Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture

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.

Learning by drawing: understanding the potential of comics-based courses in medical education through a qualitative study

In recent years, medical educators have increasingly incorporated comics into their teaching to promote humanism and empathy and to encourage reflective practice. However, it remains unclear how and to what extent comics-based courses effectively address persistent challenges in medical education, such as the need for more engaging, multimodal learning strategies and the cultivation of emotional intelligence alongside clinical competencies. The aim of this study is to investigate the experiences of students who have enrolled in courses on comics and medicine during medical school. Students in North America who had taken such a course during the previous 5 years were invited to participate in an interview about their experiences. 17 students from 10 different medical schools in North America were interviewed. To explore the students' views on the value of such courses to their medical education, we used a constructivist grounded analytic approach, employing thematic analysis to understand and interpret our interview. Students reported that comics-based courses support key aspects of their medical training that traditional pedagogical approaches may overlook, such as fostering self-reflection, enhancing empathy, and encouraging creative engagement with complex medical narratives. Moreover, comics contributed to their individual and collective professional identity formation by providing a space for introspection and shared discourse.

Embracing Medicines Development as a Profession

Medicines development has dramatically transformed in the preceding decades. It has evolved from a task undertaken by a small team to a complex series of activities, involving several functions and qualified professionals, across multiple, interrelated, scientific disciplines, worldwide. Conceptualized as a medical specialty, concerned with the research, development, and monitoring of medicines, and spearheaded largely by pharmaceutical physicians, the discipline has extended to embrace non-medically qualified scientists progressively taking on traditional roles within the medicines development ambit. There is expanded engagement of professional backgrounds. Each individual function contributes unique expertise and skills, but they all share a sense of identity, a collective commitment, and a common goal of improving human health and well-being, through innovative treatments. At the same time, milestone advancements in the research and development environment, in healthcare delivery, the regulatory ethos, data sharing with greater transparency, the exponential digitalization, and the emphasis on patient outcomes have imposed greater accountability in systems and processes, and across all global stakeholders. Increasingly, this demands a joint purpose, fostering continuous learning, and engendering a professional identity within the medicines development community, a coinage gaining incremental affirmation as equivalent to pharmaceutical medicine. The aligned set of related competencies and capabilities across the multi-professional teams involved, the sense of identifying concurrently across different, albeit complementary, communities of practice, the obligation of ongoing specialized knowledge training, the mandated enterprise-wide codes of ethics and moral conduct, and the intertwined career paths within the larger business organizational construct of academic institutions, regulatory agencies, and the biopharmaceutical industry-all profess to meet the criteria, and merit medicines development/pharmaceutical medicine be acknowledged, regarded, and recognized as a distinct profession of stature, in its own standing. The concept of pharmaceutical medicine has been floated since 1957, and has received considerable attention in scientific literature over the years. Yet, the discipline struggles to be universally understood and appreciated. This perspective scrutinizes related engendering influences and hindering elements, while advocating the furtherance of medicines development from a traditional occupation, emerging as a vocation, and transforming into a mature profession, with the vision and purpose of advancing better medicines for improved health outcomes for people, globally.

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.

Racism in medical education and the entanglement of contents and (con-)texts: a participative reflection on teaching materials and the everyday experiences of racialized students and physicians in Germany

Background

Institutional racism and racial disparities in healthcare have received greater focus in the public health sciences in recent decades. The role of medical education in this context has been researched in several studies, mostly in the US, but racism in medical education remains largely underresearched in Germany. The aim of this study is to show how racist knowledge and practices exist within German medical care and are systematically transmitted in German medical education, and how this may institutionally reproduce, legitimize, reinforce, and perpetuate disadvantages.

Methods

Based on consultations and preliminary interviews with civic stakeholders and experts, teaching and learning materials in German medical education were randomly sampled. These materials served as a starting point for participative reflection on racist knowledge and practices in German medical education. In the first step, the contents of teaching and learning materials were analyzed to identify terms, themes, or concepts that propagate racist ideas. Thereafter, we sought expert feedback on the analyzed content through one-on-one interviews and focus groups with physicians and medical students who self-identify as affected by racism.

