Supporting the development of a professional identity: General principles

The hunter and the lion: Amplifying health care consumers' voices in health care education

This commentary discusses ways in which we can amplify healthcare consumers' voice by co‐designing healthcare education to teach dimensions of professionalism.

Becoming the kind of doctor that you want to be. A qualitative study about participation in Balint group work

OBJECTIVE

Although wide-spread and appreciated, the benefit of Balint group work has been difficult to determine. Qualitative studies provide new angles for research. The aim of this study is to explore how participants in a Balint group for at least 1.5 years experienced the group work and how they were affected by their participation.

METHOD

Focus group interviews were conducted with a total of 19 members of four different Balint groups. The participants were experienced residents or younger specialists in general practice as well as from hospital specialities. A thematic analysis was performed.

RESULTS

The main themes that emerged were: Investigating emotions, Development of the physician's identity as well as Safety in the group and with the leader. The participants reported relief from stress as well as increased ability to understand the emotional side of patient encounters. They struggled to find their identity as doctors and specialists, often gaining a sense of pride in their work and becoming more secure. The group with a certified Balint leader felt like a safe place.

CONCLUSIONS

For younger doctors, participation in a Balint group for at least 1.5 years can help them build their professional identity by means of a deeper understanding of doctor-patient relationships. The role of Balint group work in relation to professional identity warrants further study.

General practice residents’ perspectives on their professional identity formation: a qualitative study

Objectives

To move beyond professionalism as a measurable competency, medical educators have highlighted the importance of forming a professional identity, in which learners come to ‘think, act, and feel like physicians’. This socialisation process is known as professional identity formation (PIF). Few empirical studies on PIF in residency have been undertaken. None of these studies focused on PIF during the full length of GP training as well as the interplay of concurrent socialising factors. Understanding the socialisation process involved in the development of a resident’s professional identity and the roles of influencing factors and their change over time could add to a more purposeful approach to PIF. Therefore, we aimed to investigate the process of PIF during the full length of General Practice (GP) training and which factors residents perceive as influential.

Design

A qualitative descriptive study employing focus group interviews.

Setting

Four GP training institutes across the Netherlands.

Participants

Ninety-two GP residents in their final training year participated in 12 focus group interviews.

Results

Study findings indicated that identity formation occurs primarily in the workplace, as residents move from doing to becoming and negotiate perceived norms. A tapestry of interrelated influencing factors—most prominently clinical experiences, clinical supervisors and self-assessments—changed over time and were felt to exert their influence predominantly in the workplace.

Conclusions

This study provides deeper empirical insights into PIF during GP residency. Doing the work of a GP exerted a pivotal influence on residents’ shift from doing as a GP to thinking, acting and feeling like a GP, that is, becoming a GP. Clinical supervisors are of utmost importance as role models and coaches in creating an environment that supports residents’ PIF. Implications for practice include faculty development initiatives to help supervisors be aware of how they can perform their various roles across different PIF stages.

Evaluation of post-simulation sonographer students' professional behaviour in the workplace

INTRODUCTION

In Australia, sonographer's professional identity is traditionally 'caught' from clinical role models. A four-year undergraduate-postgraduate course introduced professional identity education, with simulated practice, to prepare novice sonographer students prior to clinical practice. Preclinical students learnt sonographer professional behaviour, and humanistic attributes, during simulation designed with volunteer peers as standardised patients, educator role-models, immediate feedback, self-reflection, and longitudinal multi-observer assessment. This paper reports on the transfer of learnt professional behaviour and humanistic attributes to clinical practice.

METHODS

Professional behaviour evaluations completed by 94 clinical assessors described 174 students' professional behaviour and attributes one month into their initial clinical practice (2015-6). Student performance of each behaviour, and behavioural category, was quantitatively analysed by modelling binomial proportions with logistic regression.

RESULTS

Students demonstrated substantial learning transfer to clinical practice, achieving an overall mean score of 'consistent' sonographer professional behaviour and humanistic attributes (mean score of equal to or >3/4), one month into clinical practice. Professional behaviours varied in transferability, with 'response to patient's questions' showing least efficacy (P < 0.05). Increased deliberate practice with educator role-models improved transfer efficacy significantly (P < 0.001).

CONCLUSION

Preclinical application of theory to simulated practice, using standardised patients, educator role-models, immediate feedback, and multi-observer assessment, facilitated substantial transfer of sonographer professional behaviour and attributes to clinical practice. The efficacy of transfer varied but improved with increased deliberate practice and feedback.

IMPLICATIONS FOR PRACTICE

The incorporation of preclinical professional behaviour education with simulated practice into the core curriculum of sonographer courses is recommended for the formation of sonographer professional identity, improved clinical outcomes and increased patient safety during the early stages of ultrasound education.

Ambivalent professional identity of early remedial medical students from Generation Z: a qualitative study

BACKGROUND

Supporting professional identity development in medical students undergoing remediation in the first few years of their studies is an important topic. However, there is a lack of research on developing an effective and individualised process for successful remediation that targets learner identities. This study examined the identities of Generation Z remedial medical students through the lens of professional identity formation, focusing on the difficulties they faced and the support they sought.

METHODS

An exploratory qualitative case study was conducted within a constructivist paradigm. Twenty-two medical students (14 males and 8 females) who had experienced remediation in their first few years of medical university participated in this study. All participants were members of Generation Z. Qualitative data were collected through face-to-face, semi-structured interviews and analysed using thematic analysis.

RESULTS

Medical students undergoing remediation in the first few years experienced resistance to the medical profession and conflict due to the gap between the ideal and the reality they experienced after entering medical university. Students' professional identities were closely intertwined with their pre-university identities; this affected the process of professional identity formation after entering medical university. They preferred assurances of confidentiality as a prerequisite and immediately sought advice through social networks to support their professional identity development.

CONCLUSIONS

When planning professional identity development support for Generation Z medical students undergoing remediation in the first few years, it is necessary to carefully select integrative interaction methods, focus on the context of individual learners, and collaboratively discuss specific responses between students and faculty. The results of this study could be useful to faculty in developing support systems for future remedial medical students that focuses on professional identity development and mentoring of remedial medical students.

A Synchronous Hybrid Team-Based Learning Class: Why and How to Do It?

COVID-19 pandemic has transformed much of the medical curriculum delivery from in person to online. Given that interpersonal interaction facilitates team cohesion and professional identity formation, prolonged online learning with minimal social interaction might impact these competencies in medical education. To mitigate the impact of prolonged social isolation, we conducted synchronous team-based learning (TBL) classes, where half the class is physically present and the other is connected via an online platform, termed hybrid TBL. We present practical tips in implementing hybrid TBL for educators teaching in large-sized classes, should conditions exist where not all students can attend in person.

