Professional Identity In Medical Students Research Articles

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.

Формирование профессиональной идентичности студентов-медиков в процессе языковой подготовки: коммуникативный аспект

The article considers the communicative aspect of training future medical specialists for professional activity in the context of intercultural interaction. International cooperation in the field of medicine, which has increased due to the social and political importance of healthcare, increases the requirements for the professional language training of medical students, for their professional communication skills in a foreign language. The participation of medical specialists in the programs "Doctors without Borders" and the International Committee of the Red Cross requires future doctors not only proper language training, but also effective communication skills in a professional environment. It is assumed that the formation of the professional identity of medical university students can be effectively implemented if it is focused on the communicative aspect of professional language training.
 
 The purpose of the study is to determine the role of the communicative aspect of the language training of medical university students in the process of forming their professional identity.
 
 The research is based on occupational and linguistic-cultural methodological approaches. The significant role of the communicative aspect in the process of language training in the formation of the professional identity of medical university students is shown. The most important areas of professionally oriented language training are identified and characterized – training in professional communication, accuracy and clarity in the use of medical terminology, consultations with patients, registration of medical documentation and familiarization of future doctors with scientific research in a foreign language. The features of professional communication in the medical field in the context of intercultural interaction are revealed. It is proved that professional language training focused on the study of special medical terminology, cultural aspects, examples of medical documentation, as well as the participation of medical students in research activities contribute to the development of communication skills of future doctors in the process of forming their professional identity.
 
 The prospects for further research may be related to the study of the influence of the digital educational environment of the university on the process of forming the professional identity of medical students in the process of language training.

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

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. 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. 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. 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.

FORMATION OF PROFESSIONAL IDENTITY OF MEDICAL STUDENTS IN HIGHER EDUCATION INSTITUTIONS

The article analyses the main models and theories on the study of the concept of "professional identity" and the main factors influencing the formation of students' professional identity during their studies in higher education institutions. The article studies and compares the Erikson model of identity development, the theory of social identity, and the theory of career choice. The main provisions of professional identity in the works of world and national scientists are considered. Novelty of the work includes the study of domestic and international experience of educational work aimed at the formation of a positive professional identity of students. The authors propose forms and methods of work that will contribute to the formation of the professional identity of medical students, in particular, it is proposed to introduce comprehensive educational programmes and include certain topics, courses, etc. in the curriculum that would contribute to the formation of professional competence and identity of students of professional higher education. Relevance of the topic is due to the fact that the problem of professional adaptation and identification of students in higher education institutions after they have chosen a speciality, and the effectiveness of their work requires a detailed study. The authors investigated the content of the concept of "professional identity". The authors reviewed the influencing factors on the formation of professional identity, in particular, the role of educational work and the role of the teacher in the process of forming students' professional identity. The problems of professional identity formation at the university stage in Ukrainian higher education institutions are studied. The emphasis is placed on the modernisation of teaching and educational work in the higher education system of Ukraine. It is emphasised that practical training, which universities should provide through internships, cooperative programmes, research projects and practices, is of great importance in the formation of professional identity in students.

A Narrative Inquiry into the Cultivation of Professional Identity Among Medical Students Through an Online Knowledge Community

Background: Cultivating medical talents with professional identity is the ultimate goal of medical education. Nonetheless, the pre-service stage does not create sufficient opportunities to develop their professional identities. Also, there is a lack of long-term empirical data for this process. This longitudinal narrative study involved a dynamic online knowledge community in which students shared confusion, anxiety, and transformation about professional identity. Through capturing their reflections and interactions, the study explored how their professional identities developed over time through the online community in medical school and how this community best supported professional identity development. Method: We collected data from chat records and telephone interviews, using the narrative inquiry method and its interpretative tools to analyze professional identity development. Quantitative analysis was carried out to reveal some influencing factors. Results: Fine-grained analysis showed that medical students experienced a contextual change from individual identity to physician community and a collaborative process to create a supportive environment to develop a professional identity through multi-layered interactions. The analysis also identified that in a virtual community that formed group resonance, medical students balanced their self-identities and professional identity through changed perspectives to engage in selfreflection, with mentor coordination, blended interaction, and facilitating strategies as influencing factors. Our study uniquely presents online learning patterns and identity development trajectories. Conclusions: The study complements the literature about online communities and the professional identity of medical students and has important implications for online informal learning

Professional Identity of Medical Students of Malaysia: Influence of Demographic Factors