Results

Our study reveals two main findings. First, racist knowledge and practices are systematically transmitted and reproduced at different levels of German medical education. Second, the entanglement of multiple institutional dimensions contributes significantly to the perpetuation and legitimization of racist knowledge and practices in German medical education.

Conclusion

In keeping with the state of research, the study was primarily exploratory in character and may serve as a starting point for future research on institutional racism in German healthcare and medical education. In addition to the findings that can be used to develop further research questions, initial recommendations for action by civil society, institutions, and policymakers may be derived from the interviews and focus group discussions.

Peer Teachers' Professional Identity Development During a Prehospital Simulation: A Grounded Theory Study

INTRODUCTION

Peer teachers have been found to be effective instructors during simulation-based education. However, there is a lack of research regarding their professional identity development throughout the course of the teaching activity. The purpose of this qualitative study, therefore, was to develop a framework to illustrate how peer teachers develop as educators during a prehospital simulation.

METHODS

The participants in our study were 9 second-year medical students serving as peer teachers during a multiday prehospital simulation. We selected the grounded theory tradition of qualitative research to investigate the peer teachers' professional identity development. Our research team interviewed each participant twice during the simulation. We then used open and axial coding to analyze the interview data. We organized these codes into categories and determined connections between each category to construct our grounded theory framework.

RESULTS

This framework described how the peer teachers progressed through 4 stages: 1) eager excitement, 2) grounded by challenges, 3) overcoming challenges, and 4) professional identity formation.

CONCLUSION

Our results revealed that simulation-based education can serve as valuable learning environment not only for medical students, but also for peer teachers. Understanding their progressive development during the simulation will help medical educators focus on maximizing the peer teachers' growth and development during simulation.

Nurturing humanism and professionalism in a clinical setting: A multicenter study to develop a framework for a learning module for clinical students

INTRODUCTION

Professionalism represents a contract between physicians and society, with humanism at its core. Humanism must be developed in medical education, especially in clinical settings, as students meet real-life professional situations. However, dynamic and unpredictable clinical settings might expose students to authentic yet unexpected far-from-ideal situations that might hinder the humanism and professionalism process. Furthermore, culture plays an influential role, highlighting the importance of developing an appropriate and contextual learning strategy. Hence, this study aims to conceptualize strategies to teach humanism and professionalism in high-power distance and collectivistic settings.

METHODS

This multicenter qualitative phenomenological study used maximum variation sampling to recruit participants, consisting of clinical students, teachers, and coordinators from three medical schools in Indonesia. Data were collected through focus group discussions (FGDs) and in-depth interviews. Thematic analysis was conducted using the steps of coding and theorization methods.

RESULTS

A total of 15 FGDs and one in-depth interview were conducted with 57 students, 39 teachers, and 18 coordinators. Socialization theory was used to analyze themes, leading to a culturally related approach to learning. Professional identity formation (PIF) was highlighted as the center of learning humanism and professionalism, with character building as the main principle. Designing a curriculum for humanism and professionalism for clinical learning should consider the longitudinal nature of PIF and ensure that professionalism explicitly exists in the curricula. As cultural impact might pose challenges, it must also be acknowledged and addressed. Meaningful integrated learning experiences, patient exposure, and reflection serve as the cornerstones of teaching-learning strategies while considering longitudinally explicit assessments.

CONCLUSION

Nurturing humanism and professionalism in undergraduate clinical settings is a longitudinal character-building process, with PIF as its center. Longitudinal, explicit, and dynamic strategies should be considered as part of the framework of teaching-learning and assessment of humanism and professionalism, as well as faculty development efforts with close attention to cultural factors.

Traveling with a desirable destination: a dialogical analysis of professional identity formation among freshman medical students

BACKGROUND

We aimed to examine medical students' perceptions regarding their professional identity and explore their creative narratives utilizing the Dialogical-Self Theory (DST).

