Professional identity formation in disorienting times.

Abstract

The coronavirus disease 2019 (COVID-19) is a major crisis, disrupting all facets of human life. For medical professionals and trainees, the COVID-19 pandemic creates additional concerns about one’s role in providing care, the effectiveness and limitations of medical care, and personal vulnerability to infection and asymptomatic disease spread. These challenges can shape medical students’ professional identity formation (PIF), defined as how learners come to ‘think, act, and feel like a physician.’1 Medical students develop their identities as emerging professionals through training, and a crisis such as a pandemic alters, impedes or accelerates this process. A crisis catalyses transformative learning by serving as a disorienting dilemma, and educators can harness this opportunity for growth. A longitudinal integrated PIF curriculum drawing on the work of Cruess et al.1 is included in the University of California San Francisco School of Medicine curriculum. The regular 4-year curriculum contains eight separate interspersed weeks of ‘Assessment, Reflection, Coaching, and Health’ (ARCH). These full-time learning experiences highlight factors that influence socialisation into medicine - the crux of PIF. With the health system and clinical learning environment rapidly changing in response to COVID-19, classroom curricula transitioning to online platforms, and increased isolation due to social distancing, we revamped PIF content to address these disruptions. A central component of PIF is acceptance of uncertainty and ambiguity. We emphasise this theme by examining the tensions of personal versus professional duties, rationing and prioritisation of resources, and health care disparities that have been exacerbated by COVID-19 (see https://ucsf.box.com/v/COVID19-PIF-Materials). Students discuss how they negotiate ‘playing the role’ of physician, as friends and family ask about COVID-19 or question whether they should provide care that may elevate their personal risk of infection or of spreading the virus. To mitigate anxiety, fear and stress, we provide students with links to virtual wellness offerings, including physical exercise and mindfulness. To process these emotions, we use small group-based guided reflection (see https://ucsf.box.com/v/COVID19-PIF-Materials), which is core to PIF, and adapt this strategy for asynchronous and distance learning. We increased contact with faculty coaches, many of whom are involved in care for patients with COVID-19, and peers via Zoom™ (Zoom Video Communications Inc., San Jose, CA, USA) small groups to enhance socialisation and combat isolation through communities of learning. By using pre-existing small groups, we preserve rituals such as group check-ins that provide comfort and signal membership of a group and the profession. Our experience with redesign of the PIF curriculum to meet students’ learning needs during a crisis is that students are uncertain about their roles, yet eager to contribute, and are simultaneously juggling feelings of isolation, helplessness and fear. Pausing foundational science curricula and clinical clerkships to participate in guided PIF content has been mostly met with relief. Providing time for learners to reconnect with role models has facilitated conscious reflection. Opportunity to discuss their thoughts and feelings with peers has helped to counteract isolation, normalise their reactions and reduce students’ stress and anxiety. The rapidly shifting health care landscape challenges identities for all providers. Reflecting on this evolution has enabled us to maximise the transformative effect of our current circumstances for students’ learning and development.