Introduction: In medical education one of the main goal is to facilitate the development of professional identity of medical students. It is influenced by sociocultural factors whose influence has been examined by the empirical scholarship on professional identity research in a robust way. The current research studied the influence of gender, ethnicity and year of study on the professional identity of medical students using a validated instrument. Methods: The quantitative research approach using the cross sectional survey design is adopted in the present study. The instrument for the measurement of professional identity was developed using the items adapted from previous research. Stratified random sampling was used to collect the data from 318 participants. The reliability and construct validity of the instrument was evaluated using Smart PLS 3. Data was analysed, for descriptive and inferential statistics using SPSS version 26. Result: Ethnicity, gender and year of study had an impact on the professional identity of medical students. Indian ethnicity had significantly higher positive influence. The female students had higher professional identity than male medical students. As the students’ progressed to higher level of their training their professional identity progressively decreased. Conclusion: The medical students trained with similar curricular activities and the learning experiences develop different levels of professional identity. The level of professional identity developed by the medical students in deferent gender, ethnicity, and year of study differes. The sociocultural factors need to be considered when designing activities aimed at development of medical students’ professional identity.

La tutoría como un factor influyente en la identidad profesional del alumno de pregrado de medicina

Introduction: the formation of the medical professional identity is achieved in stages during which the characteristics, values and norms of the medical profession are internalized, which results in the individual thinking, acting and feeling like a doctor. Tutors in medicine should clarify and encourage the principles within study programs and learning environments in order to support the formation of the professional identity of their students. Objective: the purpose of this paper is to reveal the participation of medical tutoring as one of the most influential factors that contribute to the development of the professional identity of medical students, as well as to give some guidelines so that the training of tutors. It contemplates tools that allow them to contribute to the positive and valued construction of the professional identity of the students. Keywords: Professional identity; student; tutoring; teaching; medicine

THE RESULTS OF PSYCHOLOGICAL READINESS FOR STUDYING IN MEDICAL STUDENTS.

The aim: To analyze the psychological readiness of the first-year students to study at a medical university, difficulties in the educational process, and the formation of positive motivation to educational and professional activity. Materials and methods: In the course of research, the following techniques have been used: bibliosemantic method for the analysis of scientific publications, methodology for study the main motives for choosing a profession, suggested by S. Yu. Daukilas, methodology for study the motives of academic activity, designed at the Department of Ukrainian Studies and Humanitarian Training of Poltava State Medical University (modified by A. Rean, V. Yakunin) to conduct a survey in the process of learning Ukrainian as a foreign language by the students of Medical Faculty at the Poltava State Medical University in 2021/2022 academic year. Conclusions: Professional identity of medical students begins at the first course of study. First-year students' faces heavy academic load of general scientific, medical and biological disciplines, foreign languages, etc. It is important from the first days to create a positive psychological motivation for studying, for acquiring knowledge and skills that will be required in future professional activities. Therefore, the adaptation of educational material to the new student reality, the search for relevant forms of education, considering the individual psychological characteristics and cognitive capabilities of the new generation, the use of modern specialized multimedia tools, the involvement of students in independent research activities, etc. is of decisive importance for the formation of students' readiness for education in medical university. The study showed that the students were motivated to choose their medical profession with the method of self-reproducing for the first time and later the strength of this motive grew. The role of some motivational factors in the field of professional life, such as a personal pattern, personal life, and self-satisfaction were not so well formed. We also fixed a great motivation to implement professional knowledge abroad. Prospects for further research encompass the study of personal characteristics affecting the professional activity of future doctors is expected, including their psychological adequacy to the requirements of the profession - character, temperament, intelligence, communicative and organizational abilities, etc.

Research on the Relationship Model between Professional Identity and Life Meaning of Clinical Medical Freshmen based on Artificial Intelligence Medical Image Detection.

Objective To understand the current situation of professional identity and life significance of clinical medical freshmen in a university in Xinjiang, analyze its influencing factors, find out the influencing factors and causes, and intervene and improve them. Provide the public with better medical and health management services, so that people can independently and effectively predict and prevent diseases; at the same time, it can also guide people to make more correct and wise choices in uncomfortable situations. Methods A questionnaire survey was conducted on 793 freshmen majoring in clinical medicine with the college students' professional identity questionnaire and the Chinese version of the meaning in life scale (C-MLQ). Results The freshmen total score of professional identity was (97.48 ± 12.21). The total score of meaning in life was (53.26 ± 7.15), and the meaning in life and the professional identity were significantly positively correlated (r = 0.467, P < 0.01). Students with first choice, only child, urban living, and parents with a high educational level scored higher in their professional identity (P < 0.05). First choice (β = −0.11, P < 0.001), place of residence (β = −0.07, P=0.03), father's education level (β = 0.08, P=0.04), family monthly income (β = −0.09, P=0.02), and the presence of meaning in life (β = 0.54, P < 0.001) are the influencing factors of students' professional identity. Both professional identity and meaning in life have important relationship with the mental health of medical students. In the development of modern medicine, finding personal career orientation and goals helps to establish a correct outlook on life, values, and the world. It has a positive impact on the development of personal physical and mental health. Conclusion The professional identity and life meaning of clinical medical freshmen are at the upper middle level, which can be improved through medical education and other measures. The joint efforts of society, schools, families, and individual students are needed to improve the professional identity of medical students.