METHODS

This is a mixed-method study. First-year medical students at Tehran University of Medical Sciences (TUMS, Tehran, Iran wrote a creative narrative about their perspectives on their future profession. Based on DST, qualitative-directed content analysis and summative approach were used to identify and quantify different "I-positions" to assess professional identity formation.

RESULTS

One hundred eighty-eight first-year medical students at TUMS participated in the study in 2021-2022. In the creative narratives, the reference to "I" was more than other pronouns (he/she/they). The use of "I" positively correlated with rank in the university entrance exam (P value = 0.03). The highest application of "I" per participant belonged to the "present I-position," and the lowest to the "promoter," which has the highest rank in the formation of professional identity. Women tended to use the "present I-position" more than men (P value = 0.03).

CONCLUSIONS

First-year medical students have accepted their self-role in forming professional identity; however, they have not found a vast perspective of it, as shown by their inability to use meta I-position and promoter I-position. Therefore, educators must provide plans within the curriculum to enhance competencies of professional identity formation. These plans can include incorporating narration writing to encourage medical students to reflect on their professional identity.

Uncovering Reflections of Preclinical Medical Students from Clinical Shadowing: A Thematic Analysis

PURPOSE

Clinical shadowing(CS) offers preclinical medical students the opportunity to observe certified physicians in practice. Analyzing the content of students' reflective writings(RWs) to understand core competencies they perceived during CS, as well as stages of their reflections, can offer valuable insights for course design and instructor guidance. This study aimed to address this matter by employing a thematic analysis of students' RWs to explore the learning outcomes derived from CS.

MATERIALS AND METHODS

The dataset of the thematic analysis comprised de-identified RWs from preclinical medical students who participated in the clinical shadowing program during the first semester of the 2019 academic year at National Taiwan University College of Medicine. Two researchers independently extracted and categorized pertinent content from the texts of RWs, aligning them with the six core competencies of ACGME and mapping them to the stages of Kolb's learning cycle. Additionally, correlation with shadowing specialties and fields was investigated.

RESULTS

In total, 155 RWs were analyzed. Patient care emerged as the most frequently reflected competency(30%), followed by systems-based practice(23%), and medical knowledge(21%). The shadowing specialties and fields had an impact on the core competencies students perceived. In terms of Kolb's learning stages, concrete experience(66%) predominated in RWs, while abstract conceptualization(19%) and reflective observation(14%) were less prevalent. For each competency, concrete experience was the prevailing stage, with active experimentation being the least dominant one. Students exhibited varying proportions of reflections at different stages for each core competency.

CONCLUSIONS

Clinical shadowing experiences enable preclinical medical students to explore required clinical core competencies, with emphases depending on the shadowing specialties and fields. Currently, most reflections are concentrated at Kolb's concrete experience stage. This study offers valuable insights for designing future CS programs and improving faculty development, aimed at helping students achieve deeper and more comprehensive reflective learning in relation to core competencies, and even professional identity.

Developing an interprofessional identity complementary to a professional identity - findings related to Extended Professional Identity Theory (EPIT)

Collaboration among various professions often faces barriers owing to divergent perspectives, priorities, and expertise shaped by distinct socialization processes. These differences can hinder effectiveness, efficiency, and workforce well-being. The Extended Professional Identity Theory (EPIT) addresses this issue by fostering an interprofessional identity without weakening professional identities. Drawing from psychological theories, EPIT explains the coexistence of interprofessional and professional identities, and predicts associated behaviors. It also emphasizes the importance of combining interprofessional identity formation with developing interprofessional competencies and adapting to environmental factors to achieve synergy in (temporary or permanent) mixed profession groups. Introduced in 2018, EPIT research initially relied on the measurement of congruent interprofessional behaviors as indirect indicators of interprofessional identity that could not yet be measured. An experiment demonstrated that enhancing social identification in mixed profession groups with interprofessional assignments reduced the social hierarchy within 6 h across three meetings. The 2020 development of the Extended Professional Identity Scale (EPIS) confirmed interprofessional identity as a three-dimensional social construct. So far, several scientific studies have supported many propositions of EPIT. These propositions are related to dimensionality and various psychometric properties, cross-cultural similarities, evidence and clues for interprofessional identity formation, and its predictive validity in interprofessional education and collaborative practice. Türkiye is among several countries (e.g., the Netherlands, Belgium, Germany, Lithuania, Finland, and Indonesia) where EPIT-based interprofessional identity is being investigated. To illustrate contextual differences and their potential cross-cultural implications, it is valuable to explore how interprofessional identity adds value in the Turkish context. This approach facilitates understanding the regional implications of interprofessional identity, including interprofessional education initiatives, increased university engagement, the development of measurement instruments, challenges and future directions, and national and international collaborations. This paper aims to explain and clarify EPIT propositions compared to other theories, describe current evidence, and outline future research directions, with a focus on developments within the Turkish context as a showcase.

