How an EPA-based curriculum supports professional identity formation.
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ABSTRACT: Background
Entrustable professional activities (EPAs) are widely used in medical education, and they might be an important incentive to stimulate professional identity formation (PIF) of medical students, by actively encouraging participation in the workplace. The goal of this study was to explore the effects of an EPA-based curriculum on the PIF of medical students in undergraduate curricula.Methods
In this study at the Radboud University Medical Center in Nijmegen, the Netherlands, the authors interviewed twenty-one medical students in three focus group interviews (November 2019), and conducted a thematic analysis based on both the synthesizing concepts PIF, communities of practice and EPAs, and newly defined themes.Results
Four central themes proved crucial for understanding the influence of EPAs on PIF: creating learning opportunities, managing feedback, dealing with supervision in context and developing confidence. EPAs helped students to create learning opportunities and to choose activities purposefully, and the use of EPAs stimulated their feedback-seeking behavior. The context and way of supervision had a great impact on their development, where some contexts offer better learning opportunities than others. EPAs helped them develop trust and self-confidence, but trust from supervisors hardly appears to result from using EPAs.Conclusions
An EPA-based curriculum does stimulate PIF in the complex context of working and learning by supporting participation in the workplace and by encouraging feedback-seeking behavior. Striking the right balance between participation, feedback-seeking behavior and choosing learning activities is essential.Trial registration
This study was approved by the ethics committee of the Netherlands Association of Medical Education (NVMO, case number 2019.5.12).
SUBMITTER: Bremer AE
PROVIDER: S-EPMC8781044 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionProfessional identity formation (PIF) is recognized worldwide as an outcome of medical education grounded in the psychology of adult development and the literature on medical professionalism. However, instruments to assess and support PIF are scarce. The Professional Identity Essay (PIE) is an open-ended question assessment of PIF that elicits short narrative responses from learners and that can be analyzed to provide formative feedback and an overall stage of development. In this study, our aim was to translate and adapt the PIE to Brazilian Portuguese.MethodsWe followed a systematic procedure for the translation and cross-cultural adaptation of the instrument. A pilot study was conducted with medical students from the University of São Paulo. After providing individual formative feedback, we administered an online questionnaire to the Brazilian students to better understand the consequences of using the PIE. Content analyses of qualitative data were performed, we employ manifest content analysis, and the categories of analysis emerged from the participants' speeches.ResultsStudents found the instrument's questions easy to interpret and self-reflective. It also gave students the opportunity to consider their PIF. The PIE was perceived as reliable and brought more awareness of the students' own processes in addition to a sense of capability to foster their own development. In the same way, the students emphasized the importance of being helped in this process.ConclusionWe found sufficient evidence of the validity of the PIE in terms of content, face validity, and consequences of use. The PIE enhances self-assurance in PIF through formative assessment and is sensitive to different cultures, making it a potential tool for educators.
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Project description:PurposeTransitioning from being pharmacy students to pharmacists is challenging. Students need to reconcile their professional aspirations and what they have learnt with the realities of practice. A smooth transition can be hampered when they are unable to enact the role they have envisaged or if their expectations are not met. These challenges relate to professional identity. A key challenge for pharmacy educators is how best to support the professional identity formation (PIF) of pharmacy students. To assist with this challenge, we conducted a scoping review to identify factors influencing pharmacy students' PIF and pedagogical strategies to support PIF.MethodsIn September 2018, we undertook a scoping review of all contemporary research investigating pharmacy student PIF including all relevant qualitative, quantitative, theoretical, and gray literature. We searched eight databases for the review: MEDLINE, CINAHL, PsycINFO, Embase, Australian Education Index, PubMed, Scopus, and Web of Science. Literature published between January 2008 and September 2018 was reviewed and screened using inclusion/exclusion criteria. The selected articles were charted and thematically analyzed.ResultsWe included 22 articles in the review. Studies generally concurred about the importance of attending to PIF throughout the whole pharmacy curriculum. Yet, those studies reporting on pharmacy students' professional identities found that students experienced challenges forming their identities. While several curriculum interventions supporting PIF have been implemented, these tended to be one-offs and there was an absence of interventions engaging key stakeholders including placement preceptors, other health professionals, and patients/consumers.ConclusionSupporting the formation of pharmacy students' professional identity, while recognized as an important goal for pharmacy education, requires further empirical inquiry. Pedagogical practices focused on identity formation including adopting an integrative curricular approach are required.