Current Status of Chinese Medical Students' Professional Identity After COVID-19 and the Factors That Influence It.

This study aimed to explore the current situation regarding medical students’ professional identity after COVID-19 in China, as well as the factors that influence it. Questionnaire compiled by Fujian Medical University and self-designed were used, and participators were from one Medical University in Jiangxi Province, a central city of China. Results showed that the professional identity of medical students was upper middle level and the professional attitude was generally positive. There was a significant sex difference in terms of value (t = 2.057, p < 0.05) which the scores for boys were higher than girls, whereas the scores for girls were higher than boys when it came to aspects such as professional environment (t = -3.918, p < 0.001) and professional cognition (t = -3.855, p < 0.001). There was a significant difference in the sense of professional identity between people with and without siblings (t = 2.264, p < 0.05). The scores of students who participated in prevention and control of the epidemic were significantly higher than those who did not (t = 2.267, p < 0.01). Professional identity decreased gradually in related to higher grades, but it increased at the graduate stage; the grade [F (5,635) = 10.302, p < 0.001] and majors [F(2,635) = 5.718, p < 0.01] differences were significant. Factors such as family members’ influence, attitude toward occupation, grades, major, registered residence, and college choosing were the main factors that influenced medical students’ professional identity. Overall, the medical students’ professional identity needs to be further strengthened in the post COVID-19, it should be increased education regarding career development and planning.

Professional identity of medical students: Proposing a Meta Static Structural Model.

Introduction: The realization of professionalism and its desirable consequences, as the most important goal of medical education, primarily depends on identifying the process and mechanism of the professional identity formation, which in turn requires the accurate identification of components and structure of the concept of professional identity. Therefore, the aim of this study was to synthesize a static structural model for professional identity, based on the results of our previous research.Methods: In this study the theory or model construction methodology was used to synthesize a static structural model of professional identity formation for medical students. In this regard, the Walker and Avant method was followed through three steps: specifying focal concepts, reviewing the literature, and organizing concepts into an integrated and efficient representation.Results: In this study, based on the analysis of 9 selected conceptual models in the field of socialization and professional identity, first the key concepts of each model were extracted and then by carefully examining these concepts and determining their relationships and reviewing related texts, dimensions and components of professional identity were determined and presented in the form of a comprehensive structural static model.Conclusion: The advantage of the proposed model over the existing models is the explicit presentation of the dimensions, constructs, and sub-constructs of the concept of professional identity. In addition, this model can be used as a general pattern in all non-medical professions.

Unmasking Identity: Observations From a Cohort of Entering Medical Students.

Professional identity formation (PIF) is increasingly recognized as a core element of medical education. The use of narrative reflection is traditionally the most common means to explore PIF. We explored the use of mask-making as a process of reflective expression to encourage iterative exploration of professional identity in medical students. This project focused on elements of personal and professional identity in a cohort of entering students. One hundred fifty entering students at the Pennsylvania State University College of Medicine created a mask to use descriptive words to express their perceptions of an ideal physician (external face of the mask) and their sense of self (internal face of the mask). Responses were compared to established domains of professional identity. Students most commonly listed elements in the domain of personal characteristics to describe both their sense of self and of an ideal physician. Students were more likely to list emotional elements when describing self and more likely to use elements in the domains of relationships, attitudes, and duties/responsibilities when describing an ideal physician. The beginning of medical school is a time of significant transition. Mask making can blend visual and narrative arts to provide a complementary tool to examine professional identity formation.