Examining the perception of undergraduate health professional students of their learning environment, learning experience and professional identity development: a mixed-methods study

BACKGROUND

The quality of the learning environment significantly impacts student engagement and professional identity formation in health professions education. Despite global recognition of its importance, research on student perceptions of learning environments across different health education programs is scarce. This study aimed to explore how health professional students perceive their learning environment and its influence on their professional identity development.

METHODS

An explanatory mixed-methods approach was employed. In the quantitative phase, the Dundee Ready Education Environment Measure [Minimum-Maximum possible scores = 0-200] and Macleod Clark Professional Identity Scale [Minimum-Maximum possible scores = 1-45] were administered to Qatar University-Health students (N = 908), with a minimum required sample size of 271 students. Data were analyzed using SPSS, including descriptive statistics and inferential analysis. In the qualitative phase, seven focus groups (FGs) were conducted online via Microsoft Teams. FGs were guided by a topic guide developed from the quantitative results and the framework proposed by Gruppen et al. (Acad Med 94:969-74, 2019), transcribed verbatim, and thematically analyzed using NVIVO®.

RESULTS

The questionnaire response rate was 57.8% (525 responses out of 908), with a usability rate of 74.3% (390 responses out of 525) after excluding students who only completed the demographic section. The study indicated a "more positive than negative" perception of the learning environment (Median [IQR] = 132 [116-174], Minimum-Maximum obtained scores = 43-185), and a "good" perception of their professional identity (Median [IQR] = 24 [22-27], Minimum-Maximum obtained scores = 3-36). Qualitative data confirmed that the learning environment was supportive in developing competence, interpersonal skills, and professional identity, though opinions on emotional support adequacy were mixed. Key attributes of an ideal learning environment included mentorship programs, a reward system, and measures to address fatigue and boredom.

CONCLUSIONS

The learning environment at QU-Health was effective in developing competence and interpersonal skills. Students' perceptions of their learning environment positively correlated with their professional identity. Ideal environments should include mentorship programs, a reward system, and strategies to address fatigue and boredom, emphasizing the need for ongoing improvements in learning environments to enhance student satisfaction, professional identity development, and high-quality patient care.

Comparing and Contrasting Professional Identity Formation Among Health Professional Students

This project aims to review and compare the professional identity formation (PIF) of medical, dental, nursing, and pharmacy students while analyzing the role of interprofessional education (IPE) in this journey. Our medical research librarian conducted a literature review. Papers were selected based on the inclusion criteria developed by authors for PIF and IPE topics, which were then stratified for each health program of interest: medicine, dentistry, nursing, and pharmacy. The IPE core competencies were analyzed to understand the effect of IPE on each respective group of health professional students. Among all four major health professions, trust, collaboration, responsibility, accountability, communication, and empathy are key values within PIF. Trust, collaboration, and empathy were also regarded as core values in developing professionalism. Medical and dental students placed greater emphasis on responsibility and accountability regarding PIF. IPE played a crucial role in PIF for all students as values, teamwork, roles, and responsibilities were emphasized among each healthcare discipline of interest. This review provides significant information regarding which characteristics are emphasized for professional development across healthcare training programs. Future research to explore how certain characteristics and values influence healthcare as a whole is crucial. Investigating various influences on PIF outcomes is warranted for enhancing professional training programs and promoting interprofessional collaboration for better healthcare delivery.