Student pharmacists' perceptions of their professional identity

INTRODUCTION

Professional identity describes the internal feeling of belonging to a community, such that someone "thinks, feels, and acts" like a member of a profession. Clear professional identity formation can improve the transition from school to work. However, there is limited knowledge about student pharmacists' perceptions of their professional identity. This research aimed to identify and compare student pharmacists' perceptions of their professional identity and to compare those perceptions across class cohorts.

METHODS

Data were collected using an online questionnaire that incorporated professional identity labels drawn from previous research. The questionnaire was administered over four weeks to all student pharmacists at one United States pharmacy school. Data were analyzed using chi-square tests.

RESULTS

One hundred sixteen responses were received (24% response rate) from the four graduating class years (2020-2023). Respondents were predominantly female (73%), Caucasian (43%), and had obtained at least a bachelor's degree (58%). "Medicine Adviser" was the most frequently selected professional identity (38%). "Business Person" was the least frequently selected professional identity (0%). There was no relationship between professional identities and cohorts of students.

CONCLUSIONS

Student pharmacists in this study selected multiple professional identities, suggesting pharmacy students and the profession have yet to consolidate their own identity. There was no relationship between student pharmacists' professional identity selections and cohort, suggesting that professional identity formation did not change as a result of moving through the didactic curriculum. Additional training, curricular modification, and faculty support may be warranted to support student pharmacists with their professional identity development.

Exploring interprofessional identity development in healthcare graduates and its impact on practice

Interprofessional identity development is an emerging area of research. Whilst there is a growing body of studies exploring interprofessional identity development and interprofessional education, little is known about interprofessional identity development in healthcare professionals and the impact of interprofessional identity on practice. This study explored interprofessional identity development in graduates during their first year of work as health professionals and the influence of this on practice. All graduates had prior interprofessional education as students. Fourteen interviews with eight graduates were conducted. Data was analysed cross-sectionally using inductive thematic analysis. Three inter-related themes were developed: ‘growing confidence,’ ‘commitment to client-centred care,’ and ‘maintaining dual identification in different contexts.’ These themes demonstrated that, first, interprofessional identity development occurred along a continuum influenced by the practice context and the individual’s commitment to client-centred care. Second, confidence identifying and practising as a healthcare professional facilitates further interprofessional identity development. Third, maintaining identification as an interprofessional practitioner involves developing an increasingly sophisticated understanding of interprofessional practice by viewing interprofessional identity through increasingly complex meaning-making lenses consistent with the constructive developmental theory of self. Findings support the inclusion of pre-licensure interprofessional education and inform further interprofessional identity research in professionals beyond their first year of practice.

Finding Meaning in Medicine: Pediatric Residents' Perspectives on Humanism

OBJECTIVES

To explore pediatric residents' perspectives on humanism and how residency impacts humanism formation.

METHODS

We conducted a qualitative study with pediatric resident focus groups at Stanford. Transcripts were analyzed by two investigators using grounded theory. Subsequent literature review led us to adapt Cruess et al. 2015's professional identity formation framework to describe development of a humanism identity in residency. Member check was done to verify themes and the adapted framework.

RESULTS

Thirty two pediatric residents participated. Five themes emerged: 1) Empathy, compassion, and respect are foundational elements of humanism. 2) Each resident had a unique view of humanism derived from personal values. 3) Residents felt that the terms excellence and resilience (Gold Foundation IECARES model) did not fit with their own definitions. 4) Residents felt that humanism is a central part of their practice and training. 5) The demands, structure, and culture of residency were often in conflict with promoting humanism in residents. Based on residents' perspectives, we modified the professional identity formation and socialization conceptual framework proposed by Cruess et al. 2015 to reflect humanism identity formation during pediatrics residency. The new framework emphasizes the increased power of the healthcare system and unconscious acquisition on humanism formation in residency as compared to medical school.

CONCLUSIONS

Residents believe that humanism is a core part of practicing medicine and should be reinforced during residency training. Cruess' professional identity and socialization framework is a tool for a better understanding of the complexity of humanism development in residency.

"Fun slipping into the doctor's role"-The relationship between sonoanatomy teaching and professional identity formation before and during the Covid-19 pandemic

The various psychological dimensions of professional identity formation (PIF) are an important aspect of the study course for undergraduate medical students. Anatomical learning environments have been repeatedly shown to play a critical role in forming such an identity; however, relevance of PIF during sonoanatomical training remains underexplored. At the end of their basic anatomy studies, third-semester medical students took part in a four-day block course on anatomy and imaging. Anatomical content was revised in small groups using peer teaching and imaging methods, including one hour of hands-on sonoanatomy sessions each day. On-site sonoanatomy was identified as an excellent format to support students' transition from the pre-clinical to clinical phase as medical experts-to-be. Students enjoyed practical exercises and the clinical input, which increased their interest in the medical profession and their academic studies. This study further examined the effects of the transition into an online-only format, necessitated by the current Covid-19 pandemic. A comparison was made between the quantitative and qualitative evaluation data, and the written results of examinations of several on-site (n = 1096, mean age = 22.4 years ± 2.18), and online-only cohorts (n = 230, mean age = 22.6 years ± 2.21). The online-only transition led to a reduction of all PIF-related variables measured, losing identity-related variables, increasing students' stress levels, and reducing their long-term academic performance. Together, this study demonstrates presence of PIF in undergraduate sonoanatomy teaching, and cautions against the uncritical online-only substitution of hands-on learning environments.

Connection and conflict: influence of the hidden curriculum on veterinary residents' professional identities within the specialty of laboratory animal medicine

OBJECTIVE

To explore the role of the hidden curriculum in residents' development of professional identity during postgraduate training in laboratory animal medicine.

SAMPLE

24 residents enrolled in 1 of 7 laboratory animal medicine training programs in the eastern US.

PROCEDURE

24 qualitative, semistructured interviews were conducted and recorded. Deidentified transcriptions were analyzed by each author using open and axial coding. Constant comparative methodology was used to develop themes and subthemes. Member checks were performed to verify trustability of the conclusions drawn.

RESULTS

3 themes and their related subthemes emerged from the qualitative analysis: 1) building relationships through competent communication (building rapport, practicing clinical empathy, overcoming language barriers, communicating in the "authorized" way, and navigating email limitations), 2) tension within the process of identity formation (acting as the middleman among stakeholders, overcoming the stigma of the policing role, experiencing a lack of power to impact change, and managing a culture of conditional value of veterinary knowledge), and 3) outlets for tension in identity formation (reliance on residency mates, limitations of venting).

