Professional identity formation

INTRODUCTION

Recently, there is a perceived need to shift from teaching and learning professionalism in medical education to learning to develop a professional identity. Is there a difference between the two? Professionalism is demonstrating a behavior that is in keeping with the community or fraternity norms or standards.^[1] Professional identity formation (PIF) is defined as the possession and exhibition of the medical professional conduct toward meeting the goal of providing optimal care and service in their respective professional domain. The educational process and training helps inculcate the required knowledge, skills, values, and behavior patterns pertaining to their respective fields. It is a process that helps students ascend in the Miller’s pyramid of learning from Knowledge to Knowledge Application and perform tasks that are specific requirements in their profession.^[2]

The competency-based medical education is a curricular process that inculcates this training. This converts a person with a pre-existing identity into a professional who can perform predetermined tasks to provide efficient services. PIF is the highest step in Miller’s pyramid of learning that transforms one from a professional who can “do or perform” to “being” that professional. This happens when there is a true integration of the knowledge, skills, behavior, and values of that profession. It is a change in behavior that occurs following the application of knowledge, a true internalization of the competencies and norms learned that one thinks, acts, and feels as part of the community or fraternity.

WHAT IS PIF AND WHY IS THERE A SHIFT FROM PROFESSIONALISM TO PIF?

PIF is incorporating within and demonstrating the behavioral norms, standards, and values of a professional community, here health profession, to shift from demonstrating a behavior as per norms when someone is watching and a less professional behavior when unwatched when actually there is a need to do the right thing as prescribed by the community standards and “think, act, and feel” like a member of that community even when unobserved.^[3] Thus, there is an integration of knowledge, skills, behaviors, and values of their profession with already pre-existing identities and behaviors.^[4] It represents a continuous transformative process from being an ordinary layperson to being that health care professional who meets the expectations of the society he/she serves.^[5]

BENEFITS OF PIF

The major benefit of professional identity is that it has an influence on how one perceives, explains, presents, and conducts oneself.^[6] It also provides the framework for ethical practice. If the professional identity is not aligned, it leads to problematic behaviors that are unprofessional. It’s that transformation which differentiates a professional who can “Do” to “being” that professional itself. PIF is an essential complement to competency-based education.

THE THREE R’S IN PERSONAL IDENTITY FORMATION

The vital elements in PIF: Are the 3 R’s- Reflection, Relationships, and Resilience.

WHY IS PIF IMPORTANT?

PIF is of paramount importance for health care providers to provide holistic patient care; the duty rests with medical educators to implement a competency-based curriculum with training in PIF from the 1^st day of the student’s training. The external representation of a medical personnel’s feelings, beliefs, experiences, and values all serve as an influence in their delivery of holistic patient care. Hence, the creation of training opportunities and pedagogic space in the curriculum to enhance these core competencies of PIF becomes mandatory. PIF will help students transform and self-reflect on their own personal beliefs and values, guide them, enable them to become confident and make unbiased, non-judgmental decisions for providing holistic patient care.^[7] The efforts to form a professional identity will allow the student to think, feel, and act in alignment with the idea of a “good physician.”^[8] It is equally important for the student to reflect on how not to be, to desist from trying to create an impression (posturing), and managing impressions rather than creating and discovering the authentic self. The key to be in alignment with the idea of a good physician is to allow the authentic self to evolve and move away from “posturing.”

TWO MAIN APPROACHES FOR PIF DEVELOPMENT

We can categorize the approaches for PIF development into two: (i) individual—psychological/developmental and (ii) sociocultural.

Individual approaches to PIF are based on the conceptualization of identity formation, which is self-determined in response to life experiences, based on one’s morals, values, and beliefs, giving meaning to one’s self and one’s professional life.

Social approaches for PIF are focused on the individual’s interaction with their social surroundings, both as in a group and as an individual, and their relationships with them, which dictates the way a professional behaves and thus contributes to the development of a competent and confident health professional.^[9]

PEDAGOGICAL APPROACHES/STRATEGIES TO ENHANCE THE ATTRIBUTES OF PIF

Practical pedagogical approaches that can be incorporated into our existing curriculum to enhance the attributes of PIF can be classified based on self-awareness, teamwork, attention to self-care, empathy, integrity, respect and equal regard for all, resilience, beneficence, and mindful attention to patient care.^[7]

Development of these core values can be attained by small group discussions, team-based learning through problem-based case scenarios, workshops on time management and guiding strategies to deal with various stressors and learning resilience, transforming humiliation, and dealing with conflict to develop an authentic PIF through faculty mentoring programs.

Empathy, integrity, resilience, and mindfulness in patient care can be trained by role-playing, reflective essays, group discussions, observing faculty mentors in practice, and creating videos exploring problem-solving case scenarios.

ROLE OF MENTORS IN PIF TRAINING

All of the above sessions, when moderated by a trained facilitator, help students to respect patient’s autonomy, actively seek opportunities to do good for their patients, and allow the patient to make informed decisions and thus avoid paternalistic attitude.^[7]

ROLE OF MEDICAL EDUCATORS IN PIF

Medical educators have the responsibility to create a patient-safe workforce who follow the ethical standards and understand the core values of professional identity.

As self-introspection of students is the first step before establishing their professional identity, the role of medical educators to review the existing curriculum and identify learning outcomes that help guide PIF and aid patient best practice has become the need of the hour.

Designing self-assessments and newer protocols to incorporate ways to make a practice safe, patient-friendly environment rests with the development of updated content for PIF by the medical educators.^[9]

MEDICAL EDUCATOR CHALLENGES IN PIF AND INNOVATIVE OPPORTUNITIES

The recent focus on PIF has challenged the medical educators to promote, facilitate, and integrate the development process of PIF through formal and informal curricular approaches. Three important competencies and related pedagogic strategies have been considered to contribute to PIF. (1) Promoting reflective capacity, emotional awareness, and resiliency through interactive, reflective writing. This helps in professional and personal growth. (2) Inculcating clinician resilience and well-being through teaching modules on mind-full clinical practice and resilient responses to difficult situations. (3) Professional and personal growth through effective use of professional development e-portfolio and faculty development for reflective coaching skills. These may be considered as targeted competency development and approaches that may help effective PIF.^[10]