Professional Identity Formation Research Articles

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

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. 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. 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. 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.

Rethinking Informed Consent as an EPA in Surgery.

Over the past decade, entrustable professional activities (EPAs) have become an important element in the competency-based medical education movement. In this Commentary, the authors explore informed consent as an EPA within resident surgical training. In doing so, they foreground the concept of culture and reexamine the nature of trust and entrustment decisions from within a cultural framework. The authors identify role modeling and professional identity formation as core elements in the training process and suggest that faculty are sometimes better off using these tools than uncritically adopting a formal EPA framework for what is, in essence, a professionally oriented and values-based moral enterprise. They conclude that EPAs work best when they are developed at a local level, stressing the unique specialty and program culture as well as the care that must be taken when attempting to transfer notions of entrustment from the undergraduate medical education level to graduate medical education settings.

A systematic scoping review of group reflection in medical education.

Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

THE REALIZATIONS OF TEACHING PROFESSION: FOUR INDONESIAN NOVICE ENGLISH TEACHERS' NARRATIVES DURING THE PANDEMIC

This study explores teacher professional identity (TPI) of novice English teachers in Indonesia by looking at their narratives related to their experiences before and after they entered the profession. The central question leading this inquiry is “What realizations about the profession shape the participants’ TPI?” The data were collected from four participants through emails and follow-up interviews by phone. The data, then, were co-constructed to create coherent narratives of the four novice teachers. Further analysis was conducted by identifying their new realizations and awareness of being English teachers. These realizations about teaching and the profession were discussed in terms of the TPI elements. The findings indicate that realizations about various aspects of TPI of the novice teachers could lead to a better understanding of their professional identity formation before entering the profession, after entering the profession, and at the time of COVID-19 pandemic (2020-2021). The TPI claims in the three stages indicate the complex process of TPI formation and the implications of the process can be the foundation of English teacher education and professional development reform.

Defining undergraduate medical students' physician identity: Learning from Indonesian experience

Introduction: Developing a professional identity involves understanding what it means to be a professional in a certain sociocultural context. Hence, defining the characteristics and/or attributes of a professional (ideal) physician is an important step in developing educational strategies that support professional identity formation. To date, there are still limited studies that explore undergraduate medical students’ professional identity. This study aimed to define the characteristics and/or attributes of an ideal physician from five first-year and three fourth-year undergraduate medical students. Methods: Qualitative case studies were conducted with eight undergraduate medical students from a private Catholic medical school in Jakarta, Indonesia. The study findings were generated from participants’ in-depth interviews using in vivo coding and thematic analysis. Findings were triangulated with supporting evidence obtained from classroom observations and faculty interviews. Results: First-year participants modeled their professional identities based on their memorable prior interactions with one or more physicians. They mainly cited humanistic attributes as a part of their professional identity. Fourth-year participants emphasised clinical competence and excellence as a major part of their professional identities, while maintaining humanistic and social responsibilities as supporting attributes. Several characteristics unique to Indonesian’s physician identity were ‘Pengayom’ and ‘Jiwa Sosial’. Conclusion: Study participants defined their professional identities based on Indonesian societal perceptions of physicians, prior interactions with healthcare, and interactions with medical educators during formal and informal learning activities. Keywords: Professional Identity Formation, Indonesia Undergraduate Medical Students, Physician Identity

Singapore nurses’ perception of professional identity

Introduction: Nurses’ professional identity is important for their career orientation and clinical practice. This study explored Singaporean nurses’ perceptions of professional identity. The results provide an understanding of how guided learning and reflection could help nurses in their professional identity formation and development. Methods: Using an exploratory descriptive qualitative research study and purposive sampling by researchers teaching in the programme, 64 Registered Nurses with a diploma qualification pursuing a Bachelor of Science degree with Honours in Nursing programme in Singapore were invited to participate. They responded to open ended survey questions online, which were analysed using a thematic analysis. Ethical approval was obtained. Results: All 64 first year students were invited to participate at the start of the module and upon the completion. The response rates were 94% and 81% respectively. Two overarching themes – “nurses as professionals with knowledge and moral character” and “the construction of professional identity” - emerged from the data. Conclusion: The nurses perceived their professional nursing identity as a construct comprised of knowledge and moral characteristics, which is consistent with international literature. A professional nursing identity, relationships with other healthcare professionals, patients and confidence in practice were all interrelated. Guided reflection and discussion on clinical experiences and social interactions helped students become aware of their professional identity and responsibilities. Such purposive educational effort needs to be started early and supported through the students’ educational journey into clinical practice. Keywords: Professional Identity of Nursing, Singapore Nurses, Image of Nursing, Social Perception of Nursing in Singapore, Nurse Education

The impact of digital technology use on nurses' professional identity and relations of power: a literature review.

