Identity Transformation in Medical Students

Abstract

This paper reviews the literature on the impact of medical school on personal development and consolidation of core identity. The limited literature relies on reports from medical students' journaling exercises, discussion groups, post-graduation surveys, and repeated personality testing. We review forces acting on medical students, with potential transforming effects. These forces include high external expectations and internal fear of superficial knowledge and skills, entry into the culture of medicine with its insider jargon and hierarchy, high academic workload, and the emotional burdens of confronting cadavers and death as well as bearing witness to patients' suffering. Potential developmental delay, emergence of substance abuse and hedonic acting out, cynicism, and loss of individual core values are possible consequences. Protections against these adverse outcomes include identification of strong mentors and role models, developing post-conventional morality and relativistic thinking, finding healthy coping strategies such as peer support, and remaining intellectually creative and personally reflective.

Professional Identity in Medical Students: Pedagogical Challenges to Medical Education

“…Strong, positive role models have been identified as key to the psychological well-being of medical students, and students must form relationships with them in order to succeed. 34 Role models are not just more senior doctors but might also be "students, residents, faculty members, nurses, and other team members". 34(p47) The changing world in which contemporary medical students live, learn, and will work has, however, raised some concerns about the continued efficacy of role-modelling as a pedagogical tool.…”

“…31,47 They can also suffer from low confidence about their abilities, a concern that may increase as others around them-for example patients and nurses-increasingly identify them as doctors. [33][34]48 Students who participated in one recent study reported that negative interactions with other professionals, particularly nurses, could leave them feeling stigmatised. 31 While fear of failure can be a source of stress for medical students, some work suggests that actual crises of identity, instances where a student's actions do not match who they are, can offer opportunities for positive professional identity by demonstrating both need and opportunity to change.…”

“…34 Such challenges may lead some students to unintentionally nurture aspects of "cynicism, arrogance, and disenchantment with medical practice". 34(p50) In addition to an exemplary program of basic and clinical sciences students require a well integrated (scaffolded) curricula which incorporates a solid blending of humanities, self-reflective and creative work facilitated in a variety of learning settings such as Problem Based Learning groups, small group work and the use of mentors and preceptors has been proposed by authors in the past and still holds merits today.…”

Moral Distress in Medical Education and Training

“…Strong mentoring has powerful effect on the level of empathy observed among medical students and may be an important protection against the development of cynicism. [12][13][14] The apprenticeship model also allows for negative acculturation through what is often referred to as the hidden curriculum. This pernicious dimension to medical training has been blamed for the persistence of undesirable behaviors among physicians, as well as for a collective de-professionalization perceived by some within and without medicine.…”

Professionals’ Experiences of the Relations between Personal History and Professional Role

“…A professional role consists of experiences based on working background, education, career [5–9], and personal experiences [5, 7]. At the same time, the construction of a personal self is closely related to one's history, family background, and life experiences, including the narrative organization of everyday life and specific events that are memorable to them [10, 11].…”