Being, becoming, and belonging: reconceptualizing professional identity formation in medicine

Frontiers in Medicine, Год журнала: 2024, Номер 11

Опубликована: Авг. 27, 2024

Over the last decade, there has been a drive to emphasize professional identity formation in medical education. This shift had important and positive implications for education of physicians. However, increasing recognition longstanding structural inequalities within society profession highlighted how conceptualizations have also unintended harmful consequences. These include experiences threat exclusion, promotion norms values that over-emphasize preferences culturally dominant groups. In this paper, authors put forth reconceptualization process medicine through elaboration 3 schematic representations. Evolutions understandings formation, as described re-defining socialization an active involving critical engagement with norms, emphasizing role agency, recognizing importance belonging or exclusion on one’s sense self. The framed their analysis evidence-informed educational guide aim supporting development identities which embrace diverse ways being, becoming, profession, while simultaneously upholding standards required meet its obligations patients society.

Язык: Английский

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Critically re‐examining professional norms: Medicine's urgent need to look inwards

Medical Education, Год журнала: 2024, Номер 58(7), С. 775 - 777

Опубликована: Фев. 21, 2024

'Are physicians who they ought to be?' This commentary advocates for a critical re‐examination of what is at the core being physician via process inclusive co‐construction

Язык: Английский

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How faculty with critical care specialties learn in a university hospital: a qualitative phenomenological study

BMJ Open, Год журнала: 2025, Номер 15(1), С. e091535 - e091535

Опубликована: Янв. 1, 2025

Objectives The study aims to explore the workplace learning experiences of medical faculty in critical care specialties at a university hospital, focusing on how they develop their professional identity and construct meaning work. Design Qualitative, phenomenological study. Setting current was conducted hospital South Korea between November 2022 October 2023. Participants Five members (two males three females) from (eg, emergency medicine) with over 15 years experience, each having served as for more than 5 years. Results Six key themes emerged: cultivating ‘doctor-ishness’ realm care, beacon inner drive: guiding growth, nexus leveraging expertise fostering challenging reality becoming an ‘ideal’ faculty, shifting tides profession’s role weaving into unique rhythm practice. These collectively highlight that members’ involves transition functional professionals reflective practitioners. Conclusions Workplace is understood ongoing, context-dependent individualised process which emotions play crucial determining depth significance shaping identities. This highlights capacity agency potential, offering perspective beyond previous research has primarily focused hardships. By shedding light insider’s view underscoring need support development these high-stakes fields, our findings suggest theoretical practical interventions foster mutual growth organisations.

Язык: Английский

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Professional identity, pivotal moments, and influences: Implications for preceptor development

Currents in Pharmacy Teaching and Learning, Год журнала: 2025, Номер 17(6), С. 102345 - 102345

Опубликована: Март 22, 2025

Язык: Английский

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‘Role Model Moments’ and ‘Troll Model Moments’ in Surgical Residency: How Do They Influence Professional Identity Formation?

Perspectives on Medical Education, Год журнала: 2024, Номер 13(1)

Опубликована: Май 20, 2024

Role models are powerful contributors to residents' professional identity formation (PIF) by exhibiting the values and attributes of community. While substantial knowledge on different role exists, little is known about their influence PIF. The aim this study was explore surgical experiences with understand how these contribute

Язык: Английский

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Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis

Frontiers in Medicine, Год журнала: 2024, Номер 11

Опубликована: Июнь 13, 2024

Introduction Professional identity formation (PIF) is an ongoing, self-reflective process involving habits of thinking, feeling and acting like a physician integral component medical education. While qualitative work has suggested that PIF informed by professionalism, resilience, leadership, there dearth quantitative in this area. Multiple methods build rigor the present study aimed to quantitatively assess relative psychometric contributions leadership constructs informing PIF, using latent factor analysis approach. Methods We analyzed data from PILLAR study, which online cross-sectional assessment pre-clinical cohort students RCSI University Medicine Health Sciences, Dublin, established validated measures each area interest: resilience. A total 76 items, combining four scales, along with selection demographic questions, were used. The hypothesis by, correlates with, resilience was examined conducting confirmatory proposed three-factor higher-order model. Model estimation used Maximum Likelihood Method (MLM) geomin rotation. hypothesized (measurement) model against alternative (saturated) model, as well Results Latent variable 1,311 demonstrated best fit data; suggesting these are statistically distinct account for differential aspects PIF. This outperformed both saturated may be most or least influential inconclusive, overall not influenced year training. Discussion Building upon existing conceptual contentions, our first support contribution development professional identity, delineate inter-relationships between constructs. information can educators when designing curricula educational strategies intended enhance Future should seek influence longitudinally.

