Measuring professional identity formation early in medical school

Abstract

Aim: To assess the feasibility and utility of measuring baseline professional identity formation (PIF) in a theory-based professionalism curriculum for early medical students.

Methods: All 132 entering students completed the professional identity essay (PIE) and the defining issues test (DIT2). Students received score reports with individualized narrative feedback and wrote a structured reflection after a large-group session in which the PIF construct was reviewed. Analysis of PIEs resulted in assignment of a full or transitional PIF stage (1–5). The DIT2 score reflects the proportion of the time students used universal ethical principles to justify a response to 6 moral dilemma cases. Students’ reflections were content analyzed.

Results: PIF scores were distributed across stage 2/3, stage 3, stage 3/4, and stage 4. No student scores were in stages 1, 2, 4/5, or 5. The mean DIT2 score was 53% (range 9.7?76.5%); the correlation between PIF stage and DIT score was ρ =  0.18 (p = 0.03). Students who took an analytic approach to the data and demonstrated both awareness that they are novices and anticipation of continued PIF tended to respond more positively to the feedback.

Conclusions: These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.

Acknowledgments

We are deeply indebted to Muriel J. Bebeau, PhD, Professor in the Department of Primary Dental Care, School of Dentistry, University of Minnesota and formerly, Director of the Center for the Study of Ethical Development for her remarkable and inspiring contributions to the field and her generous mentoring and support for our work. We thank Michelle Tichy, PhD, Assistant Professor, Department of Educational Psychology & Foundations, University of Northern Iowa, for her contribution to establishing reliability of the Professional Identity Formation Essay, Ms. Heather Dumorne for assistance in manuscript preparation, Melvin Rosenfeld, PhD, Senior Associate Dean for Medical Education for his support for this project and Professors Richard and Sylvia Cruess for providing feedback on an earlier version of this manuscript. This work was supported by the Office of Student Affairs and Office of Medical Education of the New York University School of Medicine.

Ethical approval

This work was reviewed as part of the IRB approved research registry, allowing us to utilize educational data for purposes of research.

Disclosure statement

The authors reports no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Professional Identify Formation: Medical professional identify formation (PIF) is both a process of personal development and a social construction and has long been claimed to be the fundamental goal of the learning process in medical education (Cooke et al. 2010). In 1957, Merton stated that the task of medical education is to provide the medical trainee “with a professional identity so that he comes to think, act, and feel like a physician” (as quoted by Cruess et al. (2016), italics theirs).” It has been further defined as an ongoing, self-reflective process aimed at developing habits of “thinking, feeling and acting” that allow learners to be compassionate and socially responsible physicians (Cooke 2010 quoting Ware and Castelini 2000). A staged, developmental framework for PIF has been applied in health professions education (Bebeau & Faber-Langendoen 2014). There is an enthusiastic dialog in the medical education literature about whether PIF can be measured. And it was recently proposed that we add PIF to the tip of Miller’s Pyramid for the assessment of clinical competence and performance (Cruess et al. 2016).

Notes on contributors

Adina Kalet, M.D., M.P.H. directs the Research on Medical Education Outcomes unit at NYU School of Medicine, has received the SGIM National Award for Scholarship in Medical Education in 2008, and is the co-editor of the book Remediation in Medical Education: A Midcourse Correction, published by Springer.

Lynn Buckvar-Keltz, M.D. is the director of the medical student advisory program at NYU School of Medicine and was dean for student affairs for nine years. Her research interests include medical student professional development and preparedness for transition to residency.

Victoria Harnik, Ph.D is the associate dean for curriculum at the New York University School of Medicine, the content director for Anatomy in interdisciplinary pre-clerkship modules and co-authored the Elsevier’s Integrated Anatomy and Embryology textbook and an iBook series Virtual Prosections: The Series.

Verna Monson, Ph.D is a lifespan developmental psychologist (Ph.D., University of Minnesota, 2009) in independent practice. Dr. Monson is an expert in assessment of professional identity formation for graduate medical education and remediation of lapses in professionalism. She is currently engaged as a consultant to New York University Medical School.

Steven Hubbard, Ph.D is the Director of Student Affairs for NYU’s School of Medicine. He also teaches courses at NYU in learning assessment, leadership, and student development. He and his colleague Dr. Frances stage are currently updating their book Linking Theory and Practice: Case Studies for Working with College Students.

Ruth Crowe, M.D., Ph.D is the Director of Practice of Medicine, the core clinical skills training module given throughout pre-clerkship training. She is also Director of Integrated Clinical Skills, working to collaborate across the UME spectrum to integrate core clinical skills training and assessment.

Hyuksoon S. Song, Ph.D is teaching pre-service and in-service teachers in Georgian Court University, New Jersey as an assistant professor of education. For the last decade, he also participates in medical education research by designing studies, analyzing data, and drafting manuscripts.

Sandra Yingling, Ph.D is the Associate Dean for Educational Planning at the University of Illinois College of Medicine, and Assistant Professor in the Department of Medical Education. While at NYU, Dr. Yingling focused on evaluation and assessment, technology-enhanced education, and graduation requirements for clinical skills competence.

Previous presentations

Day One of Medical School: Welcome to Evidence-Based Professional Identity Formation, NEGEA April 28–30, 2016, Providence, RI, Short Communication.

Measuring Professional Identity Development in Medical Students, Academy for Professionalism in Health Care, 4th Annual Meeting, April 8–9, 2016, Philadelphia, PA, Oral Presentation.

Additional information

Funding

This work was supported by the Office of Student Affairs and Office of Medical Education of the New York University School of Medicine.