THE RESULTS OF MONITORING THE PSYCHOLOGICAL READINESS FOR PROFESSIONAL ACTIVITIES IN MEDICAL STUDENTS

The aim was to analyze the psychological readiness of a future physician for professional activity, the attitude of the first-year medical students to their profession, the formation of positive motivation to study and professional activity in general. Materials and methods: In the course of research, the following techniques have been used: bibliosemantic method for the analysis of scientific publications, methodology for study the main motives for choosing a profession, suggested by Ye.M. Pavliutenkov, methodology for study the motives of academic activity, suggested by A.A. Rean and V.A. Yakunin to conduct a survey in the process of learning medical and biological physics by the students of Medical and Dental Faculties at the Ukrainian Medical Stomatological Academy in 2018/2019 academic year, the MS Excel software application. Conclusions: Professional identity of medical students begins at the first course of studies and coincides with the heavy academic load of general scientific, medical and biological disciplines, foreign languages, etc. In the period of professional identification, it is very important to create a positive motivation for learning, to acquire knowledge and skills that will be necessary in future professional activity. Therefore, the use of the state-of-the-art multimedia specialized means, involvement of students into self-research activity, etc., is crucial for its formation. Prospects for further research encompass the study of the issue of readiness for professional activity and motivation of international students at medical higher education institutions and the development of methodological support for teaching humanities at a medical university, taking into account the abovementioned recommendations.

Challenges to assessing professional identity in medical students: a tale of two measures

ABSTRACTBackground: Professional identity formation (PIF), a foundational process in becoming a physician, includes establishment of values, moral principles, and self-awareness. The purpose of this report is to examine challenges in establishing the validity of measures of identity fusion as one facet of PIF.Method: Utilizing the modern approach of validity as a unitary concept, the authors generated six hypotheses to examine the evidence for the construct validity of the scores of Physician Professional Identity (PPI) and Identity Integration (IdIn), considering relationships of these measures with each other, year of training and data from a larger survey.Results: Responses from 3473 students at 8 medical schools revealed a weak association between the measures with distributions varying by cohort. PPI had a stronger relationship to cohort and IdIn was moderately associated with students’ attitudes relevant to social media use. Responses were independent of response format and evidence supported the interpretation of scores for IdIn as indications of integration of identity.Discussion: Sufficient evidence was found to suggest that these measures assess aspects of PIF. Use of these measures as part of a multidimensional, longitudinal approach to refining understanding of the construct of PIF and developing effective assessment strategies.

DEVELOPING A MODEL OF PROFESSIONAL IDENTITY IN MEDICAL STUDENTS: THE ROLE OF MOTIVATION AND PARTICIPATION

Background: It is very important to develop professional identity among medical students, as it will affect how they work in the future. Factors affecting professional identity in medical education context need to be explored. This study aimed to develop a model of professional identity in medical students which examine the role of motivation, self-efficacy, personal reflection, social interaction, curriculum in action perceived by students and participation in determining professional identity. Methods: A cross-sectional survey was conducted among medical students in Mataram University. A total of 303 pre-clinical (year 1 to 4) and clinical students (year 5 to 6) filled out the questionnaires. Partial least square - structural equation model analysis was performed.Results: The modification model had a good model fit (GoF 0.404). The average path coefficient was 0.303 (p&lt;0.001) and the adjusted average R square was 0.321 (p&lt;0.001). Forty percent of variance in professional identity could be explained by motivation (β=0.51, p&lt;0.001, f2=0.281) and participation (β=0.32, p&lt;0.001, f2=0.118).Conclusions: Motivation and participation of medical students may influence the professional identity. Based on the model, within the medical education processes, academic motivation of students should be maintained and fostered and participation should be supported.

Understanding the Struggles to Be a Medical Provider: View Through Medical Student Essays

BackgroundThe clinical learning environment helps to shape the professional identity of medical students. This process begins from existing personal identity and is influenced by various factors, including clinical experiences and clinical learning environment. ObjectiveThe purpose of this study was to examine medical students’ reflections as a way to identify and better characterize the modern struggles that medical students face, in order to inform the development of professional identity. MethodsStudents rotating in their emergency medicine clerkship wrote reflections on dilemmas that highlighted common struggles of becoming a doctor. Qualitative analysis was performed to determine common themes from the essays. The research team coded 173 reflections and identified themes and major domains. ResultsThe first domain was Patient–Provider Conflict, including challenging patient (34%), difficult communication (25%), competing priorities between patients’ interest and trainees need to learn (19%), and bias (13%). The second domain was Provider-Specific Issues, such as the “gray zone,” in which there is not a clear standard of practice (29%), end-of-life care (14%), emotional struggle (6%), and fear of litigation (5%). The final domain was Systems Issues, such as cost of care (12%) and role of the emergency department (6%). ConclusionsThe reflections point to a wide variety of challenges that students confront in practice that will contribute to how they develop into physicians.