This study seeks to review how the use of digital technologies in clinical nursing affects nurses' professional identity and the relations of power within clinical environments. Literature review. PubMed and CINAHL databases were searched in April 2023. We screened 874 studies in English and German, of which 15 were included in our final synthesis reflecting the scientific discourse from 1992 until 2023. Our review revealed relevant effects of digital technologies on nurses' professional identity and power relations. Few studies cover outcomes relating to identity, such as moral agency or nurses' autonomy. Most studies describe negative impacts of technology on professional identity, for example, creating a barrier between nurses and patients leading to decreased empathetic interaction. Regarding power relations, technologically skilled nurses can yield power over colleagues and patients, while depending on technology. The investigation of these effects is underrepresented. Our review presents insights into the relation between technology and nurses' professional identity and prevalent power relations. For future studies, dedicated and critical investigations of digital technologies' impact on the formation of professional identity in nursing are required. Nurses' professional identity may be altered by digital technologies used in clinical care. Nurses, who are aware of the potential effects of digitized work environments, can reflect on the relationship of technology and the nursing profession. The use of digital technology might lead to a decrease in nurses' moral agency and competence to shape patient-centred care. Digital technologies seem to become an essential measure for nurses to wield power over patients and colleagues, whilst being a control mechanism. Our work encourages nurses to actively shape digital care. We adhere to the JBI Manual for Evidence Synthesis where applicable. EQUATOR reporting guidelines were not applicable for this type of review. No patient or public contribution.

Exploring a practice theoretical tool-kit approach for studying professional and organisational learning processes: a pragmatist interpretation

ABSTRACT This article conceptually explores different practice theoretical vantage points in empirical studies of professional and organisational learning processes. Through an ethnographic study of a management development program in Denmark, possibilities and limitations of three different practice-theoretical approaches are considered. Firstly, learning processes are examined as professional identity formation through participation in the community of practice around the development program. Next, Schatzki’s practice-theoretical approach is applied, focusing on management as situated work practice. A third approach focusing on persons’ learning paths in professional and organisational practices is considered: Ole Dreier's concept of person is discussed as a further development of practice theories in line with Schatzki’s thinking. The article explores the epistemological and ontological stances taken by the three practice theories in relation to the study of learning processes. A pragmatist interpretation of a ‘tool-kit’ approach to operationalising different practice theoretical approaches in alliance is developed, considering how this can generate constructive analytical tensions for exploring and understanding learning processes.

Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study.

Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships. The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships. Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterwards. These practices strengthened learning relationships and supported students' developmental trajectories. Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.

Do not forget about me, do not forget about you. Usability of a mobile app for professional identity formation

PurposeProfessional Identity Formation is the dynamic evolution to “think, act and feel” to become part of a professional community. This document presents the development and the study that aimed to assess the usability of a m-Learning Identity App (MLIA) focused on the formation of professional identity among undergraduate medical students.Design/methodology/approachMLIA development included four phases: Conceptual, prototype, pilot and implementation, before further deployment. The conceptual model was designed by eight faculty members from three Latin American universities. The prototype was developed and tested with stakeholders. The pilot was performed during 5 weeks before the implementation. Cross-sectional data collected during implementation from 138 medical students who completed a survey to assess the usability of MLIA are presented. During deployment, 977 posts were made on Professional Identity Formation, and examples of these posts are presented.FindingsThe prototype and pilot phases demanded improvements. The survey explored (1) Familiarity, (2) Perceived ease of use, (3) Perceived usefulness for Professional Identity Formation, (4) Satisfaction, (5) Intention to reuse (6) Digital aesthetics and (7) Safety. Results from the usability assessment suggest that students perceived MLIA as a secure space with positive aesthetics and ease of use.Research limitations/implicationsImportant limitations of the present study include, firstly, that it does not provide information on the effectiveness of the MLIA in shaping professional identity in medical students, it focuses exclusively on its development (conceptual model, prototype, pilot and implementation) and usability. Secondly, the study design did not consider a control group and, therefore, does not provide information on how the App compares with other strategies addressing self-reflection and sharing of meaningful experiences related to professional identity.Originality/valueMLIA introduces a different approach to education, simulating a secure, easy-to-use, social media with a friendly interface in a safe environment to share academic and motivational moments, transitioning from being to becoming a professional.

