The Ebb and Flow of Identity Formation and Competence Development in Sub-specialty Residents: Study of a Continuity Training Setting

Abstract

Background Professional identity and competence development are evolving processes, shaped by clinical experiences and socialization in the workplace. The purpose of this study was to investigate the simultaneous development of professional identify formation and competence in a sub-specialty training program. Methods The study was conducted in a General Internal Medicine sub-specialty (PGY-4 and PGY-5) continuity training setting, at an academic health sciences center, in Canada. Participants included: current residents, recent graduates, attending physicians and administrative assistants. Data was collected from 2017–2018. A constructivist grounded theory approach was used to analyze anonymized focus group and individual interviews. Results The study identified the following: 1) learning activities that support professional identity formation in advanced residents; 2) the relationship between professional identity formation and competencies; 3) the role of administrative assistants and continuity training supervisors in supporting professional identity formation; and 4) a set of invisible learning experiences that occurred as a result of assumptions made by residents about expectations of training and expectations of patient care. Although, there was limited data available on the latter, findings suggested that invisible learning experiences may adversely impact residents’ functioning as independent physicians. Conclusions Residents’ professional identities continue to evolve with increasing competency requirements during training. Training programs, for sub-specialty residents, must balance granting of independence with supporting ongoing professional identity formation. They must also be explicit about what constitutes healthy patient care expectations and how practicing physicians manage these expectations.

An act of performance: Exploring residents’ decision‐making processes to seek help

“…Our study suggests that while supervisors seemed to be the gatekeepers of the medical community, other members within the health care team might serve as guides providing practical knowledge and enculturating them into the clinical workplace 11,12,17,20,26,48,49 . Compared to supervisors, other co‐workers afforded the ‘know‐how’ of and guided them through the local norms and practices of the particular workplace 17,20,50 . This knowledge is an essential part of socialisation into the health care team 51 as it helped residents to understand and secure their position as an accepted, legitimate team member.…”

“…Future research should address how to foster learning environments in which the health care team's shared purpose of safe patient care trumps residents’ concerns of negative assessments. We encourage other researchers to consider adopting a perspective that views all health care team members to influence workplace learning interactions 17,20,21,26,50 . Hereto, sociocultural theories can offer guidance 9‐12 .…”