EDUCATIONAL RELEVANCE

Our findings suggest that residents are navigating professional identity formation under challenging circumstances that include conflicting stakeholder needs, conditional value of veterinary knowledge, and lack of power to influence change. Residents have limited outlets for relieving the discord between their ideal professional role and their lived experiences. These results provide an important background for refining curricula and creating effective support systems for residents.

Professionalism and dental education: in search of a shared understanding

Professionalism has profound historical origins; however, the current health care environment in the UK dental sphere is changing, which presents new professional dilemmas that require continued learning and debate. Professionalism is a key aspect of the education of dental students and the lifelong learning and development of dental practitioners. However, 'being' professional can be challenging because while it is recognised as a social good, there is much debate on what professionalism means and how best it can be learned and assessed. Since 2017, the UK Council for the Dental Teachers of Professionalism, consisting of educators from UK dental schools and dental therapy hygiene institutions, has been exploring and debating the role and place of professionalism, as well as sharing challenges and good practice within UK dental education. This paper includes a narrative overview of current thinking in the academic literature on professionalism to consider the use of a shared understanding of professionalism to facilitate conversations between various stakeholders.

Impact of a Prepharmacy Program on Students' Self-Awareness of Pharmacist Professional Identity: Comparison between Virtual and In-Person Settings

Ensuring an adequate preparation for undergraduate students transitioning to pharmacy school is challenging. A significant barrier is changing from a subordinate to a critical thinking mindset while self-identifying as a professional. Here, we aimed to (1) determine whether our prepharmacy program called “Professional Identity and Me” (PRIME) could enhance learners’ self-awareness of their professional identity and (2) compare the effectiveness of the in-person and online versions of PRIME. PRIME introduced prepharmacy students to aspects of pharmacists’ professional identity including community, hospital, and interprofessional work, as well as mental health, wellness, and time and stress management skills, Top-200 drugs, prerequisite foundational sciences, and calculations. Concepts of professionalism, graduate writing, and ownership were also presented. Bridging exercises were introduced to exemplify application. We used a mixed-methods approach to assess the outcomes. The average performance in knowledge-based assessments increased before and after the PRIME program from 53.8 to 74.6% and from 47.7 to 75.9%, while the difference in the test scores was statistically significant, with a 21% increase (p < 0.001, 95% CI 15−26%) and a 28% improvement (p < 0.001, 95% CI 23−34%) for face-to-face versus virtual PRIME. The results of a student perception survey revealed PRIME was equally effective as a virtual program during the COVID-19 pandemic, suggesting transferability to other pharmacy programs.

Ethics Education for Nurses: Foundations for an Integrated Curriculum

BACKGROUND

Complexity in health care environments causes practice problems. Nurses bear responsibility for recognizing, addressing, and preventing ethical problems. Inadequacies in ethics education are partly to blame and contribute to nurse moral distress, attrition, and suboptimal care. Foundational curricula structures adequate for developing nurse moral agency are needed.

METHOD

The state of the science of ethics education in nursing was explored in-depth by a subcommittee of the American Nurses Association Ethics Advisory Board. A framework based in nursing goals was designed by nurse ethics experts to address ethics education across levels of curricula and practice. Rest's four-component model of moral behavior structures guidelines.

RESULTS

The model captures three facets of nurse moral agency: necessary characteristics, knowledge and skills, and motivation. A case is provided to illustrate its utility.

CONCLUSION

This framework provides the means to meet the profession's goal of preparing ethically competent nurses who will exercise moral agency. [J Nurs Educ. 2022;61(3):123-130.].

Reframing professional identity through navigating tensions during residency: A qualitative study

INTRODUCTION

Professional identity formation (PIF) is the internalization of characteristics, values, and norms of the medical profession. An individual's identity formation has both psychological and sociological influences. Social psychology may be useful to explore the interactions between the psychological and sociological aspects of PIF. In this study, we explored how resident physicians navigated tensions between professional ideals and the reality of medical practice to characterize PIF during residency training.

METHODS

Using constructivist grounded theory, the authors conducted 23 semi-structured interviews with internal medicine residents. Interview transcripts were processed through open coding and analytic memo writing. During data gathering and analysis, the authors utilized Social Cognitive Theory, specifically the bidirectional influence between person, behavior, and context, to analyze relationships among themes. Theoretical insights were refined through group discussion and constant comparison with newly collected data.

RESULTS

Residents described tensions experienced during residency between pre-existing ideals of "a good doctor" and the realities of medical practice, often challenging residents to reframe their ideals. The authors provide evidence for the presence of dynamic, bidirectional influences between identity (person), behavior, and environment (context), and demonstrate how PIF is informed by a complex interplay between these elements. The authors present two examples to demonstrate how residents reframed their ideals during residency training.

DISCUSSION

The complex bidirectional influences between person, behavior, and context, informed by SCT, helps illuminate the process of PIF in residency training. This study highlights the effects of the context of residency training on the development of residents' professional identities.

Facilitators of professional socialisation of learners in the clinical learning areas: A qualitative systematic review

Background

Professional socialisation is significant in nursing as it involves immersing learners in the profession so that they adopt the ethical values and conduct of the profession. It is in the clinical learning areas where learners observe and practise those values. The objective of the review was to explore the factors that promote professional socialisation of learners in the clinical learning areas. The problem is the inadequate support for learner nurses in the clinical learning areas. The South African community has lost trust in nurses and that was even acknowledged in the national nursing summit in 2011.

Objectives

To present a review of the factors that facilitate professional socialisation among undergraduate nursing learners.

Method

A systematic review was conducted on literature from 2008 to 2018. The literature search focused on factors that facilitate professional socialisation of learner nurses. A search of databases was conducted in CINAHL, MEDLINE, Google Scholar and Science Direct. The search focused on literature on professional socialisation of learner nurses published from 2008 to 2018. The search resulted in 3035 articles which were further reduced to 13 after further synthesis. Critical appraisal skills programme was used to assess the quality of the studies.

Results

Three main themes emerged. Learner factors, factors in the clinical learning areas and interpersonal factors were identified as the factors that facilitate professional socialisation of learners.

Conclusion

Learners should have self-motivation and be supported and assisted to develop a positive professional identity. The clinical learning environment should have effective communication that fosters learning. Professional nurses should act as exemplary role models so that learners can emulate the conduct and practice. The review brought to light that the professional socialisation of learners is affected by the learner factors, clinical learning areas and personal factors.