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

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. 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. 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. 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.

Mitigating stereotypes and bias in professional identity formation for those with marginalized identities

Pharmacists have many identities within the profession from medication experts, clinicians, educators, mentors, patient advocates, and more. It can be especially challenging for racially and ethnically minoritized persons (REMPs) to form a professional identity when they are surrounded by stereotypes and biases which are pervasive in the community, academia, and pharmacy practice settings. As pharmacist educators, preceptors, and mentors, it is important to create safer spaces that decrease stereotyping and biases for students so they may envision themselves thinking, acting, and feeling like a pharmacist. Here, literature on professional identity formation in underrepresented groups in the United States is reviewed to continue the conversation of creating safer spaces for underrepresented students as they develop their professional identity.

My Journey to Become a Social Worker: Defining Moments of Professional Identity Formation

Abstract Whilst a main task of social work education is to develop the student's professional identity, the literature on social workers’ identity formation is limited. Drawing on twenty-one reflective written assignments, this qualitative study examined defining moments as perceived by third-year Israeli social work students—moments seen as most influential in their process of professional identity formation. The crafting of a social worker identity was found to be an ongoing and spiral process, unfolding across three main spheres: (1) coping with challenges as an opportunity for development; (2) sparkling experiences validating the emerging professional identity; and (3) intersections of personal and professional identities. The findings suggested that through a process of guided reflection and discussion, often facilitated in supervisory sessions and classroom settings, students were able to transform their experiences into cornerstones for structuring their emerging professional identity. These dynamics underscore the significance of directly incorporating professional identity exploration as an integral part of the social work curriculum.

Understanding and barriers of professional identity formation among current students and recent graduates in nursing and midwifery in low resource settings in two universities: a qualitative study

IntroductionIn the changing healthcare landscape, a strong professional identity serves as a cornerstone for nurses. Therefore, transformative educational approaches that include professional judgement, reasoning, critical self-evaluation and a sense of accountability are required to foster professional identity. We explored the understanding and barriers to professional identity formation among recent graduates and students of midwifery and nursing in Uganda.MethodsA descriptive qualitative research design employing focus groups was used to collect data from student nurses and midwives from Makerere University, Mbarara University, and recent graduates in nursing and midwifery programs attending their internship training at Mulago National and Mbarara Regional Referral hospitals. Thematic analysis was used to analyse the data.ResultsA total of 33 students and 26 recent graduates participated in the study. The participants who reported understanding Professional identity in nursing and midwifery mentioned that these are principles, characteristics and values, competencies, ethics and code of conduct, sense of belonging and professionalism that define the nursing profession and practice. Barriers to the formation of professional identity were provided under two themes: education and health service delivery. The education theme included subthemes like nursing educators not working in clinical settings and inadequate clinical mentoring. Under the health service delivery theme, subthemes emerged included high workload, lack of interprofessional collaboration, many levels of nursing and midwifery practice, no clear scope of practice for different levels of nursing and midwifery practice, Low esteem among nurses and midwives, media and lack of policy implementation.Conclusion and recommendationParticipants were knowledgeable about professional identity in nursing/midwifery. They faced several challenges and barriers in professional identity formation during their training and internship. We recommend a need to streamline the scope of practice and enhance clinical mentorship and engagement of leadership in nursing in developing professional identity among students.

Reconsidering Pharmacy: We Need to Turn Career Regret into Career Options

Declining interest in pharmacy as a career is a growing concern. This commentary investigates the factors contributing to career regret among pharmacy graduates, based on data from the American Association of Colleges of Pharmacy National Graduating Student Survey. We identify 3 key contributing factors: workplace environment, professional identity formation, and marketing of the Doctor of Pharmacy degree. We argue that students observe, in many work environments, a lack of autonomy, repetitive tasks, and unfulfilling work. This leads to diminished job satisfaction and disillusionment. Additionally, marketing tactics and curricular structures can inadvertently contribute to career regret. We propose potential interventions, emphasizing the need for improved working conditions, more versatile roles in pharmacy, and enhanced career development services within colleges/schools of pharmacy. Additional research is needed to fully understand career regret and the steps that academic institutions can proactively take to mitigate career dissatisfaction among their graduates.

