Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis

Abstract

OBJECTIVE Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions.METHODS The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles. RESULTSA total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles.CONCLUSION The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socioeconomic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.Professional identity formation (PIF) in medicine focuses attention on the career-long process of becoming a clinician. 1,2 PIF can be thought of as a double helix: the individual and the profession form parallel strands that become intertwined. Each strand must bend in order to accommodate the other; however, this burden of bending and changing to accommodate seems to fall more acutely on the individual strand, with the profession's strand remaining more fixed. PIF frequently involves experimentation, change and uncertainty, and ideally results in the successful reconciliation of conflicting ideals, values and roles. Although successful formation of a professional identity has been linked to career success 3 and creativity at work, 4 a mismatch between an individual's internal bearings and the roles and expectations of the profession can create anxiety, frustration and feelings of inadequacy, and can result in the individual leaving the profession. 5 The role of culture, race, socioeconomic status and gender might be expected to be critical components of the individual strand, and could prove to be important confounders in the study of this complex process.We set out to gain an understanding of the current state of the PIF literature in medicine by conducting a scoping review and metasynthesis of the literature across three of the helping professions (medicine, nursing and counselling/ p...

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