Editor’s Note: Check out our June issue, which is devoted entirely to professional identity formation.

By: Hedy S. Wald, PhD, clinical associate professor of family medicine, Warren Alpert Medical School of Brown University

I enter the room at the medical school on my Family Medicine Clerkship teaching day. I co-facilitate small group collaborative reflection based on students’ own reflective writings. Today’s topic is difficult/challenging patient care experiences. I invite the learners to share. A few moments pass. One student dips his toes in the water and begins to read about a profound learning experience he has had—the loss of a pediatric patient, the unfairness of life, and all the difficult emotions that accompany this experience when you are a caring “healer.” Silence in the room follows. I pause to allow the group to embrace that silence as they begin to realize that something meaningful has just touched them and perhaps even transformed them in their process of becoming a doctor. They then begin to share.

I’ve had the honor and privilege of being immersed in medical students’ reflective writings for over ten years. “Narrative is a power tool,” I’ve written, “It has the power to reveal, the power to conceal, the power to expose power differentials. It can erect walls to conceal the true story, the untold story; conversely, it can slice through layers of life to get to the heart of the matter.” [1] More recently, I’ve been reading and responding to these narratives within the context of an expanded perspective in medical education–the reframing of approach from an exclusive focus on doing the work of a physician toward a broader focus on being a physician. [2] Over time, I’ve become more curious about the “becoming.”

Students’ being, relating, and doing within the transformative process of becoming a physician were coming through in their writings, and I began to realize that these narratives were truly a power tool. For students, these writings heightened their awareness and meaning-making to support their professional identity formation. As their teacher, I gained insights into their emerging physicianship, and I was challenged as a “reflective coach,” deepening my own professional identity in the process. Within the becoming of a professional, themes of experiencing inherent tensions as the lived reality of medicine were emerging as were concerns regarding the story of self they wished to author. Sometimes they even surprised themselves when they got that story right.

With the term “professionalism” coming out of our ears, I realized one behavior surely would be left off the checklist at some crossroads, perhaps in the middle of the night in the NICU or when faced with a dilemma of speaking up. For such situations and for the everyday, students would need to rely on their inner core, their professional identity formation, to make good choices. To cope with ambiguity, complexity, and inconsistency in the “messy swamp” of clinical practice. [3] And to be aware of and appreciate the joys and triumphs and positive role modeling that were now part of the fiber of their being. So if we were responsible educators, I pondered, how were we conceptualizing this professional identity formation “thing,” what were the salient contributors, what was the process and content, and how could we obtain a collection of voices to bring insights and inform the discourse? Respected folks in the field as well as emerging physicians were invited to share their perspectives and data on the lifelong process of becoming a physician, and the special issue on professional identity formation was born. It’s been a tremendously exciting collaboration for me.

Professional identity formation. It’s about core values, moral principles, and self-awareness. [4] It’s about educating the heart [5] and mind, the nurturing of practical wisdom. It’s about guiding our students within humanistic mentoring to ultimately impact patient care in a positive way. And for us as educators, it’s about keeping an open mind and an open heart as we continue in our own professional identity formation, reciprocally impacted by the students we teach.

A student’s reflective narrative lands on my computer screen. He’s chosen the writing prompt: “Reflect on a patient care experience(s) in which you learned something new about a primary care physician.” As I prepare to provide formative written feedback, I read about admiration for a mentor whose time and effort made a difference for a patient with medical complexities and gain a window into this student’s thoughts and feelings within the becoming of a doctor. I feel privileged to share this “sparkling moment.” [6]

“…there come the undoubtable moments when you realize you have just borne witness to something profound, an image or idea that will follow you in the coming days, months, and maybe even a lifetime as you march forward along the path to becoming a clinician.” [7]

 

1. Wald HS. Providing Quality Feedback to Students’ Reflective Writing: Theory and Practice (Faculty Manual). Warren Alpert Medical School of Brown University, 2008.
2. Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: Integrating identity formation into the medical education discourse. Acad Med. 2012;87:1185–1190.
3. Schön DA. Educating the reflective practitioner. San Francisco, CA: Jossey-Bass Publishers, 1987.
4. Holden M, Buck E, Clark M, Szauter K, Trumble J. Professional identity formation in medical education: The convergence of multiple domains. HEC Forum. 2012;24: 245-255.
5. Haramati A. A perspective on health professions education. Explore (NY). 2013;9: 272-273.
6. White M, Epston, D. Narrative Means to Therapeutic Ends. New York, NY: WW Norton, 1990.
7. Wald HS. Clinical associate professor of family medicine, Warren Alpert Medical School of Brown University. Personal communication with Kaminski P. 2015.