Professional self-identity can be defined as the degree to which an individual identifies with his or her professional group.1A current medical student, King Pascual, recently published an article in which he warns of an existential trap that members of the medical community are at risk of falling into: letting the medical profession and their title define their entire personhood.2In today’s blog post I will discuss concerns related to when a lack of separation occurs between professional and personal identity, as well as methods being utilized in medical schools in attempts to remediate this issue.

 

Changing Personal Identities to Meet Expectations

It has been shown that when people outside the medical professions acknowledge students as future health professionals, the students will gradually alter their identity over time to meet the expectations associated with their profession.1Surveys of current medical students indicate that the identity associated with the medical profession by students incurs inclusivity associated with being treated as a medical professional, and social exclusivity from perceptions as being socially separate from non-medical persons.3

Research has also established that upon graduation medical students on average have lower empathy scores compared to their age-matched peers.4

 

Impact of Self-Esteem and Emotional Well-Being

The view that doctors are different from the rest of society and should be held to a higher standard can negatively impact an individual’s self-worth when mistakes are encountered.5This notion is supported by numerous studies demonstrating a significantly higher prevalence of depression and anxiety in physicians compared to other professions.6 Further exacerbating this issue is the notion that mental health issues are more often overlooked in medical professionals, and so they are less likely to seek and receive help.6,7

 

Professional Identity Formation

        The process of internalizing the profession’s core values and beliefs is an explicit goal of education in medical schools.Medical school programs embrace certain characteristics, values, and beliefs bestowed on students throughout their curriculum.8Although there are many opinions regarding the development of professional identify, the current most widely accepted view is that professional identity is shaped through a process involving a renegotiation of the characteristics, values and beliefs previously held by the person to ultimately result in the person “thinking, acting, and feeling like a physician.”9

 

Adjustments Made By Medical Schools

For the reasons discussed earlier in this post, when personal and professional identity become indistinguishable some negative potential consequences start to become apparent. Medical schools have become more aware of this issue, and various approaches to remediate it have been implemented. Growing emphasis by universities is being placed on promoting student wellbeing as an essential component for professional development. Almost every medical school now has a center for student counseling for improving accessibility to mental health services and reducing the stigma of struggling with these issues.10Students have also shown positive responses to peer mentoring and various mindfulness programs that have been implemented.11In hopes to decrease academic pressure, some universities have even gotten rid of the traditional letter grading system and replaced it with a pass/fail system.2, 12

 

It is vital for our current and future health professionals to maintain their wellbeing while they are serving the population. Health professionals who become unable to separate their professional and personal identities risk potentially altering their humanistic and empathetic qualities, which can be a critical factor in providing high quality patient-centered care. Perceived self-worth can also diminish over time resulting from the cumulative impacts of errors made if personal and professional identity are too tightly intertwined.  The efforts of some medical schools to address these issues shows improvement, but more targeted interventions at more universities are still needed to fully address this complex issue.

 

References:

  1. Vivekananda-Schmidt P, Crossley J, Murdoch-Eaton D. A model of professional self-identity formation in student doctors and dentists: a mixed method study. BMC Med Educ. 2015;15:83. doi:10.1186/s12909-015-0365-7

 

  1. Pascual, K. Why medical students should not let medicine define them. Kevinmd.com. https://www.kevinmd.com/blog/2018/10/why-medical-students-should-not-let-medicine-define-them.html. Published October 31, 2018. Accessed November 12, 2018.

 

  1. Weaver R, Peters K, Koch J, Wilson I. “Part of the team”: professional identity and social exclusivity in medical students. Med Educ. 2011;45(12):1220-1229. doi:10.1111/j.1365-2923.2011.04046.x

 

  1. Chen DCR, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach. 2012;34(4):305-311. doi:10.3109/0142159X.2012.644600

 

  1. Judging Doctors—The Person and the Professional. Virtual Mentor. 2011;13(10):718-722. doi:10.1001/virtualmentor.2011.13.10.msoc1-1110

 

  1. Anxiety and depression: the risks of medical school. Amsa.org. https://www.amsa.org/anxiety-and-depression-the-risks-of-medical-school/. Published July 12, 2017. Accessed November 12, 2018.

 

  1. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354-373.

 

 

  1. Kalet A, Buckvar-Keltz L, Monson V, Harnik V, Hubbard S, Crowe R, Ark T, Song H, Tewksbury L, Yingling S, Professional Identity Formation in medical school: One measure reflects changes during pre-clerkship training, MedEdPublish, 2018, 7, [1], 41, doi:https://doi.org/10.15694/mep.2018.0000041.1

 

  1. Burford B. Group processes in medical education: learning from social identity theory. Med Educ. 2012;46(2):143-152. doi:10.1111/j.1365-2923.2011.04099.x

 

  1. Drolet BC, Rodgers S. A comprehensive medical student wellness program–design and implementation at Vanderbilt School of Medicine. Acad Med. 2010;85(1):103-110. doi:10.1097/ACM.0b013e3181c46963

 

  1. Redwood SK, Pollak MH. Student-led stress management program for first-year medical students. Teach Learn Med. 2007;19(1):42-46. doi:10.1080/10401330709336622

 

  1. Reed DA, Shanafelt TD, Satele DW, et al. Relationship of pass/fail grading and curriculum structure with well-being among preclinical medical students: a multi-institutional study. Acad Med. 2011;86(11):1367-1373. doi:10.1097/ACM.0b013e3182305d81