Medical students are not blank slates: Positionality and curriculum interact to develop professional identity

Abstract

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“I Can Understand Where They’re Coming From”: How Clinicians’ Disability Experiences Shape Their Interaction With Clients

“…In their reflection on the formation of medical students’ professional identities, Wong and Trollope-Kumar (2014) list multiple factors that play a role in the process of identity formation, including prior experiences, role models, curriculum, patient encounters, and societal expectations. During their training, clinicians with disabilities experience institutional pressure to conform to a professional identity (Coulehan, 2005; Fergus et al, 2018) detached from their preexisting identity that might be informed by their disability experience. As a result, they often experience a disconnect between their personal and professional identities—as they progress through their training, students often express anxiety about losing aspects of their preexisting identities in the process (Wong & Trollope-Kumar, 2014).…”

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

“…Factors that influence professional behaviour include mentorship and role-modeling 81,82 , prevailing codes of conduct 67 and social and cultural concepts of the "good physician" 82 . Manifesting such professional values and behaviours can further foster professional identity 2,5,64,[75][76][77]80,83 , through which medical students identify as a member of the profession 67,84,85 and aim to embody its roles and responsibilities 2,6,8,9,62,63,65,66,68,69,[72][73][74][75]80,83,[85][86][87][88][89][90][91][92][93][94][95][96] .…”

“…• Negative portrayal of profession by mainstream media or glamorization of traits such as cynicism 68,99,124 • Lack of opportunities or expectations to assume patient care responsibilities • Open and supportive discussions with faculty and peers 65,73,74,81,129,131 • Access to appropriate mentorship, advising and role modeling 72,128 • Guided reflective opportunities with feedback 7,10 • Mismatch between personality and values with those of team members or patients 72,82,91,100 • Challenging relationships with team member, patients or peers 88 • Hierarchical structures in clinical environment deterring students from seeking help or speaking up 7,9,72,101 • No mentors or role models 72,128 Individual Ring • Show desire and sustain motivation to gain competence and engage in life-long learning 88,101 • Attend to emotions and engage in critical thinking and reflection • Access to support systems including mentors and role models 5,69,71,80,93,121 • Exposure to challenging clinical experiences such as death and suffering 118 • Outlets for emotional and/or creative expression 89,92,119 • Tension between existing personal identity and aspiring professional identity 7,65,81 • Uncertainty or lack of confidence in clinical interactions that cast doubt on ability to fu...…”

“…This process is individualized, non-linear and heavily influenced by formal 5,98,99 , informal and hidden curricula 4,72,98 . As students move from early peripheral involvement 8,72,100 to assuming a more central role in the community of practice with increasing seniority 69,72,98,101 , intrinsic characteristics, values, beliefs, behaviours and biases are re-examined 62,63,69,80,[93][94][95][96] , refined 9,73,100 , re-aligned and integrated. Socialization is facilitated by formal ceremonies and seminal experiences such as White Coat Ceremony and cadaveric dissections 62,69 , and promoted when experiencing patient care 2,6,62,69,76,83,102 , managing clinical responsibilities 8,72,100 , working long hours 5 and reflecting upon experiences and clinical identities 5,69,71,83,96,99 .…”

Creation and utility of ‘Boston Minority Genetic Counselors’

“…In addition to the mechanism of inclusion and support enhancement proposed here, other inclusion initiatives should be assessed and explored. For example, formal curricular changes that value students’ life experiences, promote student mental health and wellness, and ensure access to multiple mentorship opportunities for minoritized students are strategies that have been proposed by medical students of minority backgrounds (Fergus, Teale, Sivapragasam, Mesina, & Stergiopoulos, 2018). Such ideas should be assessed for feasibility and utility in genetic counseling training.…”