What is Professional Identity?

Medical students and residents face a kind of endurance test. Later on their limits are tested, and their mental health and well-being are affected (see, e.g., Epstein & Primavera, 2019). At the same time, there is a call for physicians to step up to leadership to ensure the viability of the social contract between the profession and society (Brennan & Monson, 2014). Given continued and increasing disparities in healthcare outcomes in the U.S., there is a moral obligation to safeguard the health and well-being of the population that must be addressed by the profession. How can medical education best prepare future physicians for these challenges?

In medical school, students arrive prepared and vetted to succeed in professional school and become physicians. Their admissions scores and essays predict success. They can memorize definitions of professionalism and some will emulate the mannerisms and even the dress of role models. Mastering a set of professional skills on a checklist assures accreditation entities minimum competency standards are being met. But some say these steps in becoming a doctor are shallow manifestations of what it means to be a professional physician, and the translation from test or assessment to behavior across conditions and contexts is questionable (Bebeau, 2008). Passing exams and assessments can simply become performances to meet school requirements. This shallow kind of professionalism stands in contrast with one anchored in self-motivation in deep alignment with the social contract. Professional identity is what motivates one to do what is right when no one is looking. But it is more than that: Professional identity refers not just to motivation and behavior. It refers to a state of being -- of showing up with one's whole self to a patient, of being fully present (Cruess et al. 2016). It is seeing the nuances and complexities of patient health and interdependencies with society. It is discerning what is moral and just. And that requires both head and heart.*

Professional identity formation refers to the process of cultivating a deep and abiding sense of the moral responsibility of physicians to patients, the community, and to themselves. It is more than the sum of assessment scores or clinical performance. Professional identity is a kind of default lens that constructs meaning. Depending on the lens we choose, we make choices to limit our attention to just the evidence that we can see in front of us. Shifting our lens, we choose to see through the eyes of others, going with the collective flow without pausing. Or we can step back, and see through our own lens of meaning making, probe for deeper understanding of patients' challenges, and make choices based on deeply held beliefs about the role of the physician in society.

Formation is not a quick fix. We gradually develop each lens depending on experiences that disrupt our current lens and way of being. The transitions are experienced as tensions between one way of being and a more complex way. The transition from being enveloped within a socialized lens begins with feelings of being uncomfortable, of maybe having just a twinge of pain at the status quo within our team, our families or our workplace. Growth involves slowing ourselves down to reflect on those feelings, and then shifting the fulcrum of our meaning making structure from others to self. We negotiate those two centers of gravity, and the tensions can be prolonged and unbearable. Differentiating from our families or peers is central to professional identity growth. But is essential to our foundational integrity and authenticity.

In the next pages, read more about the foundational theory behind the constructive-developmental measurement approach of Professional Identity Formation and the Professional Identity Essay (PIE).

Announcement (Pi Day, 3.14):

The Professional Identity Essay (PIE): 
Its Interpretation and Use in Medical Education

July 15-16, 2019

Minneapolis, Minnesota

McNamara Alumni Center, University of Minnesota

For details and registration, click here.