Shifts between the types of NAA were also observed among year groups.

CONCLUSION

NAA are positively associated with the PIF process, with students' active involvement in research and competitionrelated activities as predictors in this area. Supporting these activities becomes imperative for medical schools in order to optimize students' potential, motivation, and PIF.

Ready or Not, Here We Come: A Qualitative Study of the Transition From Graduate Medical Education to Independent Practice

Background The transition from graduate medical education (GME) into independent practice is challenging for new attendings despite achieving "readiness for practice," by Accreditation Council for Graduate Medical Education (ACGME) Milestones. Most medical literature on this transition is specialty-specific and rarely involves assessment of new-to-practice attendings (NTPAs). Objective Lack of attending readiness results in compromised patient care. To inform GME leaders and managers, we sought to identify areas of struggle for NTPAs across specialties. With this information, we hope to spur national GME curriculum evolution, better support our NTPAs, and ultimately provide better patient care. Methods Qualitative freelisting was used in 2021 to explore how NTPAs, educational program leaders, and managers perceive the transition struggles. Response lists were collected electronically, then cleaned and categorized by the research team using iterative inductive combination of similar concepts. Salience index scores (Smith's S) were calculated and plotted graphically to identify inflection points for each group, above which domains were deemed salient. Results One hundred eighty-six participants completed surveys, yielding 518 individual responses and a response rate of 34%. Of the ACGME competencies, systems-based practice domains were most frequently salient, including "workload" and "billing." "Confidence," "supervision," "work-life balance," "decision-making," and "time management" were salient struggles in all groups. Each group had domains only achieving salience for them. Professional development domains including "confidence," "imposter syndrome," and "culture" achieved salience in different groups. Conclusions This study identifies domains of struggle for NTPAs, which fall outside ACGME competency frameworks including workload, new environments, and professional development. Domains identified by NTPAs, program leaders, and managers were not identical.

Physician, know thyself: Applying brand management principles to professional identity in academic medicine

CONTEXT

A career in medicine is a journey of countless opportunities, challenges and choices. Determining the "right" decision for any given career choice ultimately must come from within; thus, a clear understanding of a physician's core professional identity is critical. Existing conceptualizations of professional identity within medicine focus primarily on medical training; however, it is clear that professional identity evolves throughout one's career. We propose the use of brand management principles as a novel means of understanding and expressing a physician's evolving professional identity throughout their career.

METHODS

We propose a conceptual framework for managing academic physician professional identity based upon brand management principles derived from marketing and consumer research literature. The four key framework elements include brand identity ("Who am I?"), brand delivery ("What actions do I choose to present myself to others"), brand experience ("How are my actions experienced by others?") and brand image ("How do others see me?"). Successful management of one's brand starts with understanding the core professional brand identity, then determining the best way to deliver this identity through specific actions experienced by target audiences (e.g., patients, collaborators, colleagues, employers, learners, promotion committees, etc.), and ends with the target audience having a clear and compelling brand image that reflects the underlying professional identity. Alignment of these components results in an array of benefits; misalignment can result in feelings of burnout or career stalling.

CONCLUSIONS

We contend that physicians can and should see themselves as their own unique brand. Though often confused with naked self-promotion, developing a professional brand is an identity exploration and reflection experience that allows individuals to better control the course of their careers. A strong personal brand has numerous practical applications; three key examples presented herein include navigating promotion through the professoriate, managing one's reputation and achieving professional fulfilment.

The effectiveness of online educational interventions on impostor syndrome and burnout among medical trainees: a systematic review

BACKGROUND

Impostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.

METHODS

A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

Among the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.

CONCLUSIONS

Current evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.

CLINICAL TRIAL NUMBER

As this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.

Gaining Respect and Mitigating Risk: A Qualitative Exploration of How New Attendings Navigate Interpersonal Relationships with Recent Resident Peers

Background

Physicians moving through training experience changes in personal and professional relationships, which can increase stress, uncertainty, and burnout. Social connection can be an important resource but can introduce complexity and conflict. This study aimed to explore how early-career attendings navigate and manage changing organizational and friendship roles with recent resident peers (near-peers) through this critical transition.

Methods

We conducted a reflexive thematic analysis of interviews with early-career attendings working with near-peers from the same institution where they trained. Twenty three of 27 (85%) eligible attendings from two United States health systems participated in semi-structured interviews between April and June 2023.

Results

Familiarity from working at the same institution where new attendings completed training made it more difficult to command authority. Early-career attendings at times struggled with insecurities about their ability to fulfill their new role and challenges from others in recognizing their new attending identity. These tensions could heighten emotions in the clinical setting and spill over into relationships with residents outside the workplace, impacting social lives and well-being. Early-career attendings engaged in strategies to manage the social realm of their transition with near-peers, including prioritizing their organizational role in the clinical setting and mitigating risks to their professional reputation by creating stronger boundaries between their personal and professional lives.

Conclusions

This study provides new insight into how attendings navigate changing personal and professional relationships with recent resident peers and offers strategies on how to manage the social realm of this liminal transition.