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Project description:Background:Despite being regulated and spoken about as professionals, there is little formal research examining professional identity formation among regulated pharmacy technicians. Methods:A semistructured interview protocol was generated, based on Holden et al.'s typology of professional identity formation (PIF). Regulated pharmacy technicians in Ontario with a minimum of 2 years' experience working a minimum of 32 hours/week were recruited to participate. Interviews were transcribed, coded and analyzed based on professional identity formation. Results:A total of 15 regulated pharmacy technicians from southern Ontario participated in this study. Regardless of demographic background, most participants demonstrated identity splinting as the dominant form of professional identity formation. Issues related to social valuing of the role of the technician and environmental opportunities to develop and grow were highlighted as significant barriers. Interpretation:These findings suggest regulated pharmacy technicians have incomplete professional identities due in part to reasons linked to pharmacists and the pharmacy profession. The type of professional identity expressed by participants in this study may limit opportunities for full and optimal expression of their role. Conclusions:Further work is necessary to better understand the professional identity formation of regulated pharmacy technicians, to help support the evolution of this role. Can Pharm J (Ott) 2020;153:xx-xx.
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Project description:BackgroundProfessional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF.MethodsA systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data.ResultsA total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF.DiscussionPIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.
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Project description:BackgroundMedical education has enjoyed mixed fortunes nurturing professional identity formation (PIF), or how medical students think, feel and act as physicians. New data suggests that structured mentoring programs like the Palliative Medicine Initiative (PMI) may offer a means of developing PIF in a consistent manner. To better understand how a well-established structured research mentoring program shapes PIF, a study of the experiences of PMI mentees is proposed.MethodologyAcknowledging PIF as a sociocultural construct, a Constructivist approach and Relativist lens were adopted for this study. In the absence of an effective tool, the Ring Theory of Personhood (RToP) and Krishna-Pisupati Model (KPM) model were used to direct this dual Systematic Evidence-Based Approach (Dual-SEBA) study in designing, employing and analysing semi-structured interviews with PMI mentees and mentoring diaries. These served to capture changes in PIF over the course of the PMI's mentoring stages. Transcripts of the interviews and mentoring diaries were concurrently analysed using content and thematic analysis. Complementary themes and categories identified from the Split Approach were combined using the Jigsaw Approach and subsequently compared with mentoring diaries in the Funnelling Process. The domains created framed the discussion.ResultsA total of 12 mentee interviews and 17 mentoring diaries were analysed, revealing two domains-PMI as a Community of Practice (CoP) and Identity Formation. The domains confirmed the centrality of a structured CoP capable of facilitating longitudinal mentoring support and supporting the Socialisation Process along the mentoring trajectory whilst cultivating personalised and enduring mentoring relationships.ConclusionThe provision of a consistent mentoring approach and personalised, longitudinal mentoring support guided along the mentoring trajectory by structured mentoring assessments lay the foundations for more effective mentoring programs. The onus must now be on developing assessment tools, such as a KPM-based tool, to guide support and oversight of mentoring relationships.
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Project description:BackgroundProfessional identity development is an area of contemporary interest within medical education. It can be defined as 'the foundational process one experiences during the transformation from lay person to physician'. In order for this transformation to occur, medical values and principles are internalised. A robust professional identity is key to confident practice as a medical professional. As such, research regarding what works to encourage identity development is popular. New models of educational delivery, such as the increasingly popular Longitudinal Integrated Clerkship model (LICs), present an interesting opportunity to investigate impact on identity. As no previous literature reviews focus on identity development within LICs, it is unclear what is already known about their impact. Therefore, a scoping review synthesising current knowledge and mapping areas for future research is necessary.MethodsArksey and O'Malley's scoping review steps will be used as a methodological framework. MEDLINE, EMBASE, PubMed, Web of Knowledge, ERIC, PsychINFO, Google Scholar, JSTOR, Scopus, and Web of science will be searched (from inception onwards). We will include single studies of any design (e.g. quantitative and qualitative) and reviews examining professional identity within Longitudinal Integrated Clerkships involving health profession students. Two reviewers will complete all screening and data abstraction independently. Deductive coding will be presented as a quantitative textual meta-analysis. Inductive coding will be presented in narrative format.DiscussionThis scoping review will explore professional identity formation within LICs, evaluating any known impact of the educational model and mapping the ways in which identity within LICs has been researched. Mapping of current knowledge should highlight whether LICs as an educational model can influence professional identity development and outline gaps in what is known about their impact to date. Theory used in LIC-based identity research will also be mapped, in order to summarise the main theoretical orientations of research to date. It is anticipated that through such evidence synthesis, directions for future research will become clear.Systematic review registrationOpen Science Framework: osf.io/hk83p.