Decision-making process of changing major for medical students in a comprehensive university: a qualitative study

Objective To explore the decision-making process of medical students who turned the major from the medicine to other majors, and the related factors that hindered them continuing to study the medicine. Methods According to the design of interpretative phenomenon logical analysis, semi-structured in-depth interviews were used to collect the data. Participants were six undergraduate students who had moved from medical major to another major. Interviews were recorded on audio-tape with the students' per-mission and then transcribed verbatim. The transcribed interviews were analyzed according to six steps of in-terpretative phenomenological analysis. Results Even if the participants had left the medical major, they still expressed a strong sense of professional identity for the doctor. However, they also admitted that the pro-fessional process of medicine students was very hard and tired, and couldn't get the equal return for their payment. They thus were lack of confidence for the future. Some of the participants talked about the fact that they had been curious about the future of medical students. Internet and seniors were the main avenues for obtaining job-related information, but they were often plagued by the negative information. Education about career adaptation should be carried out as soon as possible, to strengthen the professional identity of medical students, and enhance their ability to defend against negative information, which could help to deal with the status of high turnover rate for medical students. Conclusion Based on the students' perspective, exploring the decision-making process of turning major for medical students will contribute to the educators taking ef-fective strategies to improve the students' career identity, stabilize their professional thought, and reduce the loss of the medical students. Key words: Medical students; Changing major; Decision process; Qualitative study

Correlation between academic motivation and professional identity in medical students in the Faculty of Medicine of the Universitas Gadjah Mada Indonesia

Abstract Background Professionalism is a skills area that should be mastered by medical graduates. The period of formal education is essential for the formation of professionalism. The involvement of internal factors, such as academic motivation, and external factors, such as the learning environment, might play a role in the development and learning of professional identity. Aim To determine the profiles of academic motivation and its relationship between student professional identity during their degree courses. Methods This cross-sectional study included 531 medical students in the early, mid, and late phases of their courses in the Gadjah Mada University Faculty of Medicine. The Academic Motivation Scale of Vallerand was used to assess academic motivation, and the Professional Identity Scale of Adams to assess professional identity. Results The mean scores of academic motivation domains including intrinsic, extrinsic, and lack of motivation among medical students in the Gadjah Mada University Faculty of Medicine were 5.02 ± 0.87, 4.86 ± 0.88, and 1.83 ± 0.96 (mean ± standard deviation), respectively. No significant differences were found between the intrinsic and extrinsic motivation scores among students in the three phases of education, while the scores on lack of motivation among students in earlier phases were lower than students in the mid and late phases (P

Developing a Physician׳s Professional Identity Through Medical Education

Professionalism represents a fundamental characteristic of physicians. Professional organizations have developed professionalism competencies for physicians and medical students. The aim of teaching medical professionalism is to ensure the development of a professional identity in medical students. Professional identity formation is a process developed through teaching principles and appropriate behavioral responses to the stresses of being a physician. Addressing lapses and critical reflection is an important part of the educational process. The “hidden curriculum” within an institution plays an important role in professional identity formation. Assessment of professionalism involves multiple mechanisms. Steps in remediating professionalism lapses include (1) initial assessment, (2) diagnosis of problems and development of an individualized learning plan, (3) instruction encompassing practice, feedback and reflection and (4) reassessment and certification of competence. No reliable outcomes data exist regarding the effectiveness of different remediation strategies.

Developing a patient focussed professional identity: an exploratory investigation of medical students' encounters with patient partnership in learning.

Patient encounters are central to the provision of learning opportunities for medical students and their development as medical professionals. The primary aim of the study reported in this paper was to discover how partnering medical students with patients with chronic illness in undergraduate learning influenced the development of a patient centred professional identity and professionalism. An exploratory interpretive research design was used to address the research aim within a patient partner program (P3). Three qualitative data collection methods were used: (1) focus groups (2) extended response questionnaire and (3) semi-structured interviews. Data were coded and analysed thematically. The professional identity of medical students is constructed along traditional lines in the preclinical years. Patient-partnership offers a disruption to this development by way of an intersection with patients with chronic illness which potentially allows meaningful construction of what a patient-centred identity should be. This point of reflection provides an opportunity to engage at a higher level in medical identity development and professionalism. The findings discussed in this paper further stimulate the patient-centred agenda by understanding the conflict associated with the student-patient nexus in medical education and its potential for building professionalism and a patient-centred professional identity. To continue the drive for a patient-centred professional identity there must be ongoing engagement with patients in medical education, preferably commencing early in a student's journey so that it becomes the expected norm. This study has highlighted that a true patient-centred emphasis is being encountered too late in their socialisation process.