The Effect of Identity Dissonance and Consonance on Professional Identity Formation in Medical Students

Abstract

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.