Everybody is able to reflect, or aren't they? Evaluating the development of medical professionalism via a longitudinal portfolio mentoring program from a student perspective

Introduction: Reflective competence is fundamental for responsible medical practice and must be systematically incorporated in medical training. To promote this, a longitudinal portfolio-based mentoring program was made mandatory at the Medical Faculty of the University of Tübingen in 2013. This study examines medical students' attitudes toward professional reflection and toward the program in general to draw conclusions about conditions as well as the needs-based design of the program. Method: In winter semester 2017/18, a retrospective questionnaire survey with free text fields was conducted (total sample: N=1.405; students S 1-9; response 37%; S 1-4 "Pre-clinic": n=231; S 5-9 "Clinic": n=241). Opinion trends of semester groups were identified through seven semi-structured interviews with semester speaker and peer tutors. Results: Differences in understanding and attitudes resulted in three positions: 1=approval, 2=ambivalence, 3=rejection. All three groups included individuals from pre-clinical and clinical settings with varying levels of experience. Prior experience and hidden curriculum influenced the position. Opinion trends confirmed the feedback. Conclusion: Although reflection appears in the National Competence-based Learning Objectives Catalogue for Medicine (NKLM), reflective competence is not regarded as equivalent to other study content. Motivation, commitment on the part of the mentors, and a trusting mentor-mentee relationship are effective. The flexibility of the portfolio in terms of content and methodology, as well as the curricular integration of the program are also beneficial.

The Role for Simulation in Professional Identity Formation in Medical Students

INTRODUCTION

Authentic clinical experiences and reflection are critical for medical student professional identity formation (PIF). Individualized learning plans and competency-based education accelerate time to graduation, thus creating more demand for students to gain PIF experiences early in medical education. This pilot study investigated student professional identity experiences related to participation in a clinical simulation during the first week of medical school.

METHODS

All first-year medical students at an academic health center participated in a clinically relevant simulation-based orientation to medical school (SOMS). Participants completed evaluation surveys measuring PIF-related experiences during the SOMS.

RESULTS

All participants completed the survey (N = 186). Students agreed that the SOMS helped them feel what it is like to be a doctor (90%) and transition to the role of student-physician (91%). Student comments about the SOMS-reflected PIF-related processes, such as building a sense of a community of practice among their peers in their roles as a healthcare team. Students also valued the opportunity to engage in reflection about their roles as student-physicians.

CONCLUSIONS

Simulation experiences can be used as a trigger for self-reflection to assist in medical student professional identity development as early as the first weeks of medical school. Simulation exercises may improve PIF and could further enhance medical student PIF by adding them longitudinally into the curriculum.

Clinical teachers' professional identity formation: an exploratory study using the 4S transition framework

OBJECTIVES

The aim of this study was to explore factors that may influence the formation of professional identity in clinical teachers, specifically during the transition period from practitioner to teacher.

METHODS

This was a descriptive qualitative study. We used Schlossberg's 4S framework to explore influential factors comprised of the following: situation, self, support, and strategies. This study was conducted in teaching hospitals of a relatively new private medical school in Bali, a province in Indonesia. The participants were 30 clinical teachers who were selected using a maximum variation sampling strategy based on length of work experience, gender, specific educational roles as coordinators, and clinical specialty. Data were derived from three focus-group discussions and 13 in-depth interviews. A thematic analysis method was used to analyse the data.

RESULTS

The thematic analysis revealed that 12 subthemes related to the 4S framework influenced the development of clinical teachers' identity. It was also shown that reflective ability and community of practice, which was included in the self and strategy factors, respectively, were the two most important factors during the transition period in the development of professional identity.

CONCLUSIONS

Factors, both within and outside the self, can either support or hinder the formation of professional identity in clinical teachers. We suggest that when faculty development programs are designed, these factors should be incorporated, such as including a community of practice as part of the formal faculty development programs and the development of a teaching portfolio that nurtures reflective practice.

The personal dimension of allied health professional identity: A scoping review in health sciences literature / Die persönliche Dimension der beruflichen Identität von Gesundheitsfachkräften: ein Scoping-Review in der gesundheitswissenschaftlichen Literatur

Introduction

With a shift in healthcare from diagnosis-centered to human- and interprofessional-centered work, allied health professionals (AHPs) may encounter dilemmas in daily work because of discrepancies between values of learned professional protocols and their personal values, the latter being a component of the personal dimension. The personal dimension can be defined as a set of personal components that have a substantial impact on professional identity. In this study, we aim to improve the understanding of the role played by the personal dimension, by answering the following research question: What is known about the personal dimension of the professional identity of AHPs in (allied) health literature?

Methods

In the scoping review, databases, CINAHL, ERIC, Medline, PubMed, and PsychINFO were searched for studies focusing on what is regarded as ‘the personal dimension of professional identity’ of AHPs in the health literature; 81 out of 815 articles were included and analyzed in this scoping review. A varying degree of attention for the personal dimension within the various allied health professions was observed.

Result

After analysis, we introduce the concept of four aspects in the personal dimension of AHPs. We explain how these aspects overlap to some degree and feed into each other. The first aspect encompasses characteristics like gender, age, nationality, and ethnicity. The second aspect consists of the life experiences of the professional. The third involves character traits related to resilience and virtues. The fourth aspect, worldview, is formed by the first three aspects and consists of the core beliefs and values of AHPs, paired with personal norms.

Discussion

These four aspects are visualized in a conceptual model that aims to make AHPs more aware of their own personal dimension, as well as the personal dimension of their colleagues intra- and interprofessionally. It is recommended that more research be carried out to examine how the personal dimension affects allied health practice.

Training undergraduate students for rapid on-site evaluation of fine needle aspiration cytology samples using a simulation based education activity

INTRODUCTION

Demand for rapid onsite evaluation (ROSE) of fine needle aspiration (FNA) cytology is rising and the role is increasingly being performed by non-medical cytologists. Undergraduate training for cytologists has traditionally focused on laboratory-based procedural activities and their theoretical underpinning, with minimal attention given to communication and other skills required to operate in an interprofessional setting. We evaluated the effectiveness and student reaction to a simulation-based education (SBE) exercise in ROSE designed to fill this void.

METHODS

We designed and evaluated a SBE exercise based on FNA ROSE across two tertiary institutions with 79 students. The exercise accurately reproduced the demands on cytologists operating as part of a multi-disciplinary team in a time- pressured environment.

FINDINGS

Pre- and post-simulation questionnaires indicated an improvement in technical knowledge related to the procedure. Students' perception of their competence and confidence in their role also improved significantly post simulation. Students uniformly found the exercise engaging and a valuable addition to their curriculum.

DISCUSSION

The simulation successfully provided a pseudo-clinical environment that highlighted the realities of practising technical and diagnostic tasks under time- pressure and interacting with other health professionals to provide an optimal patient outcome. The exercise is useful supplement to on-the-job training for ROSE.

Development of professionalism vignettes for the continuum of learners within a medical and nursing community of practice

BACKGROUND

It is challenging to develop professionalism curricula for all members of a medical community of practice. We collected and developed professionalism vignettes for an interactive professionalism curriculum around our institutional professionalism norms following social constructivist learning theory principles.

