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. 2024 Nov 11;13(1):540-552.
doi: 10.5334/pme.1549. eCollection 2024.

Identity Work: A Qualitative Study of Residents' Experiences Navigating Identity Struggles

Adam P Sawatsky  1 , Caroline L Matchett  2 , Frederic W Hafferty  3 , Sayra Cristancho  4 , William E Bynum  5 , Jonathan S Ilgen  6 , Lara Varpio  7
Affiliations

Identity Work: A Qualitative Study of Residents' Experiences Navigating Identity Struggles

Adam P Sawatsky et al. Perspect Med Educ. .

Abstract

Introduction: Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training.

Method: We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles.

Results: We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance.

Discussion: This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure illustrates Rich picture describing a resident’s identity struggle in the emergency department
Figure 1
Rich picture example (Interview 5).
See this image and copyright information in PMC

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