Exploring professional identity and its predictors in health profession students and healthcare practitioners in Saudi Arabia

The government of Saudi Arabia is making significant efforts to improve the quality of health education and healthcare services. Professional identity has been linked to the quality of healthcare services provided by practitioners, however, data concerning the professional identity of health profession students (HPS) and healthcare practitioners (HCP) are still lacking in Saudi Arabia. The current study aimed to assess the level of professional identity in HPS and HCP in Saudi Arabia and to investigate its predictors. Cross-sectional data were collected from 185 HPS and 219 HCP in Saudi Arabia using river sampling technique. Data related to the sample characteristics were collected; an adapted version of the Macleod Clark Professional Identity Scale was utilized to collect data about the level of professional identity. Total score of professional identity was later calculated for each participant. Median professional identity scores for HPS and HCP were 38.0 (34.0-41.0) and 41.0 (37.0-43.0), respectively, out of 45. Significantly higher median professional identity score was found among HCP as compared to HPS (p <0.001). Data obtained from the multiple linear regression analysis, using the backward elimination method technique indicated that only working status (HPS vs. HCP) significantly predicted the professional identity score in all models performed. In conclusion, high levels of professional identity were reported among HCP and HPS in Saudi Arabia. Changes related to professional identity should be monitored in public and private educational and healthcare organizations to enhance the quality of healthcare services provided in the country.

Team players and helpers - describing professional identity among finnish physicians in a cross-sectional study

BACKGROUND

Every physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity.

METHODS

This study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 (N = 24,827) in 2018. The sample was drawn from physicians born on even numbered days (N = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions.

RESULTS

The descriptions which most physicians identified with were "member of a working group/team" (82%), "helper" (82%), and "health expert" (79%); the majority reported these as describing them very or quite well. Identity descriptions such as "prescriber of medications" (68% vs. 45%), "prioritiser" (57% vs. 35%) and "someone issuing certificates" (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions "provider of comfort" (62% vs. 40%) and "someone engaged in social work" (45% vs. 25%), with which women identified more frequently than men.

CONCLUSIONS

Strong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

Evaluating the Impact of the National Health Service Digital Academy on Participants' Perceptions of Their Identity as Leaders of Digital Health Change: Mixed Methods Study

BACKGROUND

The key to the digital leveling-up strategy of the National Health Service is the development of a digitally proficient leadership. The National Health Service Digital Academy (NHSDA) Digital Health Leadership program was designed to support emerging digital leaders to acquire the necessary skills to facilitate transformation. This study examined the influence of the program on professional identity formation as a means of creating a more proficient digital health leadership.

OBJECTIVE

This study aims to examine the impact of the NHSDA program on participants' perceptions of themselves as digital health leaders.

METHODS

We recruited 41 participants from 2 cohorts of the 2-year NHSDA program in this mixed methods study, all of whom had completed it >6 months before the study. The participants were initially invited to complete a web-based scoping questionnaire. This involved both quantitative and qualitative responses to prompts. Frequencies of responses were aggregated, while free-text comments from the questionnaire were analyzed inductively. The content of the 30 highest-scoring dissertations was also reviewed by 2 independent authors. A total of 14 semistructured interviews were then conducted with a subset of the cohort. These focused on individuals' perceptions of digital leadership and the influence of the course on the attainment of skills. In total, 3 in-depth focus groups were then conducted with participants to examine shared perceptions of professional identity as digital health leaders. The transcripts from the interviews and focus groups were aligned with a previously published examination of leadership as a framework.