METHODS

Medical students, residents, physicians, nurses and research team members provided real-life professionalism vignettes. We collected stories about professionalism framed within the categories of our Faculty's code of conduct: honesty; confidentiality; respect; responsibility; and excellence. Altruism was from the Nursing Code of Ethics. Two expert committees anonymously rated and then discussed vignettes on their educational value and degree of unprofessional behaviour. Through consensus, the research team finalized vignette selection.

RESULTS

Eighty cases were submitted: 22 from another study; 20 from learners and nurses; and 30 from physicians; and eight from research team members. Two expert committees reviewed 53 and 42 vignettes, respectively. The final 18 were selected based upon: educational value; diversity in professionalism ratings; and representation of the professionalism categories.

CONCLUSION

Realistic and relevant professionalism vignettes can be systematically gathered from a community of practice and their representation of an institutional norm, educational value, and level of professional behaviour can be judged by experts with a high level of consensus.

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

BACKGROUND

Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF.

METHODS

A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data.

RESULTS

A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF.

DISCUSSION

PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.

A Pathway to Professional Identity Formation: Report of the 2020-2021 AACP Student Affairs Standing Committee

EXECUTIVE SUMMARY Professional identity formation (PIF) involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to "think, act and feel" like a member of that community. Professional identity influences how a professional perceives, explains, presents and conducts themselves. This report of the 2020-2021 AACP Student Affairs Standing Committee (SAC) describes the benefits of a strong professional identity, including its importance in advancing practice transformation. Responding to a recommendation from the 2019-2020 SAC, this report presents an illustrative and interpretative schema as an initial step towards describing a pharmacist's identity. However, the profession must further elucidate a universal and distinctive pharmacist identity, in order to better support pharmacists and learners in explaining and presenting the pharmacist's scope of practice and opportunities for practice change. Additionally, the report outlines recommendations for integrating intentional professional identity formation within professional curricula at colleges and schools of pharmacy. Although there is no standardized, single way to facilitate PIF in students, the report explores possibilities for meeting the student support and faculty development needs of an emerging new emphasis on PIF within the Academy.

'Doctors can't be doctors all of the time': a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media

OBJECTIVE

The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

DESIGN

A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

SETTING AND PARTICIPANTS

Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews.

RESULTS

Three overarching themes, each containing subthemes were reported. 'Staying in contact and up to date' outlines how social media platforms provide useful resources and illustrates the potential risks of social media. 'Online persona' considers how social media has contributed to changing the nature of interpersonal relationships. 'Towards standards and safety' raises the matter of how to protect patients, doctors and the medical profession.

CONCLUSION

Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.

Professional identity formation for underrepresented in medicine learners

Professional identity formation (PIF) is a dynamic developmental process by which individuals merge the knowledge and skills of clinical practice with the values and behaviors of their personal identity. For an individual physician, this process is a continuum which begins with their nascent interest in the field of medicine and extends through the end stages of a medical career. The impact of PIF has become a growing focus of medical education research in the last decade, and in that time, little attention has been paid to the influence underrepresented in medicine (UIM) identities may have on this fundamental process. Importantly, in discussions of how medical educators can support and encourage successful PIF, there is little discussion on the distinct challenges and different needs UIM learners may have. The purpose of this paper is to address the current literature around PIF for UIM trainees. This review explores various threats to identity formation, including identity fusion, stereotype threat, minority tax, implicit bias, and lack of mentorship. Evidence-based strategies to mitigate these challenges is also presented, including furthering institutional support for PIF, building the community of practice, supporting an inclusive environment, and developing PIF assessment tools. Through exploring these challenges and solutions, we are better able to address the needs of UIM trainees and physicians as they proceed in their PIF during their lifelong journey in medicine.

Transition to clinical practice during the COVID-19 pandemic: a qualitative study of young doctors' experiences in Brazil and Ireland

OBJECTIVES

To explore and compare the perspectives of junior doctors in Brazil and Ireland regarding transition and professional socialisation during the COVID-19 pandemic, with the purpose of identifying better ways to support doctors as they assume their new professional role.

DESIGN

27 semistructured interviews. Transcripts were analysed using qualitative thematic analysis. Cruess' framework of professional socialisation in medicine supported the interpretation of these data.

SETTING

Public health hospitals across four Brazilian states (Santa Catarina, São Paulo, Ceará, Paraíba) and County Cork in the South of Ireland.

PARTICIPANTS

Twenty-seven male and female medical junior doctors who had graduated between November 2019 and April 2020.

RESULTS

Fourteen Brazilian and 13 Irish junior doctors were interviewed for this study. Entry to clinical practice during the pandemic had a significant impact on factors influencing the professional socialisation of junior doctors. This impact was reflected across the following six thematic areas: lack of preparedness; disrupted trajectory of role adaptation; fewer opportunities for experiential learning; solidarity and isolation; altered interactions with patients; challenges to health and well-being.

CONCLUSIONS

Transition to clinical practice is an important stage in junior doctors' professional socialisation and identity formation. The COVID-19 pandemic created the opportunity for medical graduates to enter the workforce earlier than usual. Entering the workforce during this period created a lack of confidence among junior doctors concerning the boundaries of their new role and responsibilities, while simultaneously disrupting their social integration. Priorities to mitigate the impact of COVID-19 and future pandemics on this transition are presented.

Fostering the development of professional identity within healthcare education-interdisciplinary innovation

INTRODUCTION

Historical theories on development of professionalism are no longer sufficient in modern radiation therapy or radiography curricula with the focus moving from 'virtues-based professionalism' to 'professional identity formation'. Professional identity formation is a new concept that is described as a transformative journey from being a layperson to 'becoming' a professional. Knowledge, values, and behaviours are transformative and unique to each individual. The overall aim is to produce a consensus statement outlining evidence based programme initiatives to support healthcare students' professional identity formation.

METHODS

'Think tank' methodology was used for individual and final combined group reflective tasks to enable the creation of an evidenced based consensus statement. Participants discussed their personal views and beliefs regarding the process of Professional Identity Formation for teaching, learning, assessment, and evaluation. Discussions were recorded, transcribed, and analysed using thematic analysis from an interpretivist perspective. 'Think Tank' participants were asked to attend masterclasses to gain a greater understanding of professional identity formation from leading experts before the final combined 'Think Tanks'.

RESULTS

Faculty and students across all Disciplines (N22) within the school of medicine attended the 'Think Tank' sessions.

DISCUSSION

During each student's transformative process of professional identity formation, healthcare educators need to create evidence based pedagogic opportunities to support them. It is no longer sufficient to leave to chance within a 'hidden' or 'informal' curriculum. Professional identity is more than a set of learned behaviours that are assessed within the clinical environment.

