Professional Identity Formation in Medical Education (Part I): Core Principles, Application, Challenges and Solutions
DOI:
https://doi.org/10.54536/ajhp.v4i3.8730Keywords:
Competency-Based Education, Medical Education, Professional Identity, ProfessionalismAbstract
Professional identity formation (PIF) reshaped the aim of undergraduate medical education from the simple acquisition of competencies to the developmental process through which a learner comes to think, act, and feel as a physician. Despite the increasing curricular attention, PIF persists inconsistently defined, theorized, operationalized and assessed. This review aimed to consolidate the concept, theory, and core principles of PIF; and to critically appraise its benefits, current challenges, and evidence-informed solutions. A narrative review was carried out. Databases including PubMed, MEDLINE, ERIC, and PsycINFO were searched using the terms; “professional identity formation,” “medical professionalism,” and “undergraduate medical education.” Seminal texts in developmental psychology, sociology, and educational theories were also included. The PIF is grounded in social learning theory and communities-of-practice frameworks. It’s identified core principles were explicit curricular outcomes, structured reflection, longitudinal mentorship, role modelling, and developmental assessment. PIF is operationalized through mentorship and coaching programs, reflective instruction, community-based and simulation-based education. Benefits of PIF included; more consistent professional practice, improved student wellbeing, curricular consistency and enhanced patient care. Persistent challenges include the adverse effect of the hidden curriculum, tensions with competency-based medical education, identity discordance and burnout. PIF represents a transformative framework for undergraduate medical education that complements and extends competency-based frameworks. Medical schools must move beyond simple professionalism instruction toward sustained, systemic approaches that foster authentic physician identity throughout the undergraduate medical years continuum. Future research should focus on longitudinal outcome studies, the use of validated longitudinal multimodal measurement tools, and equity-informed approaches to PIF.
References
Al-Eraky, M. M., & Chandratilake, M. (2012). How medical professionalism is conceptualized in an Arabian context: A validation study. Medical Teacher, 34(Suppl. 1), S90–S95. https://pubmed.ncbi.nlm.nih.
Al-Eraky, M. M., Donkers, J., Wajid, G., & van Merrienboer, J. J. G. (2014). A Delphi study of medical professionalism in Arabian countries: The Four-Gates model. Medical Teacher, 36(Suppl. 1), S8–S16. https://pubmed.ncbi.nlm.nih.gov/?term=AlEraky+Delphi+medical+professionalism+Arabian+countries+Four-Gates+model
Al-Eraky, M. M., Donkers, J., Wajid, G., & van Merrienboer, J. J. G. (2015). Faculty development for learning and teaching of medical professionalism. Medical Teacher, 37(Suppl. 1), S40–S46. https://doi.org/10.3109/0142159X.2015.1006604
Anurat, K., Thamyongkit, S., Pakakasama, S., & Sumrithe, S. (2024). Assessing the role of mentors in mitigating burnout and enhancing professional development in medical education. International Journal of Medical Education, 15, 19–27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11288619/
Bi, S., Vela, M. B., Nathan, A. G., Gunter, K. E., Cook, S. C., López, F. Y., Nocon, R. S., & Chin, M. H. (2020). Teaching intersectionality of sexual orientation, gender identity, and race/ethnicity in a health disparities course. MedEdPORTAL, 16, Article 10970. https://doi.org/10.15766/mep_2374-8265.10970
Brown, M. E. L., Coker, O., Heybourne, A., & Finn, G. M. (2020). Exploring the hidden curriculum’s impact on medical students: Professionalism, identity formation and the need for transparency. Medical Science Educator, 30(3), 1107–1121. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368648/
Buck, E., West, C., Graham, L., Frye, A. W., & Teal, C. R. (2019). Challenges to assessing professional identity in medical students: A tale of two measures. Medical Education Online, 24(1), Article 1649571. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713161/