A Pilot Study Using a Virtual Art-Based Intervention to Support Well-Being in Persons With Cognitive Impairment and Their Care-Partners

ObjectivesWith aging, interventions promoting emotional well-being and cognitive function become essential, especially for persons with cognitive impairment (PCIs) and their care-partners (CPs). Art-based interventions, specifically Visual Thinking Strategies (VTS), have strong evidence of promoting observational skills and professional identity formation in education settings, yet little work has been done in clinical settings. The recent pandemic presented a unique need and opportunity for PCIs and their CPs to engage in enriching remote experiences. MethodsThis study piloted a 3-session virtual program using VTS-led facilitated discussion of visual art for 3 PCI-CP dyads to assess the impact on measures of emotional well-being and self-esteem, and to obtain feedback from participants about their experience. ResultsFindings indicated that virtual VTS activities for PCI-CP dyads were feasible and well-accepted by both PCIs and CPs. ConclusionsVirtual art interventions may have the potential to promote and sustain emotional well-being for PCIs and CPs.

The interprofessional practice experiences of final-semester prelicensure BSN students completing clinical immersion: A descriptive qualitative study

BackgroundThe goal of interprofessional practice experiences in health professions programs is to develop interprofessional collaborative practice skills. PurposeThe purpose of the study was to explore the meaning final-semester Bachelor of Science in Nursing students attributed to interprofessional practice experiences during clinical immersion. MethodsThe theoretical framework for this descriptive qualitative study was experiential learning theory. A sample of 12 participants was drawn from final-semester prelicensure Bachelor of Science in Nursing students at a college of nursing at a public research university. Data were collected through one-on-one semi-structured interviews and analyzed through inductive thematic analysis. ResultsThe analysis yielded four themes: professional and interprofessional identity, working with team members, communication practices, and trusting relationships. Patterns across themes were clinical environment culture, nursing school preparation, nurse preceptor role, fear/concern/worry, and night shift. ConclusionConsistency in preceptors, welcoming clinical environments, and opportunities to practice communicating with team members contributed to interprofessional collaborative practice skill development and improved perceptions of readiness for practice. Academic and clinical educators may use findings to (a) identify immersion placements for interprofessional practice experiences, (b) design curricula reflective of interprofessional practice, (c) advance teaching strategies to promote interprofessional practice, and (d) create learning environments that aid in professional and interprofessional identity formation.

Self-care integration into a prelicense nursing curriculum

BackgroundBoth nursing students and nurses face stressors. Part of a strong nursing professional identity includes the ability to perform self-care activities. However, self-care has not been a formalized component of nursing education. MethodsThis mixed-methods scholarship of teaching and learning project used a pre-post design with survey and narrative responses to determine relationships between purposeful integration of self-care spaces and mini lessons and students’ perceived self-care barriers, motivators, and participation. ResultsResults indicated positive changes on many aspects of the survey, particularly in stress control, relaxation, and work-life balance; however, there was a decline in reported sleep. The most popular mini lessons were exercise, sleep hygiene, meditation, and meal preparation. Time emerged as a major barrier to participation in self-care activities, along with low motivation and self-imposed expectations. ConclusionsIncorporating a variety of self-care opportunities into the first semester of a nursing program may be a beneficial way to support students. Self-care activities could also be scaffolded throughout the program to reinforce learning and contribute to professional identity formation.

Manifestations of professional identity work: an integrative review of research in professional identity formation

ABSTRACT Professional identity formation (PIF) is an integral part of educating professionals. A well-formed professional identity helps individuals to develop a meaningful professional self-understanding that facilitates their transition to and sustainability in professional work. Although professional identity and its formation are well theorized, it is largely unclear how the underpinning interpretive process of professional identity work leads to observable changes in thoughts, feelings and behaviours, and how these insights can be used in educational practice. To address this gap, we conducted an integrative review of 77 empirical articles on professional identity formation and inductively developed a four-fold typology of professional identity work, through which individuals reportedly make the shift from individual to professional. The theoretical contribution of this article is a more nuanced understanding of the practical manifestations of professional identity work. As a practical contribution, the typology may be used as a heuristic through which educators of professionals can support their students’ professional identity formation, particularly where this is halted or complicated by obstructions.

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

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. 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. 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. 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.