RESULTS

Of the 41 participants, 42% (17/41) were in clinical roles, 34% (14/41) were in program delivery or management roles, 20% (8/41) were in data science roles, and 5% (2/41) were in "other" roles. Interviews and focus groups highlighted that the course influenced 8 domains of professional identity: commitment to the profession, critical thinking, goal orientation, mentoring, perception of the profession, socialization, reflection, and self-efficacy. The dissertation of the practice model, in which candidates undertake digital projects within their organizations supported by faculty, largely impacted metacognitive skill acquisition and goal orientation. However, the program also affected participants' values and direction within the wider digital health community. According to the questionnaire, after graduation, 59% (24/41) of the participants changed roles in search of more prominence within digital leadership, with 46% (11/24) reporting that the course was a strong determinant of this change.

CONCLUSIONS

A digital leadership course aimed at providing attendees with the necessary attributes to guide transformation can have a significant impact on professional identity formation. This can create a sense of belonging to a wider health leadership structure and facilitate the attainment of organizational and national digital targets. This effect is diminished by a lack of locoregional support for professional development.

The Importance of Learning with Patients: Post-Pandemic Takeaways on Learning Professionalism in Clinical Settings

Background

Public demands for high-quality healthcare require medical schools to ensure that physicians attain various competencies, including professionalism and humanism. This can be accomplished through various interactions and socialisations within the healthcare community. These meaningful learning experiences become more critical as students face unpredictable learning opportunities in clinical settings. However, professional development focuses on lapses, remediation and knowledge retention rather than its practice. To nurture professional and humanistic physicians, this study explores how medical students perceive learning professionalism in clinical settings.

Methods

This is a qualitative phenomenology study involving medical students in clinical rotations at the Faculty of Medicine Universitas Indonesia. Respondents were chosen through a purposive sampling method that considered their gender and clinical years. Data were collected through focus group discussions (FGDs) and thematic analysis was used.

Results

Three FGDs were conducted with 31 clinical students. Learning professionalism in clinical settings presents challenges, including the hidden curriculum (HC), limited exposure to patients and the clinical learning environment because of the social restrictions caused by the COVID-19 pandemic. The tailored strategy to learn professionalism in the clinical learning environment was more teacher-driven, including role modelling, debriefing, providing feedback and teaching context-specific knowledge on professionalism, followed by patient interactions.

Conclusion

The significance of students' interactions with the clinical learning environment, especially with patients and clinical teachers as role models, is the key to learning professionalism in clinical settings. This finding is an important takeaway in curriculum design for professionalism.

Assessing the role of mentors in mitigating burnout and enhancing professional development in medical education

Objectives

To assess the correlation between mentor behaviours and medical student burnout and their professional development within medical education.

Methods

A cross-sectional study using convenience sampling was conducted among third-, fifth-, and sixth-year medical students (N=307). Participants voluntarily completed anonymous online questionnaires measuring the Mentor Behavior Scale, the Maslach Burnout Inventory-Student Survey, and the Professional Self-Identity Questionnaire. Multivariate regression analysis was performed to analyse relationships between student burnout, mentor behaviours and their impact on professional development.

Results

Among participants, 26% (N=80) experienced burnout, which was significantly associated with lower competency support (OR = 2.0, 95% CI: 1.1-3.5, p = 0.016), medication use (OR = 2.1, 95% CI: 1.1-4.0, p = 0.029), and a lower Grade Point Average (OR = 3.3, 95% CI: 1.6-6.9, p = 0.001) compared to non-burnout students. In the development of professional identity, a high level of mentor relationship structure had statistically significant associations with higher scores in key domains of the Professional Self-Identity Questionnaire, including teamwork (OR = 3.9, 95% CI: 1.5-9.9, p < 0.01), communication (OR = 3.4, 95% CI: 1.5-7.7, p < 0.01), ethical awareness (OR = 3.3, 95% CI: 1.4-8.0, p < 0.01), and record use (OR = 2.8, 95% CI: 1.2-6.5, p < 0.05).

Conclusions

The impact of mentor behaviours on medical students is evident. Enhancing mentorship by addressing specific mentor behaviours can improve programme quality. Future research should explore the long-term effects and strategies for effectively implementing targeted enhancements in mentor behaviours.

