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Browsing by Subject "professional identity formation"
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Item The Effect of Identity Dissonance and Consonance on Professional Identity Formation in Medical Students(2020-03-06) Byram, Jessica N.Professional identity formation (PIF) in medical students is often considered a straightforward process of professional socialization where students adopt the norms, values, knowledge, and skills required of physicians. However, no studies have examined the processes through which medical students’ identities are transformed during the professionalization process and how their developing professional identities blend with their existing identities. Nine medical students from Indiana University School of Medicine completed this study spanning the second (MS2) and third (MS3) years of medical school. Participants completed three semi-structured interviews at the start of MS2, end of MS2, and end of MS3, and submitted 10 audio diaries at two-month intervals between interviews. In audio diary recordings, participants discussed who they wanted to be as physicians and how their experiences transformed their developing professional identities. A thematic analysis of interviews and audio diaries were used to create a framework of PIF.This study found several processes of PIF that related to how consonant one considered his/her personal identity to be to the identity of a ‘typical’ medical student and physician, and the degree to which one’s experiences fulfilled his/her expectations and conceptions of medicine, medical students, and physicians. Medical students experiencing identity consonance utilized processes to adapt their personalities and found their experiences to confirm their commitment to medicine. Those experiencing positive identity dissonance used processes to accommodate their personality and had experiences that challenged their connection to medicine. While they found medical professionalization to be arduous, their negative experiences were often seen as necessary processes. Finally, several participants experienced negative identity dissonance, in which they refused to modify their personality to match that of the "typical" medical student and doubted their ability to make it through medical education. This study identified identity dissonance in medical students and the processes they used to cope with it. Doubt has only recently been described in medical students but this study established the impact doubt has on PIF in that it prevents medical students from seeing themselves as future physicians. Dissonance was also experienced by participants who felt they did not have the identity of a typical medical student or physician (e.g., they are female, non-white, lower socioeconomic status, or introverted) and they had experiences with patients and faculty that confirmed they did not meet this stereotyped identity. Students experiencing identity dissonance, particularly those with negative experiences, are at greatest risk of internalizing a professional identity that is inconsistent with members of the profession and may even leave professional education. Medical educators need to recognize and address identity dissonance and the sources that are creating it to assist the medical students in becoming the physicians they aspire to be.Item A Foucauldian Archaeology of Modern Medical Discourse(2020-09) Azim, Homaira M.; Scheurich, James J.; Brokaw, James J.; O'Loughlin, Valerie D.; Byram, Jessica N.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.Item How Physicians Draw Satisfaction and Overcome Barriers in their Practices: “It Sustains Me”(Elsevier, 2017) Branch, William T., Jr.; Weil, Amy B.; Gilligan, MaryAnn C.; Litzelman, Debra K.; Hafler, Janet P.; Plews-Ogan, Margaret; Rider, Elizabeth A.; Osterberg, Lars G.; Dunne, Dana; Derse, Arthur R.; Pittman, J. Richard; Frankel, Richard M.; Department of Medicine, IU School of MedicineObjective Major reorganizations of medical practice today challenge physicians’ ability to deliver compassionate care. We sought to understand how physicians who completed an intensive faculty development program in medical humanism sustain their humanistic practices. Methods Program completers from 8 U.S. medical schools wrote reflections in answer to two open-ended questions addressing their personal motivations and the barriers that impeded their humanistic practice and teaching. Reflections were qualitatively analyzed using the constant comparative method. Results Sixty-eight physicians (74% response rate) submitted reflections. Motivating factors included: 1) identification with humanistic values; 2) providing care that they or their family would want; 3) connecting to patients; 4) passing on values through role modelling; 5) being in the moment. Inhibiting factors included: 1) time, 2) stress, 3) culture, and 4) episodic burnout. Conclusions Determination to live by one’s values, embedded within a strong professional identity, allowed study participants to alleviate, but not resolve, the barriers. Collaborative action to address organizational impediments was endorsed but found to be lacking. Practice implications Fostering fully mature professional development among physicians will require new skills and opportunities that reinforce time-honored values while simultaneously partnering with others to nurture, sustain and improve patient care by addressing system issues.