CONCLUSION

The development of this consensus statement is an innovative educational strategy that will ultimately enhance the education of professionalism in the clinical environment for radiographers and radiation therapists. Through seeking an understanding of the educational needs of students and faculty, the multidisciplinary team were able to create a tailored approach to professional identity formation within the institution. This student-faculty partnership is unique and beneficial to all parties involved and is an effective method of seeking a shared understanding.

Learning how to work in an interprofessional environment: how students transition to allied health professionals working interprofessionally

Allied health professionals (AHPs) often work with other health professions to provide specialized support so that patients receive optimal care. Therefore, new graduate AHPs need to be able to engage collaboratively with various health professionals in the provision of health care services. This study examines new AHP graduates' experiences and reflections on the transition to working in an interprofessional environment. Participants were new graduates (n = 18) from different universities, working in a hospital context, from occupational therapy, speech pathology, social work, pharmacy, and physiotherapy. Qualitative data were collected via two semi-structured interviews conducted over 12 months. The data were analyzed using thematic analysis, with three key themes emerging: (a) The role of the work context, 2) Learning to work interprofessionally, and 3) Developing an interprofessional identity. We discuss the implications for universities and workplaces in enhancing interprofessional practice and learning opportunities among new graduates.

Perception of social media behaviour among medical students, residents and medical specialists

INTRODUCTION

Behaviour is visible in real-life events, but also on social media. While some national medical organizations have published social media guidelines, the number of studies on professional social media use in medical education is limited. This study aims to explore social media use among medical students, residents and medical specialists.

METHODS

An anonymous, online survey was sent to 3844 medical students at two Dutch medical schools, 828 residents and 426 medical specialists. Quantitative, descriptive data analysis regarding demographic data, yes/no questions and Likert scale questions were performed using SPSS. Qualitative data analysis was performed iteratively, independently by two researchers applying the principles of constant comparison, open and axial coding until consensus was reached.

RESULTS

Overall response rate was 24.8%. Facebook was most popular among medical students and residents; LinkedIn was most popular among medical specialists. Personal pictures and/or information about themselves on social media that were perceived as unprofessional were reported by 31.3% of students, 19.7% of residents and 4.1% of medical specialists. Information and pictures related to alcohol abuse, partying, clinical work or of a sexually suggestive character were considered inappropriate. Addressing colleagues about their unprofessional posts was perceived to be mainly dependent on the nature and hierarchy of the interprofessional relation.

DISCUSSION

There is a widespread perception that the presence of unprofessional information on social media among the participants and their colleagues is a common occurrence. Medical educators should create awareness of the risks of unprofessional (online) behaviour among healthcare professionals, as well as the necessity and ways of addressing colleagues in case of such lapses.

Validation of the professional identity questionnaire among medical students

BACKGROUND

Professionalism represents a cornerstone of the medical profession, prompting medical educators to actively develop instruments to measure professional identity formation among medical students. A quantitative approach to this problem has been lacking. Hence in this study, we investigate the validity and reliability of using Brown et al.'s [1986] Professional Identity Questionnaire (PIQ) to measure professional identity among medical students.

METHODS

We used the American Psychological Association's account of validity and reliability to examine the PIQ in terms of its internal structure, its relation to a validated motivation scale, its content, and its internal consistency. To this end, we performed two factor analyses, a Pearson's correlation test, an expert evaluation and measured Cronbach's alpha, respectively..

RESULTS

Factor analysis revealed two latent factors underlying the items of the PIQ. We found a negative to positive spectrum of Pearson's correlations corresponding to increasingly internal qualities of motivation. Experts unanimously rated four out of ten of the PIQ's items as relevant, reliability analysis yielded a Cronbach's alpha value of 0.82.

CONCLUSION

Despite poor ratings by experts in the field, these results illustrate the PIQ as a valid and reliable quantitative measure of medical students' professional identity; its two factors reflecting the measure of attached and detached attitudes towards the medical profession. Educators may use the instrument as a tool for monitoring PIF among their students, as well as for designing and evaluating their medical curriculum. Future research might build on the current findings by investigating other dimensions of the PIQ's validity, including response process validity, predictive validity and consequential validity.

Mechanisms involved in the formation of professional identity by medical students

BACKGROUND

Despite in-depth discussions regarding professional identity of doctors, there is still a gap in our understanding of how this professional identity actually evolves.

OBJECTIVE

To outline some major mechanisms involved in formation of medical students' professional identity.

METHODS

A qualitative study based on thematic analysis. 296 diary entries, written by eight medical students as part of the three-year course 'Becoming a Physician,' were reviewed. The course, conducted in small groups, gradually exposes students to the clinical field, and emphasizes awareness to marginalized populations, and interpersonal communication skills.

RESULTS

Following the social constructivist learning theory, where learners individually and socially construct meaning attributed to their experiences, we identified three major mechanisms based on students' written reflections. These include linking current experiences to past; comparing different types or aspects of knowledge, doctors or medicine; and future perspective taking.

CONCLUSIONS

This study sheds light on the possible mechanisms used by medical students in forming their professional identity prior to their clinical training. Knowing these mechanisms can help medical educators better understand and support their students in formation of their professional identities. Conducting reflective writing could serve as an effective tool for learners to comprehend the meanings of their experiences.

General practice is "different": a qualitative study of adaptation experiences of East Staffordshire general practice speciality trainees

BACKGROUND

Undergraduate medical education and foundation training are still largely hospital based. General practice trainees also spend nearly half of their speciality training in hospitals. Aims: To explore adaptation experiences of general practice speciality trainees throughout the training. Method: Semi-structured participant-observer interviews with 18 purposively selected trainees on the East Staffordshire vocational training scheme, observation, stakeholder discussions and concurrent inductive thematic analysis. Results: Undergraduate and early general practice experience during speciality training, general practice trainer role modelling and mastering core general practice skills, facilitated transition. An inclusive and supportive general practice environment, facilitating engagement with a community of practice involving peers, general practice trainers and vocational training programme fostered belongingness. A reduced sense of belongingness during hospital rotations impacted on training and work. Building bridging social connections, personal agency initiatives to bring general practice relevance into hospital training, signposting to general practice relevant duties and mastery of secondary care relevant competencies helped gain belongingness in hospital. While some international graduates required assistance in specific areas; overall, general practice trainees had optimistic views of their future. Conclusion: The main contribution of this study was to relate the adaptation experiences of trainees to learning and practice based on Wenger's communities of practice to enable a better understanding of how they can be influenced to enhance training.Abbreviations: CoP: Community of practice; GP: General practice; GPST: General practice speciality trainee; M: Male; F: Female; ST1: First-year GPST; ST2: Second-year GPST; ST3: Third-year GPST; UKG: UK-based primary medical qualification; IMG: Non-UK primary medical qualification.