The state of health professions students' self-directed learning ability during online study and the factors that influence it

BACKGROUND

Universities have widely switched from traditional face-to-face classes to online instruction as a result of the epidemic. Self-directed learning is becoming the new norm for university students' learning styles. The ability of health professions students to learn independently during online study directly impacts the effectiveness of online medical education. The ability to learn on their own initiative may be affected by health professions students' professional identities, defined as their positive perceptions, evaluations, emotional experiences, and identity as professionals related to medicine. This study aimed to look into the current status and the factors that influence health professions students' self-directed learning ability (SDLA) during online study and its relationship with professional identity.

METHODS

This study was conducted from September to November 2022 at a medical school in East China. An online questionnaire was used to collect participants' status of online learning, self-directed learning ability (SDLA), and professional identity.

RESULTS

One thousand two hundred ninety-eight health professions students demonstrated intermediate self-directed learning ability during online study. In terms of teacher-student interaction (F = 14.778, P < 0.001), student-student interaction (F = 15.713, P < 0.001), and learning concentration (F = 13.424, P < 0.001), there were significant differences in health professions students' self-directed learning ability. Professional identity and self-directed learning ability positively correlated (r = 0.589-0.802, P < 0.01). Academic atmosphere and professional identity were significant predictors.

CONCLUSIONS

The self-directed learning ability of health professions students while receiving instruction online is at an intermediate level and is influenced by several factors. Developing health professions students' professional identities can enhance their ability for self-directed learning.

Combatting Burnout Culture and Imposter Syndrome in Medical Students and Healthcare Professionals: A Future Perspective

It is the year 2050, and the world of medicine has undergone significant changes. With the advent of advanced technology and medical breakthroughs, medical schools have become even more competitive. Medical students are now required to have an exceptional academic record, outstanding research experience, and a perfect social media presence. However, with the rise of social media, a new phenomenon has emerged, one that has been plaguing medical students for years - imposter syndrome.

A mixed-methods SWOT analysis of a medical student Balint group programme

BACKGROUND

Balint groups use case-based discussions to explore, reflect on, and enhance the clinician-patient relationship. They facilitate the development of empathy and reflective practice and reduce burnout. This study aimed to explore how the benefits of a traditional Balint group format can be accessed and optimised for medical students during a one-year pilot programme.

METHODS

Eight medical student Balint groups ran for six weeks during 2022-2023, with 90 students participating. Themes were identified from student feedback using qualitative content analysis. Group leaders kept reflective session notes and used these alongside student feedback to undertake a strengths, weaknesses, opportunities, and threats analysis.

RESULTS

Strengths of the programme were emotional containment, learning to reflect, and community identity. Weaknesses were themed as strange situations, dragging along, and facilitator as an object. Opportunities were identified in expanding the scope and sharpening focus. Psychological defences and the engagement dilemma threatened the future success of the Balint group programme.

DISCUSSION

Medical student Balint groups provide a unique space to combine learning and emotional support with personal, professional and community development. However, the traditional Balint group format may need adapting to be widely accessible to undergraduate learners. Sustainably integrating Balint groups into the medical school curriculum requires ongoing engagement work at both an individual and organisational level.

Identification of Factors Influencing Professional Identity Development in Medical Students at Basic Sciences Stage

Introduction

Medical education is beyond gaining a certain level of knowledge and mastering a specific set of skill. Medical students should try to improve the self and system, which necessitates personal growth and professional identity development. In this study, we aimed to investigate the factors which contribute to the formation of professional identity of medical students in basic sciences stage and finding out the significance of each factor.

Methods

In this cross-sectional practical survey, semi-structured interviews were done with 10 medical students. The interview results yielded several items, which were used to make a 14-item questionnaire, the validity and reliability of which were verified. The contribution of the items to the factors was verified through factor analysis, the prerequisites of which were KMO and Bartlett test, which were done and approved. The significance of the factors obtained was evaluated and ranked through one sample t-test and Friedman test, respectively.

Results

The result showed that professional identity development in the stage of basic sciences was influenced by several factors, including educational, socioeconomic, personal, and familial ones. Also, the personal factor ranked first, followed by socioeconomic, educational, and familial factors, respectively.

