Do you remember the first time you felt like a real physician? Forming a professional identity—thinking, acting and feeling like a physician—is a crucial part of the medical education process, but not an easy one to define, teach or measure.
As part of a special meeting last month at the University of Texas at Austin, faculty from the 11 schools in the AMA’s Accelerating Change in Medical Education initiative met with AMA leaders and University of Texas educators to discuss forward-thinking curricula that will prepare future physicians for an increasingly complex health care system. Professional identity formation was one of the primary topics of discussion.
Professionalism and professional identity are not synonymous. Professional identity formation is a process, according to a recent article in Academic Medicine. Physicians’ behavior is guided by the socially negotiated ideal of the “good physician.” Medical students must learn to play the role of physician, acquire the language of medicine, understand the hierarchy of the profession and its power structures, and learn how to live with ambiguity, which happens through socialization and experiences.
Incorporating this journey of self-discovery into medical education proves challenging. Some experts suggest programs should be explicit about the nature of professional identity formation, making students aware of the concept to engage them as active participants in the process. Another suggestion is to redesign the medical school admissions process, seeking out individuals who already possess the attributes of the “good physician”—caring, compassionate individuals who are good listeners and have refined communications skills.
The University of Texas is seeking to integrate professional identity formation into its curriculum, beginning with early learners who are interested in medicine but aren’t yet fully engaged as professionals. In this level, learners are mostly passive observers and not yet in medical school. Coursework includes team-based learning dilemmas, presented as clinical problems in ethical situations. In this stage, solving problems is a main objective.
In the next phase, learners are developing their identities. At this point, the learner wants to provide care but does not take primary responsibility for the care. This level would be the medical student early in his or her clerkship rotations. Learners in this phase write reflective essays and take humanities and ethics courses to bridge the premedical, preclinical experiences with clinical experiences.
Finally, phase three would be a trainee who understands the professional role and gravity of being a responsible health care professional. In this phase, the learner has a sense of duty—this daily practice of humanism is the goal for the graduating medical student. At this point, the learner seeks volunteer opportunities and likely engages in career mentorship.
It’s a fluid, complicated process, with major changes in a learner’s identity often taking place following seminal events, such as the first contact with a cadaver or the death of a patient. This process will change, just as medical education is changing.
The “current emphasis on team health care [for instance,] will require an alteration in the professional identity of physicians,” the physician authors of the Academic Medicine article wrote. “The professional identity of the future must be more open to the expertise of others in order to be appropriate to the more inclusive and globalized world.”
Tell us: At what point in your medical education did you first start to think, feel and act as a physician? Share your thoughts in a comment below or on the AMA Facebook page.