Lookism, a Leak in the Career Pipeline? Career Perspective Consequences of Lookism Climate and Workplace Incivility

Despite strides toward gender equality in the workforce, women continue to face significant challenges, including the "glass ceiling" and the "leaky pipeline", partially stemming from low occupational self-confidence. This study examined whether a climate of lookism leads to workplace mistreatment, undermining employees' perceptions of job competence and career potential, with a focus on gender differences. Using a cross-sectional design, data from 699 Italian workers (42.8% male, 56.3% female) were analyzed through multi-group structural equation modeling. The model explored relationships between lookism climate, workplace incivility, imposter syndrome, and perceived employability. The results revealed a full serial mediation for women; lookism climate was positively related to workplace incivility, which in turn was related to imposter syndrome, negatively impacting perceived employability. For men, no serial mediation was found; lookism climate was directly related to both incivility and imposter syndrome, with no significant relationship between the two. Like women, men experienced a negative relationship between imposter syndrome and perceived employability, yet this relationship was stronger for men. This study highlights that identifying and addressing workplace climates that foster subtle mistreatment can prevent larger issues like the leaky pipeline, suggesting targeted organizational-level intervention and prevention strategies can enhance job competence perceptions and career potential for both genders.

The bumpy ride to a medical PhD degree: a qualitative study on factors influencing motivation

INTRODUCTION

In parallel with a tremendous increase in medical PhD enrolments, concerns have risen about PhD candidates' poor well-being, increasing attrition rates for PhD programmes, and, eventually, a decline in clinician-scientists. According to the Self-Determination Theory, autonomous motivation is strongly linked to positive aspects of well-being and other positive outcomes such as study completion and success. In this way, motivation has a pivotal role in successful completion of medical doctoral programmes. In this study we explored factors affecting motivation during the PhD journey and aimed to contribute to engaging doctoral education environments, and, eventually, a sustainable clinician-scientist workforce.

METHODS

This constructivist qualitative interview study was conducted among ten medical PhD candidates in the final phase of their PhD. We used timeline assisted interviews to identify meaningful experiences throughout their PhD journey. Thematic analyses as an iterative process resulted in overarching themes.

RESULTS

We identified six themes influencing autonomous and controlled motivation along the challenging PhD journey: (1) Initial motivation to start a PhD matters; (2) Autonomy as a matter of the right dose at the right time; (3) PhD as proof of competence and/or learning trajectory?; (4) It takes two to tango; (5) Peers can make or break your PhD; (6) Strategies to stay or get back on track.

CONCLUSION

This study revealed factors that contribute positively and/or negatively to autonomous and controlled motivation. Some factors impacted motivation differently depending on the PhD phase and individual strategies. Additionally, some factors could coincide and change from positive to negative and vice versa, showing that a successful journey cannot simply be reduced to an absence of negative experiences.

The Military Medical Officer's Current-Day Professional Identity: An Enhanced Model

BACKGROUND

As the landscapes of war have evolved, so too has the role of the military medical officer (MMO). Colonel (Retired) Barry Wolcott developed a "vector" model in the 1990s, illustrating the dual professional role of the MMO. Since then, propelled by the War on Terror, MMOs have adapted to treating patients in volatile, uncertain, complex, and ambiguous operational environments. This study, therefore, aimed to explore modern-day aspects of the MMO's role in order to enhance Wolcott's depiction of the MMO's professional identity in contemporary operational environments.

MATERIALS AND METHODS

We used the qualitative phenomenological tradition to design our study. We interviewed military physicians from a variety of specialties in order to explore their experiences and professional identity as MMOs. Our research team then coded each of these interview transcripts. We organized these codes into categories, which served as the themes of our study.

RESULTS

The following themes emerged from our data regarding the role of the MMO in the operational environment: Primary roles (officer, physician, educator, and diplomat) and aptitudes (innovation, advocacy, cultural competency, and leadership). The MMO's roles as officer and physician often intersect, with dual foci on the mission and the patient. The MMO also serves as an educator to medics and line officers. In addition, they act as diplomats both outside and within the military. Within each of these primary roles, the MMO innovatively prepares for future landscapes of war and advocates for both the individual warfighter and the unit/command. Finally, the MMO navigates both foreign and internal cultural differences and demonstrates leadership in enabling the military's mission.

CONCLUSIONS

The role of the MMO is complex and multifaceted. The recognition of the contemporary MMO's unique skill set is essential for the effective education and training of future military health care leaders. The value of capitalizing on this unique skill set has been demonstrated in recent civ-mil responses. Because their intricate skill set is specialized for the operational environment, long-term retention of MMOs is key to force readiness.

Integrative approaches to methods training for early-career scientists: Rationale and process evaluation of the first cohort of the Michigan Integrative Well-Being and Inequality Training Program

Background

The Michigan Integrative Well-Being and Inequality (MIWI) Training Program aims to provide state-of-the-art, interdisciplinary training to enhance the methodological skills of early-career scientists interested in integrative approaches to understanding health disparities. The goals of this paper are to describe the scientific rationale and core design elements of MIWI, and to conduct a process evaluation of the first cohort of trainees (called "scholars") to complete this program.

Methods

Mixed methods process evaluation of program components and assessment of trainee skills and network development of the first cohort (n = 15 scholars).

Results

The program drew 57 applicants from a wide range of disciplines. Of the 15 scholars in the first cohort, 53% (n = 8) identified as an underrepresented minority, 60% (n = 9) were within 2 years of completing their terminal degree, and most (n = 11, 73%) were from a social/behavioral science discipline (e.g., social work, public health). In the post-program evaluation, scholars rated their improvement in a variety of skills on a one (not at all) to five (greatly improved) scale. Areas of greatest growth included being an interdisciplinary researcher (mean = 4.47), developing new research collaborations (mean = 4.53), and designing a research study related to integrative health (mean = 4.27). The qualitative process evaluation indicated that scholars reported a strong sense of community and that the program broadened their research networks.

Conclusions

These findings have implications for National Institutes of Health (NIH) efforts to train early-career scientists, particularly from underrepresented groups, working at the intersection of multiple disciplines and efforts to support the formation of research networks.