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

Abstract

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

Keywords: diversity & inclusion; education; professional identity formation; professionalism; socialization.

Figure 1

The process of professional identity formation in medicine. A revised schematic representation of professional identity formation, indicating that individuals enter the process of socialization with unique values, beliefs and behaviors that are informed by their pre-existing identities, and develop evolving personal and professional identities through a continuous process of engagement with and critical examination of the norms & values of the profession (upper portion). The process of social engagement into medicine’s communities of practice begins with selection into the program and results in learners perceiving variable degrees of belonging to those communities (lower portion). Adapted from Cruess et al. (1).

Figure 2

Factors influencing socialization into medicine’s communities of practice. A revised schematic representation of the multiple factors involved in the process of socialization in medicine upon which medical education can impact. The large center box surrounded by the dotted line, which includes diverse role models and mentors and experiential learning, indicates their importance to this process. The large circle surrounding the entire figure highlights the importance of the real world (including its sociopolitical context), the culture of the education system and the impact of the healthcare system within which individuals must both learn and practice, on the process of socialization. Adapted from Cruess et al. (1).

Figure 3

Learner experiences and reactions during the process of socialization. A revised schematic representation of the common experiences of learners (upper portion) and frequently expressed reactions and emotions in relation to those experiences (lower portion) during the socialization process. These experiences and associated reactions significantly impact upon perceptions of competence and belonging or exclusion, as determined by self and by others. In turn, these have an important influence on evolving personal and professional identities and their formation. Adapted from Cruess et al. (1).