Becoming a clinician: Trainee identity formation within the general practice supervisory relationship

OBJECTIVES

Becoming a clinician is a trajectory of identity formation in the context of supervised practice. This is a social process where the supervisory relationship is key. Therefore, to know how to support identity formation of clinical trainees, it is necessary to understand how this happens within the supervisory relationship. Our aim was to develop a conceptualisation of trainee identity formation within the general practice supervisory relationship to aid its support.

METHODS

We took a critical realist approach using case study design and 'cultural worlds' theory as a conceptual frame. Each case comprised a general practice trainee and supervisor pair. Our data were weekly audiorecordings of interactions between trainee, supervisor and a patient over 12 weeks augmented by post-interaction reflections and sequential interviews. We undertook interpretive analysis using dialogic methods focusing on the doing of language and the cultural discourses expressed.

RESULTS

We identified three social discourses centring on: clinical responsibility; ownership of clinical knowledge, and measures of trainee competency. Versions of these discourses defined four trainee-supervisor relational arrangements within which trainee and supervisor assumed reciprocal identities. We labelled these: junior learner and expert clinician; apprentice assistant and master coach, and lead clinician and advisor. We found a trajectory across these identity arrangements. Behind this trajectory was an invitation by the supervisor to the trainee into the social space of clinician and a readiness of the trainee to accept this invitation. Congruence in supervisor and trainee positioning was important.

CONCLUSIONS

In the supervisory relationship, trainee and supervisor adopted reciprocal identities. For trainees to progress to identity of 'lead clinician,' supervisors needed to invite their trainee into this space and vacate it themselves. Congruence between supervisor positioning of their trainee and trainee authorship of themselves was important and was aided by explicit dialogue and common purpose. We offer a model and language for trainees, supervisors and departments or schools to facilitate this.

'Challenges in experiential learning during transition to clinical practice: A comparative analysis of reflective writing assignments during general practice, paediatrics and psychiatry clerkships'

INTRODUCTION

This study explored the reflective writing (RW) of senior medical students across a co-ordinated reflection education programme in General Practice, Paediatrics and Psychiatry clerkships during their transition to clinical clerkships. The study compared RW themes from within and across three clerkships in order to understand the influence clerkships had on experiential learning and developing professional identity.

METHODS

All medical students in their penultimate year were invited to participate in the study. 135 reflection assignments were analysed. A qualitative thematic analysis of students' RW was performed. An inductive approach was used and data saturation was achieved.

RESULTS

Clerkship specific themes were the intimacy of the experience in General Practice, the powerlessness students felt and the challenge of delivering family centred care in Paediatrics and the sense of perceived risk in Psychiatry. Common themes across the three clerkships were of emotional struggles in developing a professional identity.

CONCLUSION

There is an educational need for developmental space for students during General Practice, greater focus on preparing students for relationship building during Paediatrics and addressing stigma and personal safety issues in students during the Psychiatry clerkships. Across clerkships there is a need for better use of evidence based pedagogies to support emotional development.

"It is this very knowledge that makes us doctors": an applied thematic analysis of how medical students perceive the relevance of biomedical science knowledge to clinical medicine

BACKGROUND

Intensive study of the biomedical sciences remains a core component of undergraduate medical education with medical students often completing up to 2 years of biomedical science training prior to entering clerkships. While it is generally accepted that biomedical science knowledge is essential for clinical practice because it forms the basis of clinical reasoning and decision-making, whether medical students perceive an expanded role for their biomedical science knowledge remains to be examined.

METHODS

We conducted a qualitative research study to explore how medical students in the first clerkship year perceived the relevance of biomedical science knowledge to clinical medicine during this pivotal time as they begin their transition from students to physicians. To identify previously unidentified perspectives and insights, we asked students to write brief essays in response to the prompt: How is biomedical science knowledge relevant to clinical medicine? Ten codes and four themes were interpreted through an applied thematic analysis of students' essays.

RESULTS

Analysis of students' essays revealed novel perspectives previously unidentified by survey studies and focus groups. Specifically, students perceived their biomedical science knowledge as contributory to the development of adaptive expertise and professional identity formation, both viewed as essential developmental milestones for medical students.

CONCLUSIONS

The results of this study have important implications for ongoing curricular reform efforts to improve the structure, content, delivery, and assessment of the undergraduate medical curriculum. Identifying the explicit and tacit elements of the formal, informal, and hidden curriculum that enable biomedical science knowledge to contribute to the development of adaptive expertise and professional identity formation will enable the purposeful design of innovations to support the acquisition of these critical educational outcomes.

Report of the 2019-2020 AACP Student Affairs Standing Committee

The 2019-2020 Student Affairs Standing Committee addressed charges related to professional identity formation (PIF) in order to set direction and propose action steps consistent with Priority #3.4 of the AACP Strategic Plan, which states "Academic-practice partnerships and pharmacist-involved practice models that lead to the progress of Interprofessional Practice (IPP) are evident and promoted at all colleges and schools of pharmacy." To this end, the committee was charged to 1) outline key elements of PIF, 2) explore the relationship between formal curricular learning activities and co- or extra-curricular activities in supporting PIF, 3) determine the degree to which there is evidence that strong PIF is embedded in student pharmacists' educational experience, and 4) define strategies and draft an action plan for AACP's role in advancing efforts of schools to establish strong PIF in pharmacy graduates. This report describes work of the committee in exploring PIF and provides resources and background information relative to the charges. The committee offers several suggestions and recommendations for both immediate and long-term action by AACP and members to achieve goals related to integrating PIF into pharmacy education. The committee proposes a policy statement relative to the committee charges. Furthermore, the report calls upon the profession to develop a unified identity and incorporate support for PIF into pharmacy education, training, and practice.

Clinical Teachers' Perceptions of Their Role in Professional Identity Formation

PURPOSE

A fundamental goal of medical education is supporting learners in forming a professional identity. While it is known that learners perceive clinical teachers to be critically important in this process, the latter's perspective is unknown. This study sought to understand how clinical teachers perceive their influence on the professional identity formation of learners.

METHOD

In 2017, a research assistant conducted 16 semistructured interviews of clinical teachers from 8 specialties at McGill University. The research assistant audiorecorded and subsequently transcribed interviews for analysis. Following principles of qualitative description, the research team developed a coding scheme using both inductive codes (from the words of the participants) and deductive codes (based on the literature and the theory of communities of practice). Through a cross-case analysis, the team then identified salient themes.

