Abstract

Critical care clinicians practice a liminal medicine at the border between life and death, witnessing suffering and tragedy which cannot fail to impact the clinicians themselves. Clinicians' professional identity is predicated upon their iterative efforts to articulate and contextualize these experiences, while a failure to do so may lead to burnout. This journey of self-discovery is illuminated by clinician narratives which capture key moments in building their professional identity. We analyzed a collection of narratives by critical care clinicians to determine which experiences most profoundly impacted their professional identity formation. After surveying 30 critical care journals, we identified one journal that published 84 clinician narratives since 2013; these constituted our data source. A clinician educator, an art historian, and an anthropologist analyzed these pieces using a narrative analysis technique identifying major themes and subthemes. Once the research team agreed on a thematic structure, a clinician-ethicist and a trainee read all the pieces for analytic validation. The main theme that emerged across all these pieces was the experience of existing at the heart of the dynamic tension between life and death. We identified three further sub-themes: the experience of bridging the existential divide between dissimilar worlds and contexts, fulfilling divergent roles, and the concurrent experience of feeling dissonant emotions. Our study constitutes a novel exploration of transformative clinical experiences within Critical Care, introducing a methodology that equips medical educators in Critical Care and beyond to better understand and support clinicians in their professional identity formation. As clinician burnout soars amidst increasing stressors on our healthcare systems, a healthy professional identity formation is an invaluable asset for personal growth and moral resilience. Our study paves the way for post-graduate and continuing education interventions that foster mindful personal growth within the medical subspecialties.

Highlights

  • Toronto.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

  • The reflective pieces consistently demonstrate that becoming an Intensive care units (ICUs) clinician usually begins with a strong drive to save lives followed by a gradual realization that their profession has an important role in caring for patients who are dying

  • We sought to examine longitudinal Professional identity formation (PIF) by analyzing narratives written by clinicians–trainees and senior learners alike–within Critical Care Medicine, a speciality that is responsible for some of the highest rates of burnout among its staff [30, 31]

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Summary

Objectives

The goal of this study was to analyze these narratives, written by ICU clinicians, to answer: What are the experiences shared through narratives that impact ICU clinicians’ identity formation? How is meaning sought in these experiences? What impact do these experiences have upon their personal and professional lives?

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