Язык: Английский

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Transformations in medical education: A prudential perspective

Health care science, Год журнала: 2024, Номер 3(2), С. 73 - 77

Опубликована: Март 18, 2024

A decade ago we asked the question, "Is there something in medicine that is eternal or enduring?" Our aim was to write a manuscript entitled, "That which does not change medicine." The publication begins as follows: "The practice of involves continual change, driven by constant stream developments understanding biological structure and function relevant human diseases, parallel improvements pharmacologic other technological interventions. This also evolving social philosophies, ethical trends, lifestyles." [1] That preamble reverberates strongly now then, perhaps even more so, given velocity change. When deliberated on aspects medical should remain stable, had few premonitions implantable chips, robotic surgery, virtual reality, artificial intelligence (AI) would soon become ubiquitous. needle has clearly moved, propelled extraordinary advances bioengineering, computer data sciences; major shifts governance organization clinical practice; powerful sociocultural trends. As explore current transformative are reminded our earlier conclusions: certain dimensions are, indeed, immutable. Most importantly, relationship between physician patient depends moral obligations, characterized compassionate response best described engagement [2]. requisite virtues affective much cognitive. challenge for educators, physicians, policymakers accommodate benefits transformational both conceptual, whilst remaining true fundamental, dyadic relationship. Thus, pedagogic welcome innovations but do so with restraint is, an attitudinal disposition neither cynical nor inhibitory rather alert mindful, especially when faced announcements innovation will solve problems overburdened hospital system. By insisting cautious approach may avoid pendulum swings too far, resulting unintended consequences costly backtracking undo damage untrammeled enthusiasms. We consider two illustrative germane healthcare delivery: one education technology. try anticipate understand impacts conclude posing set questions be useful those who manage systemic changes. An innovation, unfolding schools world-wide often regarded "transformative," competency-based (CBME). analyze this trend, relying hierarchy knowledge frame reference. historian Jill Lepore, using metaphor filing cabinet four drawers, proposed categorization [3]. Each drawer contains different kind. top "mysteries"; second "facts"; third "numbers"; lowest "data". With respect their epistemologies, she suggests mysteries accessible revelation (thus, discernable "God"); facts derived way experimental scientific methods observations (i.e., product natural sciences humanities); numbers entities can counted (e.g., measured statisticians epidemiologists); and, generated computers science). these categories potentially valuable practice. CBME lives, metaphorically speaking, Lepore's drawer. Its ontology reductionist; it views professional development accumulation small quanta knowledge, accompanied accretion discrete psychomotor skills, then presented stepwise progress personal abilities. epistemology, tenacity defines educational outcomes behaviorally measurable ways, aligned psychometrics. model been able mitigate well-documented deficiencies assessments performance; however, its implementation, theoretical coherence, axiological foundations have criticized. Numerous commentators bemoaned monopolized resources, distracted leaders, undermined loco parentis nature teaching, most distressingly, failed provide holistic picture students' capabilities [4]. fraught controversy. It apparent tensions exist obligation attend identity formation [5]. recent commentary attempts rescue concept "competencies" distinguishing from "competence" foregrounding latter; argues competence multilayered visualizes continuum existing three separate levels [6]. first layer, considered develop primarily undergraduate (UGME) labeled "canonical competence," represents amalgam foundational declarative sprinkling basic skills. Higher order capabilities, such creativity, curiosity, adaptability, humility, leadership, postponed later phases training, layers encapsulated hackneyed phrase, "the art "art" supposedly acquired preferentially during residency independent curricular edifice reinforces reductionist suggesting needs focus rote undermines arguments appropriateness UGME. There striking disconnect wholesale adoption paucity compelling evidence superiority. In Canada, country long promoted CBME, report Royal College Physicians Surgeons confirmed only minority resident physicians supportive [7]. Understandably, many jurisdictions decided slacken transition adopting competency-compatible lieu model. experience serve note caution leaders health professions. changes presumed salutary, recommend following reflections: Might represented transformation risk overwhelming alternative ways indispensable institutional values? Could deforming transforming? To what extent new innovative tool result advantages adopter (in illustration, managers) culminate improved client teachers learners)? Perhaps time make haste slowly! introduction AI illustrates how ideas received, adopted, translated strategically pragmatically medicine. heralded exciting yet disruptive. technology unfolded pari passu domains. promises pitfalls former summarized [8] avalanche studies, reviews, commentaries scope, risks introducing various types clinically related tasks diagnosis, documentation, scheduling, workflow, simple surgery) diverse specialities [9]. For purposes analysis, put aside specific modes domains application essences technology, writ large. turn Aristotelian philosophical constructs. etymology word Greek technē (or ars, Latin)—commonly craft. ancient Greeks viewed antithesis tuchē (luck). Tuchē refers happenstance events occur chance controlled humans. Technē aims introduce predictability. Philosopher Martha Nussbaum notes, "Technē …. deliberate some part world, yielding control over tuchē; concerned management need prediction concerning future contingencies" [10]. Control contingencies cardinal feature. highly awash contingencies. Clinical defined as: "a science-using must diagnose treat illnesses one" [11]. definition helps situate context practices. notion "science-using." support physicians' abilities diagnosing, treating, prognosticating reducing inherent responsibilities. Although founded databases "N" gigabytes, resolutely mode "one one." Aristotle distinguished branches thought pertinent activities practical domains: fabricating forging porcelain plate) versus performing navigating ship). activity requires distinct cognitive disposition. technē—a productive characteristics: identifies features common group cases generalizable); culminates definable external agent involved making; explains phenomena through cause effect; directly teachable; succeeds creating artifacts canonical methods. These characteristics normative aspects, hearken back layer competence, retrofit noted earlier. contrast pursuit, corresponds phronēsis. Phronēsis prudence wisdom. analogous virtue Confucianism ren (humanness), moderated yi (justice), guides person "to localized factors" [12]. Practical wisdom allows apprehend singular contextual factors particular case). less formulaic than technē; deliberation about worthwhileness thus tied judgment; dependent excellence character; results inextricable agent; nurtured transmitted experiential learning. argued practices focused N 1, endeavors understood lens phronēsis [13, 14]. important underline above concepts crystalline terms open debate. discussion controversies beyond remit article. point wish pedagogical reasoning involve choreography generalization particularization. integrate nomothetic idiographic approaches, philosopher Wilhelm Windelband [15]. AI, like all cannot escape dance. will, undoubtedly, help formulate generalizations precepts routinely used outputs improve decision making rendering diagnostic evaluations, notably rely visual interpretations dermatology radiology), prognostications increasingly accurate. Time-honored heuristics served well generations fine-tuned rendered obsolete AI. If trials confirm overall good. However, nameless "generic" counts. individual matters greatly. Would robot engage suffering manners wise clinician? see patient, personhood, accompany them healing journey comparable three-dimensional space fellow being? Randomized studies demonstrated large language model-based systems generate responses empathic tone provided clinicians [16]. Some interpreted findings proof Chatbot displays "bedside manners" equivalent superior [17]. Such conclusions unwarranted. Interpersonal connections empathy complex multifaceted constructs reduced question-and-answer duet. Considering sharpen distinctions machine encounter. Two empirical revealed characteristics; include having capacity sustaining hope, rule breaking, bubble undivided attention, encountering patients reveal centrality care, decisions influenced embodied perceptions gut feelings intuitions [2, 18]. These, agency, unlikely achievable robots. destined desirable assistive functions, particularly generalizations, computations, pattern recognition. particularization approaches within domains, decision-making engagement, contend never pass muster. reason … "Data, Information, Knowledge, Wisdom" pyramid represent intellectual progression possession unprocessed insight. origins uncertain [19]. find useful, least because positions "wisdom" at pinnacle. perhaps, "mysteries" visualized Lepore her propose aspirational goal. magic recipe acquisition. Practiced discernment, guided reflection, longitudinal learning, preferably sage mentors, candidate ingredients. Benjamin Chin-Yee, direct necessary reflections. He "… refer simply material describes thinking interacting world; …(it) value-neutral reflects range choices values; pure ends fixed means instead exists ends" [20]. framing warranted models. Critical posed: (i) Whose interests anyone overlooked? (ii) Will any tradition threatened if loss acceptable? (iii) Does deployment suggest realignment core values beliefs (intentionally inadvertently) promotion demotion? guiding principles ethos telos physician, we, professionals, obliged recall students focal duties. must, therefore, assure entrusted us care benefit harmed creativity. Both authors participated conception design written perspective. worked revisions contributed final version. None. declare no conflict interest. Not applicable. Informed consent applicable article subjects were involved. Data sharing datasets analyzed formulation commentary.