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Project description:IntroductionResearch suggests that students become less patient-centered and empathetic in response to both internal and external factors, including the organizational culture, or hidden curriculum, of medical school. Students often feel compelled to make compromises when they experience tension between competing values in clinical teaching environments. To address this, we implemented a modular, longitudinal professionalism curriculum for third-year medical students, based on a conceptual model that highlights a student's ideal, as well as the internal and environmental forces that can either sustain or change their ideal over time.MethodsAs students progressed through the third year, they participated in various modules linked to different clerkships, each focusing on a different aspect of the conceptual model. Each module includes a reflective writing exercise followed by a faculty-facilitated discussion.ResultsIn general, students rated the group discussions and faculty facilitation as the most useful parts of each session and the writing exercises as the least useful. Written comments were mostly favorable and suggested that the session facilitated self-reflection and provided a safe environment for students to discuss stressors of third-year clerkships.DiscussionThis curriculum represents a unique approach to fostering professional role formation through its broad potential applicability to multiple types and levels of learners, its adaptability to fit various course lengths and learning environments, and its incorporation of a conceptual model that allows individual learners to address different facets of the sustaining and acculturating forces that impact their personal professional identity formation for future encounters.
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Project description:BackgroundUnderstanding the internalized, psychological sense of being a professional may provide important insight into understanding pharmacists' behaviours and attitudes in practice.MethodsIt is difficult to directly or quantitatively measure an internalized psychological state such as profession-hood. An indirect method was selected in which pharmacists who were themselves patients or caregivers were identified and invited to discuss their experiences, as a vehicle for better understanding how they relied upon personal and professional identities during high-stress, impactful times.ResultsA total of 17 community pharmacists from southern Ontario participated in this study. Regardless of demographic background, participants reported little reliance on professional identity, knowledge or role as a pharmacist when advocating for themselves or a loved one.InterpretationThese findings suggest that community pharmacists have incomplete, separated or functional (rather than existential) professional identities. This lack of professional identity may influence behaviours in practice such as interactions with other health care professionals or patients or self-confidence in clinical decision-making.ConclusionsFurther work is necessary to better understand the socialization and professional identity formation of pharmacists to help support them through the current evolution of pharmacy towards more interdependent and complex clinical roles and decision-making.
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Project description:IntroductionConceptual frameworks for professional identity (PI) formation highlight the importance of developmental stages and socialization as the learner progresses from legitimate peripheral to full participation. Based on extant literature and clinical impressions, the authors aimed to explore factors associated with PI formation in psychiatry residents over time, and hypothesized that time in training, seniority status, and duration of exposure to psychiatry prior to residency would be associated with PI formation.MethodsEighty out of 96 psychiatry residents (response rate, 83.3%) from the National Psychiatry Residency Program in Singapore participated and rated their PI development using the Professional Self Identity Questionnaire (PSIQ) across four timepoints from January 2016-December 2019. The residents were classified as junior (first 3 years) or senior residents (years 4-5). Linear mixed model analyses were conducted, with time in training, seniority status (junior versus senior residents), duration of psychiatry postings prior to residency, and their interaction as associated factors with PI over time.ResultsTime in training, seniority, and duration of psychiatry postings before residency (all p < 0.01) were significantly associated with higher PSIQ scores at baseline. Over time, although all residents had increases in PSIQ scores, this rate of change did not differ significantly between junior and senior residents.DiscussionExposure to psychiatry postings before residency, time in learning, and seniority are factors which influence PI development in residents. This has implications for psychiatry residency selection and training, adequate clinical exposure during training rotations, and continual support for new and senior residents to foster PI formation over time.
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Project description:BackgroundAs technology advances, some schools are moving away from human cadaveric dissection to teach anatomy, leading to concern regarding the possible loss of a professional identity building experience. This study explored the role of dissection in students' professional identity formation.MethodsA mixed-methods study was conducted using survey methodology and semi-structured interviews of medical students at an American-style graduate-entry medical school in Singapore. The questionnaire adopted the conceptual framework of the Ring Theory of Personhood and the MacLeod-Clark Professional Identity Scale was used to measure professional identity, followed by semi-structured interviews of students using Braun and Clarke's six-phase reflexive thematic analysis.ResultsRespondents did not differ substantively from non-respondents by age, nationality, or ethnicity, and year of entering medical school, however, they were slightly more female dominant. The number of hours of hands-on participation in dissection showed no significant relationship (r2 = 0.010; p = 0.424) with professional identity formation measured by the MacLeod-Clark Professional Identity Scale. Despite the survey results, semi-structured interviews revealed rich and nuanced findings suggesting the influence of dissection in participants' professional identity formation through deepening students' appreciation of humanistic values and enhancing their notions of patients' personhood. Notably, students without dissection experience did not express these sentiments and were orientated towards knowledge acquisition.ConclusionWhile our findings do not suggest that dissection strongly impacts students' professional identity formation, students shared thought-provoking experiences which suggest some level of its contribution. Careful consideration of this phenomenon should be exercised prior to removing dissection in favour of technological alternatives.
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