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

Abstract

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.

Keywords: Postgraduate medical education; Professional identity formation; Qualitative research; Social cognitive theory.

Fig. 1

Schematic of the bidirectional influence between identity, behavior, and context, adapted from Bandura’s Social Cognitive Theory. Bandura’s “reciprocal determinism” described that behavior, personal factors, and environmental influences operated interactively as determinants of one another. We have adapted this model, focusing on “identity” as a summarization of “personal factors” to represent the process of professional identity formation during residency as a complex, dynamic bidirectional interaction between identity, behavior, and context

Fig. 2

Schematic of professional identity formation as the bidirectional influences between identity, behavior, and context in reframing “A good doctor convinces patients to accept [his/her] advice.” Arrows represent directional influences between identity, behavior, and context. Associated bulleted examples were identified by the resident as factors in reframing his ideal of “a good doctor convinces patients to accept [his/her] advice” to “a good doctor is a consultant; patients make decisions for themselves.” These bulleted examples are associated with the adjacent arrow

Fig. 3

Schematic of professional identity formation as the bidirectional influences between identity, behavior, and context in reframing “A good doctor knows everything.” Arrows represent directional influences between identity, behavior, and context. Associated bulleted examples were identified by the resident as factors in reframing the ideal of “a good doctor knows everything” to “a good doctor knows his/her limitations and asks for help.” These bulleted examples are associated with the adjacent arrow