Crossley, J., & Vivekananda-Schmidt, P. (2009). The development and evaluation of a Professional Self Identity Questionnaire to measure evolving professional self-identity in health and social care students. Medical Teacher, 31(12), e603–e607. https://pubmed.ncbi.nlm.nih.gov/19995162/
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89(11), 1446–1451. https://pubmed.ncbi.nlm.nih.gov/25054423/
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2015). A schematic representation of the professional identity formation and socialization of medical students and residents: A guide for medical educators. Academic Medicine, 90(6), 718–725. https://pubmed.ncbi.nlm.nih.gov/25785682/
Cruess, R. L., Cruess, S. R., & Steinert, Y. (2016). Amending Miller’s pyramid to include professional identity formation. Academic Medicine, 91(2), 180–185. https://doi.org/10.1097/ACM.0000000000000913
Cruess, S. R., Cruess, R. L., & Steinert, Y. (2019). Supporting the development of a professional identity: General principles. Medical Teacher, 41(6), 641–649. https://pubmed.ncbi.nlm.nih.gov/30739517/
Danckers, M., Nusynowitz, J., Jamneshan, L., Shalmiyev, R., Diaz, R., & Radix, A. E. (2024). The sexual and gender minority (LGBTQ+) medical trainee: The journey through medical education. BMC Medical Education, 24(1), Article 58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795322/
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine, 81(4), 354–373. https://doi.org/10.1097/00001888-200604000-00009
Endalcachew, M., Deberg, J., Swee, M., Suneja, M., & Kumar, B. (2023). Professional identity formation among undergraduate pre-medical students: A scoping review protocol. Systematic Reviews, 12(1), Article 172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10517468/
Frank, J. R., Snell, L. S., ten Cate, O., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P., Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo, R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638–645. https://doi.org/10.3109/0142159X.2010.501190
Goldie, J. (2012). The formation of professional identity in medical students: Considerations for educators. Medical Teacher, 34(9), e641–e648. https://doi.org/10.3109/0142159X.2012.687476
Goldie, J. (2013). Assessment of professionalism: A consolidation of current thinking. Medical Teacher, 35(2), e952–e956. https://doi.org/10.3109/0142159X.2012.714888
Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine’s hidden curriculum. Academic Medicine, 73(4), 403–407. https://doi.org/10.1097/00001888-199804000-00013
Hafferty, F. W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), 861–871. https://doi.org/10.1097/00001888-199411000-00001
Helmich, E., Yeh, H. M., Kalet, A., & Al-Eraky, M. (2017). Becoming a doctor in different cultures: Toward a cross-cultural approach to supporting professional identity formation in medicine. Academic Medicine, 92(1), 58–62. https://pubmed.ncbi.nlm.nih.gov/27782917/
Hirsh, D., Gaufberg, E., Ogur, B., Cohen, P., Krupat, E., Cox, M., Pelletier, S., & Bor, D. (2012). Educational outcomes of the Harvard Medical School–Cambridge integrated clerkship: A way forward for medical education. Academic Medicine, 87(5), 643–650. https://doi.org/10.1097/ACM.0b013e31824d9821
Ho, M. J. (2013). Culturally sensitive medical professionalism. Academic Medicine, 88(8), 1014–1015.https://pubmed.ncbi.nlm.nih.gov/?term=Ho+MJ+Culturally+sensitive+medical+
professionalism+2013
Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191. https://doi.org/10.1097/ACM.0b013e3181b17e55
Holden, M., Buck, E., Clark, M., Szauter, K., & Trumble, J. (2012). Professional identity formation in medical education: The convergence of multiple domains. HEC Forum, 24(4), 245–255. https://doi.org/10.1007/s10730-012-9197-6
Holden, M. D., Buck, E., Luk, J., Ambriz, F., Boisaubin, E. V., Clark, M. A., Mihalic, A. P., Sadler, J. Z., Sapire, K. J., Spike, J. P., Vince, A., & Dalrymple, J. L. (2015). Professional identity formation: Creating a longitudinal framework through TIME (Transformation in Medical Education). Academic Medicine, 90(6), 761–767. https://doi.org/10.1097/ACM.0000000000000719
Jarvis-Selinger, S., Pratt, D. D., & Regehr, G. (2012). Competency is not enough: Integrating identity formation into the medical education discourse. Academic Medicine, 87(9), 1185–1190. https://doi.org/10.1097/ACM.0b013e3182604968
