Professional identity is defined as the internalized values of a profession as a representation of the self, and is formed through a process of socialization, or how a student learns to become a member of their profession. As medical students transition to residency, new social environments, clinical experiences, and curricular emphases can impact how they identify as professionals. The purpose of this thesis is to investigate how professional identity formation (PIF) occurs in surgical residents over their first year of postgraduate training. Twenty-four surgical residents were interviewed at the start of their postgraduate training. Questions explored participants’ understanding of what it means to be a medical professional. Six months later, residents completed a follow-up interview to investigate how their experiences in their training programs have influenced their professional identity. Thematic analysis was utilized to identify themes in responses. Central to participants’ understanding of their professional identity was their relationships with patients and the public, other healthcare professionals, their training program, and their own expectations for themselves. After six months, less emphasis was placed on the influence of the public and one’s own personal expectations. Factors such as patient encounters, a team-based work environment, time constraints and high volumes of work, and being prepared for all situations were all identified as crucial to professional development. It is important for medical education programs to consider their impact on the development of students, especially regarding the transition to competency-based medical education (CBME) that is currently occurring in medical education. This change could impact the social environment and formal curricula of these programs. The explicit study of PIF is important not only for students as they develop into independent health professionals, but also to ensure the proper care of the patients these surgeons will be working with. / Thesis / Master of Science (MSc)

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Recent literature on professional identity formation (PIF) conceptualizes the developmental process into stage theories that remove critical context. This study employed a longitudinal approach to PIF that explored the processes through which professional identity is formed in second (MS2) and third (MS3) year medical students and how their perceptions of professionalism transformed and influenced their PIF. Methods: Nine medical students (n=9) from Indiana University School of Medicine completed this study spanning MS2 and MS3. Participants completed three semi-structured interviews and submitted 10 audio diaries at two-month intervals between interviews. Participants also completed the Professionalism Assessment Tool (PAT) at the beginning of MS2 (PAT1) and end of MS3 (PAT2). Interviews and audio diaries were analyzed using the constant comparative approach and a Wilcoxon signed-rank test was used to determine significant differences between mean domain scores of PAT1 and PAT2. Results: This study found several processes of PIF within five themes: Exploring Self in Medicine, Connecting to Image of Medicine, Embodying Role, Internalizing Values, and Exploring Specialty Choice. Processes of participating in patient care and selecting a specialty have the most profound impact on PIF and resulted in medical students feeling like members of the medical community. Analyses revealed participants’ perceptions of professionalism became more complex with clinical experiences and their perceptions of their ability to enact those behaviors transformed across the study period. Furthermore, the participants’ perceptions of professionalism set the foundation for the values they desired to demonstrate as part of their professional identities. Conclusions: This study presents a cohesive picture of how PIF occurs across MS2 and MS3 and how professionalism influences this important developmental process. These results indicate PIF is best cultivated within a medical curriculum where students are able to utilize processes to foster its development. Since professionalism serves as an important foundation to professional identity and a comprehensive understanding is needed for medical students to appreciate a physician’s role in society, the curriculum must be structured in a way to promote a complex, reflective understanding of professionalism that is based on values, actions, and who one wants to be as a physician.

The study explored the learning experiences of first-year resident physicians during the first year of graduate medical education. The experiences of four intern physicians in the first year of residency training at an urban academic health system provided the site for the research. An exploratory case study research design was employed to examine the learning experiences of these new physicians. A qualitative approach was used to analyze data from interviews and ethnographic observations. The findings of this research study provide evidence surrounding how and what these physician trainees learned regarding professionalism during the first year of residency training. The findings indicate these first-year resident physicians experienced significant learning related to professionalism through incidental learning in the clinical environment, particularly from role models and the hidden curriculum. The interns learned both positive and negative professional behaviors from attending physicians. The findings illustrate the increases and decreases of confidence due to the development of clinical skills, increase in responsibilities, and increase in autonomy experienced by all four participants across the first year of residency training. Additionally, the findings highlight the important role of critical incidents, particularly memorable patient encounters, as potentially transformative learning experiences for these interns. Finally, the findings enumerate the pervasive influence of the hidden curriculum of graduate medical education on what these new physicians learned about professionalism, particularly the unprofessional social norms transmitted through attending physicians and others within the context of clinical learning. The findings of the research study support the conclusions that a) incidental learning experiences during the first year of residency education directly influenced how and what these new physicians learned regarding professionalism; b) these intern physicians experienced non-transformative learning during the first year of residency, but critical reflection and critical self-reflection after critical incidents did hold the potential to result in learning that was transformative; and c) the ubiquitous nature of the hidden curriculum significantly impacted what these first-year residents learned about professionalism. These conclusions contribute to the literature related to the development of professionalism in the new physician and the power of the hidden curriculum in medical education to influence professional identity development. Implications for medical educators and recommendations for future research are also identified.