Conclusion

In this study, it was concluded that the participants were more influenced by their own personal attitudes as compared to their familial, socioeconomic, or educational factors. Moreover, the factors which contributed to the professional identity of medical students were not at the same level of significance. To train physicians with high professional identity, medical education authorities are recommended to consider the above-mentioned factors.

Nurturing professional behaviours and ethical practice: From students to professionals

Medical professionalism refers to the set of values, behaviours, and ethical principles that guide the conduct of medical professionals in their interactions with patients, peers and the broader healthcare system. From a training perspective, it is easier to focus on striving to achieve excellence in medical practice and meeting “industry” accepted standards than to remediate unprofessional behaviours of practitioners.1 Medical professionalism encompasses a commitment to providing high-quality patient care, maintaining ethical standards, and upholding the trust and respect of patients and the community. This is essential for ensuring patient safety, promoting effective healthcare delivery, and preserving the integrity of the medical profession. Systematic reviews published on unprofessional behaviours of medical students, such as failure to engage, dishonest and disrespectful behaviours, and lack of self-awareness have shown to have a negative impact on peers, teachers and patients leading to poor teamwork and provision of quality care.2

Gender Differences in Professional Adversities and Mental Health Among Surgical and Nonsurgical Medical Trainees: An Internet-Based Survey

BACKGROUND

Physicians in training face a variety of stressors throughout their professional development and according to their gender. Among them, surgical trainees appear to be especially at risk for mental health problems.

OBJECTIVE

The aim of the present study was to compare demographic features, professional activities and adversities, depression, anxiety, and distress among men and women trainees of surgical and nonsurgical medical specialties.

DESIGN AND PARTICIPANTS

A cross-sectional, retrospective, comparative study was conducted on a total of 12,424 trainees (68.7% nonsurgical and 31.3% surgical) from Mexico through an online survey. Demographic features, variables related to professional activities and adversities, depression, anxiety, and distress were evaluated through self-administered measures. Comparative analyses using the Cochran-Mantel-Haenszel test for categorical variables and multivariate analysis of variance including medical residency program and gender as fixed factors to test their interaction effect for continuous variables were used.

RESULTS

An important interaction between medical specialty and gender was found. Women trainees from surgical specialties report more frequent psychological and physical aggressions. Women from both specialties had higher distress, significant anxiety, and depression than men. Men from surgical specialties worked more hours per day.

CONCLUSIONS

Gender differences are evident in trainees for medical specialties, with a larger impact in surgical fields. Mistreatment of students is a pervasive behavior that affects society as a whole, and actions to improve learning and working environments in all medical specialties, but mostly in surgical fields, are urgently needed.

Teacher as role model in developing professional behavior of medical students: a qualitative study

Objectives

This study aimed to explore students' perspectives on the attributes of medical teachers as role models to students' professional behaviour in the educational process.

Methods

A phenomenological study was conducted to obtain participants' perceptions concerning the professional attributes of medical teachers. The participants were 21 final-year medical students in the School of Medicine, Universitas Gadjah Mada, who had completed and passed the national examination. The participants were recruited purposively to represent genders and performance (i.e., high-performing and average-performing students). The participants were divided into two focus groups based on their performance, each facilitated by non-teaching faculty members to avoid bias. Thematic analysis was conducted to analyze focus group transcripts by two independent coders. Codes were synthesized into themes related to the study aims.

Results

Seven themes were identified related to observed role model attributes, for instance, passionate lecturers, caring and empathetic, supportive and involving, objectivity, incompetence and compromising, poor communication and conflict, and time management. Subsequently, five themes were identified in participants' responses towards the observed role model, for instance, exemplary models, respect and motivating, confusion and inconvenience, avoiding and hate, and value collision and harmonization.

Conclusions

This study revealed a range of role model attributes and responded positively and negatively during learning encounters. As negative attributes are also prominent and observed by students, there is a need for medical schools to perform faculty development for the professional enhancement of medical teachers. Further study should be conducted to investigate the impact of role modelling on learning achievement and future medical practice.