Kalet, A., Buckvar-Keltz, L., Harnik, V., Monson, V., Hubbard, S., Crowe, R., Song, H. S., & Yingling, S. (2017). Measuring professional identity formation early in medical school. Medical Teacher, 39(3), 255–261. https://doi.org/10.1080/0142159X.2017.1270437
Kalet, A., Buckvar-Keltz, L., Monson, V., Harnik, V., Hubbard, S., Crowe, R., Song, H. S., & Yingling, S. (2018). Professional identity formation in medical school: One measure reflects changes during pre-clerkship training. MedEdPublish, 7, Article 41. https://doi.org/10.15694/mep.2018.0000041.1
Koh, E. Y. H., Koh, K. K., Renganathan, Y., & Krishna, L. (2023). Role modelling in professional identity formation: A systematic scoping review. BMC Medical Education, 23(1), Article 194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052869/
Krishna, L. K. R., Hamid, N. A. B. A., Phua, G. L. G., Mason, S., Hill, R., Lim, C., Ong, S. Y. K., Ong, E. K., & Ibrahim, H. (2024). Peer mentorship and professional identity formation: An ecological systems perspective. BMC Medical Education, 24(1), Article 1007. https://doi.org/10.1186/s12909-024-05992-0
Krishnasamy, N., Hasamnis, A. A., & Patil, S. S. (2022). Developing professional identity among undergraduate medical students in a competency-based curriculum: Educators’ perspective. Journal of Education and Health Promotion, 11, Article 361. https://doi.org/10.4103/jehp.jehp_329_22
Kristoffersson, E., Diderichsen, S., Verdonk, P., Lagro-Janssen, T., Hamberg, K., & Andersson, J. (2018). To select or be selected – Gendered experiences in clinical training affect medical students’ specialty preferences. BMC Medical Education, 18(1), Article 268. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245780/
Krupat, E., Pelletier, S., Alexander, E. K., Hirsh, D., Ogur, B., & Schwartzstein, R. (2009). Can changes in the principal clinical year prevent the erosion of students’ patient-centered beliefs? Academic Medicine, 84(5), 582–586. https://doi.org/10.1097/ACM.0b013e31819fa92d
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press. https://doi.org/10.1017/CBO9780511815355
Liang, J. Z., Ng, D. K. W., Raveendran, V., Teo, M. Y. K., Quah, E. L. Y., Chua, K. Z. Y., et al. (2024). The impact of online education during the Covid-19 pandemic on the professional identity formation of medical students: A systematic scoping review. PLOS ONE, 19(1), Article e0296367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10769105/
Madrigal, J., Rudasill, S., Tran, Z., Bergman, J., & Benharash, P. (2021). Sexual and gender minority identity in undergraduate medical education: Impact on experience and career trajectory. PLOS ONE, 16(11), Article e0260387. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604342/
Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14(4), 595–621. https://doi.org/10.1007/s10459-007-9090-2
Melton, J., & Varpio, L. (2022). A critical review of professional identity formation interventions in medical education. Academic Medicine. https://pubmed.ncbi.nlm.nih.gov/35947478/
Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9 Suppl.), S63–S67. https://doi.org/10.1097/00001888-199009000-00045
Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44(1), 40–49. https://doi.org/10.1111/j.1365-2923.2009.03440.x
Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009. https://doi.org/10.1097/ACM.0b013e318221e615-
Noreen, K., Zuberi, R. W., Aftab, K., & Fatima, S. (2023). Assessment of medical professionalism: Development and psychometric analysis of Professionalism Assessment Tool (PAT) in Pakistani context using Delphi techniques. Pakistan Journal of Medical Sciences, 39(2), 385–391. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10025719/
Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., Veloski, J. J., & Hodgson, C. S. (2005). Disciplinary action by medical boards and prior behavior in medical school. The New England Journal of Medicine, 353(25), 2673–2682. https://doi.org/10.1056/NEJMsa052596
Passi, V., Johnson, S., Peile, E., Wright, S., Hafferty, F., & Johnson, N. (2013). Doctor role modelling in medical education: BEME Guide No. 27. Medical Teacher, 35(9), e1422–e1436. https://doi.org/10.3109/0142159X.2013.806982
Sarraf-Yazdi, S., Krishna, L. K. R., et al. (2024). A scoping review and theory-informed conceptual model of professional identity formation in medical education. Medical Education. https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.15399