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Indiana University-Purdue University Indianapolis (IUPUI) / Medical education researchers have long been interested in understanding medical professional identity formation and its implications for the healthcare system. Various theories have been proposed to explain identity formation. Among them, Foucault’s discourse theory maintains that it is the discourse of medicine that constitutes medical professional identities. This study deployed a Foucauldian archaeological methodology to analyze the structure of modern medical discourse and establish links between discourse and professional identity formation in medical students. A total of forty-six medical students at Indiana University School of Medicine participated in either individual or focus group interviews. Direct observation of the clinical and educational settings was also performed, which resulted in additional textual data in the form of fieldnotes. Archaeological analysis of discourse was undertaken in three levels of the statements, the discursive elements, and the discursive rules and relations. Results entailed a detailed depiction of the structure of medical discourse including discursive objects and modes of enunciation, discursive concepts, and theoretical strategies related to each object. Discursive objects are things that are talked about in modern medical discourse. This study identified four discursive objects as disease and treatment, the doctor, the human body, and the sick person. Modes of enunciation are the different ways in which people talk about objects of medicine, whereas concepts consist of the notions people draw from when talking about objects of medicine. Theoretical strategies indicate certain positions that people take in relation to the objects of medicine. Rules of formation and conditions of existence for each discursive element were also established. Since Identities are entrenched through language and interaction, developing a systematic understanding of the structure of medical discourse will shed new light on medical professional identity formation. Results of this study also have profound implications for teaching professionalism and medical humanities in medical curricula. Furthermore, as a research methodology used for the first time in medical education, archaeology not only opens new territories to be explored by future research, it also provides an entirely new way to look at them.

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En 2007, une étude divulgue la corrélation entre les aptitudes communicationnelles des futurs médecins et les probabilités de plaintes au cours de leur carrière. En 2021, la communication médecin-patient se manifeste d’ailleurs comme le principal élément sous-jacent aux plaintes envers les médecins. Avec cette problématique, il est question d’interroger les statistiques croissantes, notamment en s’intéressant à la place de l’enseignement dans la formation de l’identité professionnelle des futurs médecins. Ce mémoire a pour objectif de questionner le rôle de communicateur tel qu’établi par le référentiel de compétences CanMEDS. Pour y arriver, douze entretiens avec des acteurs de l’École de médecine de l’Université de Montréal à différents stades de leur professionnalisation ont été tenus. De l’analyse thématique des entretiens est ressorti 3 thèmes : la professionnalisation institutionnelle, les réalités du contexte pédagogique et les obstacles à la formation de l’identité professionnelle du rôle de communicateur. Ceux-ci pointent vers l’omniprésence d’une approche basée sur la médecine factuelle plutôt que basée sur la vertu à travers la formation de l’identité professionnelle. Le processus professionnalisant pour devenir un médecin est largement fondé sur la présence de comportements observables et mesurables, et ce, de l’admission à l’évaluation continue des compétences communicationnelles. Ainsi, le développement de leur identité professionnelle navigue plus difficilement la relation médecin-patient. La professionnalisation actuelle passe à côté de certaines opportunités de rétroactions et d’apprentissage autoréflexives. Le constat final présente une opportunité de développer un parcours qui intègre les arts et les sciences sociales pour le développement du rôle de communicateur. / In 2007, a study revealed a correlation between the communication skills of future physicians and their likelihood of receiving complaints during their career. In 2021, physician-patient communication was the main issue underlying complaints about physicians. With this problem in mind, we question the growing statistics, particularly by looking at the place of teaching in the professional identity formation of future physicians. The goal of this master’s thesis is to question the physician’s communicator role as established by the CanMEDS competency framework. To this end, twelve interviews were held with actors from the University of Montreal School of Medicine at different stages of their professionalization. From thematic analysis of the interview data, three themes emerged: institutional professionalization, the realities of the educational context, and the challenges to professional identity formation in the role of communicator. These point to the pervasiveness of an evidence-based medicine approach rather than a virtue-based medicine approach to professional identity formation. The professionalizing process of becoming a physician is largely based on the presence of observable and measurable behaviours, from admission to ongoing assessment of communication skills. As a result, it is more difficult to navigate an authentic physician-patient relationship in the development of their professional identity. Current professionalization misses some opportunities for self-reflective feedback and learning. The final finding presents an opportunity to develop a pathway that integrates the arts and social sciences for the development of the communicator role.