Язык: Английский

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Unveiling the paradoxes of implementing post graduate competency based medical education programs

Medical Teacher, Год журнала: 2024, Номер unknown, С. 1 - 8

Опубликована: Май 28, 2024

Purpose Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate education, yet its implementation poses significant challenges, especially with regard to sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute our understanding of post graduate competency-based (PGCBME) processes and serve a first-step in enhancing better implementation. Thus, purpose current study is identify associated PGCBME

Язык: Английский

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Complexity and objectivity in teaching interprofessional healthcare communication

Patient Education and Counseling, Год журнала: 2024, Номер 131, С. 108558 - 108558

Опубликована: Ноя. 21, 2024

Язык: Английский

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An Exploration of Pediatricians’ Professional Identities: A Q-Methodology Study

Healthcare, Год журнала: 2024, Номер 12(2), С. 144 - 144

Опубликована: Янв. 8, 2024

Professional identities may influence a wide range of attitudes, ethical standards, professional commitments and patient safety. This study aimed to explore the important elements that comprise pediatricians’ identities. A Q-methodology was used identify similarities differences in identity. Forty pediatricians were recruited from two tertiary referral hospitals Taiwan. list statements developed by five attending physicians three residents. R software analyze Q-sorts load viewpoints formulate viewpoint arrays. Additional qualitative data—one-to-one personal interviews—were analyzed. Twenty-eight forty pediatricians, 11 males 17 females, with an average age 39.9 (27–62) years, associated four viewpoints. We labeled identified for identity as (1) recognition, (2) communication, (3) empathy (4) insight. The recognition comprised youngest participants—28–36 years—with majority residents (77.8%), while oldest participants—38–62 all physicians. All participants insight married. found be multifaceted concept especially areas into care.

Язык: Английский

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