Sarraf-Yazdi, S., Teo, Y. N., How, A. E. H., Teo, Y. H., Goh, S., Kow, C. S., Lam, W. Y., Wong, R. S. M., Ghazali, H. Z. B., Lauw, S.-K., Tan, J. R. M., Lee, R. B. Q., Ong, Y. T., Chan, N. P. X., Cheong, C. W. S., Kamal, N. H. A., Lee, A. S. I., Tan, L. H. E., Chin, A. M. C., Chiam, M., & Krishna, L. K. R. (2021). A scoping review of professional identity formation in undergraduate medical education. Journal of General Internal Medicine, 36(11), 3511–3521. https://doi.org/10.1007/s11606-021-07024-9
Sharpless, J., Baldwin, N., Cook, R., Kofman, A., Morley-Fletcher, A., Slotkin, R., & Green, S. (2015). The becoming: Students’ reflections on the process of professional identity formation in medical education. Academic Medicine, 90(6), 713–717. https://doi.org/10.1097/ACM.0000000000000729
Silveira, G. L., Monson, V., Poço, P. C. E., Haydar, A., Brenelli, S. L., Succi, F. M. P., de Menezes Succi, G., de Arruda Martins, M., & Tempski, P. Z. (2023). Assessment of professional identity formation: A transcultural validation of the professional identity essay for Brazilian Portuguese. BMC Medical Education, 23(1), Article 738. https://doi.org/10.1186/s12909-023-04627-0
Stern, D. T., & Papadakis, M. (2006). The developing physician—Becoming a professional. New England Journal of Medicine, 355(17), 1794–1799. https://doi.org/10.1056/NEJMra054783
Sternszus, R., Slattery, N. K., Cruess, R. L., ten Cate, O., Hamstra, S. J., & Steinert, Y. (2023). Contradictions and opportunities: Reconciling professional identity formation and competencybased medical education. Perspectives on Medical Education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637293/
Swanwick, T., Forrest, K., & O’Brien, B. C. (Eds.). (2018). Understanding medical education: Evidence, theory and practice (3rd ed.). Wiley-Blackwell. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119373780.ch17
Teherani, A., Hauer, K. E., Fernandez, A., King, T. E., Jr., & Lucey, C. (2018). How small differences in assessed clinical performance amplify to large differences in grades and awards: A cascade with serious consequences for students underrepresented in medicine. Academic Medicine, 93(9), 1286–1292. https://doi.org/10.1097/ACM.0000000000002323
Thistlethwaite, J. E., Bartle, E., Chong, A. A. L., Dick, M. L., King, D., Mahoney, S., Margolis, S. A., Papageorgiou, A., & Tucker, G. (2013). A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26. Medical Teacher, 35(8), e1340–e1364. https://doi.org/10.3109/0142159X.2013.806981
Toh, R. Q. E., Koh, K. K., Lua, J. K., Wong, R. S. M., Quah, E. L. Y., Panda, A., Wong, C. H. J., Chia, E. W. Y., Ho, C. Y., Lim, W. Q., Teo, Y. H., Ong, Y. T., Chong, C. S., Ng, C. L., & Krishna, L. K. R. (2022). The role of mentoring, supervision, coaching, teaching and instruction on professional identity formation: A systematic scoping review. BMC Medical Education, 22, Article 531. https://doi.org/10.1186/s12909-022-03589-z
Venkataraman, S., Nguyen, M., Chaudhry, S. I., Desai, M. M., Hajduk, A. M., Mason, H. R. C., Webber, A., & Boatright, D. (2024). Racial and ethnic discrimination and medical students’ identity formation. JAMA Network Open, 7(10), Article e2439727. https://doi.org/10.1001/jamanetworkopen.2024.39727
Volpe, R. L., Hopkins, M., Geathers, J., Watts Smith, C., & Cuffee, Y. (2021). Negotiating professional identity formation in medicine as an ‘outsider’: The experience of professionalization for minoritized medical students. SSM - Qualitative Research in Health, 1, Article 100017. https://www.sciencedirect.com/science/article/pii/S2667321521000172
Wald, H. S., Anthony, D., Hutchinson, T. A., Liben, S., Smilovitch, M., & Donato, A. A. (2015). Professional identity (trans)formation in medical education: Reflection, relationship, resilience. Academic Medicine, 90(6), 753–760. https://pubmed.ncbi.nlm.nih.gov/?term=Wald+professional+identity+trans+
formation+reflection+relationship+resilience+2015
Webber, A., Nguyen, M., Chaudhry, S. I., Mason, H. R. C., Desai, M. M., & Boatright, D. (2025). Gender discrimination and medical student development. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11838681/
Wong, A., & Trollope-Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education, 48(5), 489–501. https://doi.org/10.1111/medu.12382
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