RESULTS

Participants struggled to describe their influence on learners' professional identity without first being prompted to focus on their own identity and its formation. Once prompted, clinical teachers reported viewing their personal and professional identities as integrated and believed that caring for patients was integral to forming their professional identity. They identified explicit role modeling, engaging in difficult conversations, and providing graded autonomy as ways in which they could influence the identity development of learners. However, they had difficulty discerning the magnitude of their influence.

CONCLUSIONS

This study was the first to explore professional identity formation from the perspective of clinical teachers. The 2010 Carnegie Foundation report called for an increased focus on professional identity formation. Giving clinical teachers the space and guidance to reflect on this process, helping them make the implicit explicit, and supporting them in using their own experiences as learners to inform their teaching appear to be critical steps in achieving this goal.

Pedagogical practices that influence professional identity formation in baccalaureate nursing education: A scoping review

OBJECTIVES

The purpose of this review was to identify pedagogical practices that contribute to professional identity formation in undergraduate nursing education and to map the components of professional identity described within these practices.

DESIGN

A scoping review using a six-stage methodological framework was used to capture a range of evidence describing how professional identity has been conceptualized and integrated into nursing curriculum.

DATA SOURCES

Databases searched included: Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® 1946-Present, EBSCO CINAHL (1981 to present), OVID PsycINFO (1806 to Present), ProQuest ERIC, ASSIA, and Sociological Abstracts. Additional studies were identified by scanning the reference lists of relevant articles.

REVIEW METHODS

The study team collaboratively designed the data charting table and two coauthors independently screened the studies using Covidence software. Qualitative content analysis was used to categorize learning outcomes into five components of professional identity that were associated with pedagogical practices identified in the studies.

RESULTS

A total of 114 peer-reviewed journal articles were initially charted. Articles were categorized as intervention studies (46, 40%), perspective studies (40, 35%), theoretical papers (17, 15%), or reviews (11, 10%). To ensure feasibility in collating and reporting the results, the review focused on the 46 empirical intervention studies that described associations between pedagogical practices and professional identity formation learning outcomes for students.

CONCLUSIONS

This scoping review illustrates the range of contexts in which nursing students learn, the multidimensional nature of identity formation, as well as the breadth of pedagogical practices and learning outcomes that guide course design. The results can be used to inform future curriculum planning and to identify focused research questions to extend our understanding of evidence-based teaching practices supporting professional identity formation.

Defining the Digital Self: A Qualitative Study to Explore the Digital Component of Professional Identity in the Health Professions

Background

Recent medical education literature pertaining to professional identity development fails to reflect the impact social media has on professional identity theory. Social media is transforming the field of medicine, as the web-based medium is now an avenue for professional development and socialization for medical students and residents. Research regarding identity development in social media has been primarily confined to electronic professionalism through best practice guidelines. However, this neglects other potential aspects pertinent to digital identity that have not yet been explored.

Objective

This study aims to define the properties and development of the digital self and its interactions with the current professional identity development theory.

Methods

A qualitative study was conducted using thematic analysis. A total of 17 participants who are social media education and knowledge translation experts were interviewed. The initial participants were from emergency medicine, and a snowball sampling method was used following their respective web-based semistructured interviews to enable global recruitment of other participants from interprofessional disciplines. The research team consisted of a diverse group of researchers including one current social media knowledge translation physician clinician educator, one postdoctoral researcher who is regularly engaged in social media knowledge translation, and 3 nonphysician research assistants who are not social media users. Half of the team conducted the initial coding and analysis, whereas the other 2 investigators audited the procedures followed.

Results

A total of 4 themes were identified that pertain to digital identity. In the first theme, origins of initial digital identity formation were found to be derived from perceived needs in professional roles (eg, as a medical student or resident). The second theme consisted of the cultivation of digital identity, in which digital identity was developed parallel to professional identity. The third theme that emerged was the management between the professional and personal components of digital identity. Participants initially preferred keeping these components completely separate; however, attempts to do so were inadequate while the integration of both components provided benefits. The fourth theme was the management of real-life identity and digital identity. Participants preferred real-life identity to be wholly represented on the web. Instances of misalignment resulted in identity conflict, compromising one of the identities.

Conclusions

Social media introduces new features to professional identity in the digital world. The formation of digital identity, its development, and reconciliation with other identities were features captured in our analysis. The virtual component of professional identity must not be neglected but instead further explored, as educational institutions continue to give more importance to navigating professional identity development.

Opportunities and challenges for physical rehabilitation with indigenous populations

Indigenous peoples in colonised countries internationally experience a disproportionately high burden of disease and disability. The impact of many of these conditions, such as musculoskeletal pain, can be ameliorated by participating in physical rehabilitation. However, access by Indigenous peoples to physical rehabilitation is low. Overcoming barriers for Indigenous peoples to access high-quality, effective, culturally secure physical rehabilitation should be a priority. Physical rehabilitation outcomes for Indigenous peoples can be enhanced by addressing health system, health service, and individual clinician-level considerations. System-level changes include a greater commitment to cultural security, improving the funding of physical rehabilitation to Indigenous communities, building the Indigenous physical rehabilitation workforce, and developing and using Indigenous-identified indicators in quality improvement. At the health service level, physical rehabilitation should be based within Indigenous health services, Indigenous people should be employed as physical rehabilitation professionals or in allied roles, and cultural training and support provided to the existing physical rehabilitation workforce. For clinicians, a focus on cultural development and the quality of communication is needed. Indigenous ill-health is complex and includes societal and social influences. These recommendations offer practical guidance toward fair, reasonable, and equitable physical rehabilitation outcomes for Indigenous peoples.

WHIRL Study: Workplace Health Interprofessional Learning in the Construction Industry

Interprofessional learning (IPL) is essential to prepare healthcare trainees as the future public health workforce. WHIRL (Workplace Health InteRprofessional Learning) was an innovative IPL intervention that engaged volunteer healthcare trainees (n = 20) in multi-professional teams to deliver health checks (n = 464), including tailored advice and signposting, to employees in the UK construction industry (across 21 events, 16 sites, 10 organisations) as part of an ongoing research programme called Test@Work. Volunteers undertook a four-part training and support package of trainer-led education, observations of practice, self-directed learning and clinical supervision, together with peer mentoring. In a one-group post-test only design, IPL outcomes were measured using the Inventory of Reflective Vignette-Interprofessional Learning (IRV-IPL), and the psychometric properties of the IRV-IPL tool were tested. WHIRL demonstrably improved healthcare trainees' interprofessional skills in all five areas of collaboration, coordination, cooperation, communication, and commendation. The IRV-IPL tool was found to be a valid and reliable measure of interprofessional competencies across three scenarios; before and after health promotion activities, and as a predictor of future health promotion competence. This industry-based workplace IPL programme resulted in the attainment of health check competencies and bridged the gap between research, education and clinical practice.