Abstract
Using interpretative phenomenological analysis to make meaning of the experiences of three highly qualified registered nurses who had enrolled in an undergraduate medical programme, this study provides insight into their personal journeys of wanting to become ‘different’ doctors. In so doing, they conceptualised their future selves as adding clinical reasoning and diagnostic skills to the patient-centred caring ethic of their nursing practice, becoming a multi-skilled community member or helping to fix the health care culture. By customising their identities, e.g. by splinting (aligning with their stronger nursing identity), by enriching current nursing practice with newly acquired theory as medical students or by patching a perceived deficiency (i.e. patient-centredness) in medicine, they tailored their identities. Their journeys had, however, not been the natural progression they had anticipated, threatened by perceived and/or real intrinsic (e.g. working as nurses whilst studying medicine) and extrinsic (e.g. interprofessional rivalry) factors. Rather than being accepted as legitimate newcomers to the medical profession, the women sometimes felt like intruders. Some nursing colleagues accused them of desertion. In response, they generally withheld their identities as nurses or medical students, compartmentalising their group membership. This study has highlighted the role of personal (e.g. prior experience; agency; resilience; personality) and contextual factors in ‘becoming’ a doctor. A recommendation emerging from this study is the need for interprofessional learning in the medical curriculum to cultivate a health care culture of collaboration rather than competition. Future research is required in terms of how allied health professionals transition to medicine.
Similar content being viewed by others
References
Andrew, N. (2012). Professional identity in nursing: Are we there yet? Nursing Education Today, 32, 846–849.
Australian Bureau of Statistics. (2015). 3412.0—Migration, Australia, 2013–2014. Retrieved February 22, 2016, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3412.0.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioural change. Psychological Review, 84(2), 191–215.
Barbour, J. B., & Lammers, J. C. (2015). Measuring professional identity: A review of the literature and a multilevel confirmatory factor analysis of identity constructs. Journal of Professions and Organization, 2, 38–60.
Barr, H. (1998). Competent to collaborate: Towards a competency-based model for interprofessional education. Journal of Interprofessional Care, 12, 181–187.
Barrow, M., McKimm, J., & Gascoigne, S. (2011). The policy and the practice: Early-career doctors and nurses as leaders and followers in the delivery room. Advances in Health Sciences Education, 16, 17–29.
Benbassat, J. (2013). Undesirable features of the medical learning environment: a narrative review of the literature. Advances in Health Sciences Education, 18, 527–536.
Biggerstaff, D. L., & Thompson, A. R. (2008). Interpretive phenomenological analysis (IPA): A qualitative methodology of choice in healthcare research. Qualitative Research in Psychology, 5, 173–183.
Birks, M., Mills, J., Francis, K., Coyle, M., et al. (2010). Models of health service delivery in remote or isolated areas of Queensland: A multiple case study. Australian Journal of Advanced Nursing, 28(1), 25–33.
Bridges, J. M. (1990). Literature review on the images of the nurse and nursing in the media. Journal of Advanced Nursing, 15, 850–854.
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89(11), 1446–1451.
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2015). A schematic representation of the professional identity formation and socialization of medical students and residents: A guide for medical educators. Academic Medicine, 90(6), 718–725.
Frost, H. D., & Regehr, G. (2013). “I am a doctor”: Negotiating the discourses of standardization and diversity in professional identity construction. Academic Medicine, 88(10), 1570–1577.
Goldie, J. (2012). The formation of professional identity in medical students: Considerations for educators. Medical Teacher, 34, e641–e648.
Hafferty, F. W., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), 861–871.
Health Workforce Australia. (2012). Health Workforce Australia. Australia’s Health Workforce Series. Health Workforce by Numbers. Issue 1, February 2013. Retrieved August 6, 2014, from https://www.hwa.gov.au/sites/uploads/australias_health_workforce_series_doctors_in_focus_20120322.pdf.
Hewett, D. G., Watson, B. M., Gallois, C., Ward, M., & Leggett, B. A. (2009). Intergroup communication between hospital doctors: Implications for patient care. Social Sciences and Medicine, 69, 1732–1740.
Hilton, S. R., & Slotnick, H. B. (2005). Proto-professionalism: How professionalism occurs across the continuum of medical education. Medical Education, 39, 58–65.
Hoeve, Y. T., Jansen, G., & Roodbol, P. (2014). The nursing profession: public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70(2), 295–309.
Hogg, M. A., & Reid, S. A. (2006). Social identity, self-categorization, and the communication of group norms. Communication Theory, 16, 7–30.
Holden, M., Buck, E., Clark, M., Szauter, K., & Trumble, J. (2012). Professional identity formation in medical education: The convergence of multiple identities. HEC Forum, 24, 245–255.
Hornsey, M. J. (2008). Social identity theory and self-categorization theory: A historical review. Social and Personality Psychology Compass, 2(1), 204–222.
Hornsey, M. J., Oppes, T., & Svensson, A. (2002). “It’s OK if we say it, but you can’t”: Responses to intergroup and intragroup criticism. European Journal of Social Psychology, 32, 293–307.
Ibarra, H. (1999). Provisional selves: Experimenting with image and identity in professional adaptation. Administrative Science Quarterly, 44, 764–791.
Ibarra, H., & Barbulescu, R. (2010). Identity as narrative: Prevalence, effectiveness, and consequences of narrative identity work in macro work role transitions. Academy of Management Review, 35(1), 135–154.
Kaiser, R. (2002). Fixing identity by denying uniqueness: An analysis of professional identity in medicine. Journal of Medical Humanities, 23(2), 95–105.
Langendyk, V., Hegazi, I., Cowin, L., Johnson, M., & Wilson, I. (2015). Imagining alternative professional identities: Reconfiguring professional boundaries between nursing students and medical students. Academic Medicine, 90(6), 732–737.
Leong, J. (2014). From nurse to doctor: The career path less encouraged. Retrieved April 26, 2015, from http://blogs.einstein.yu.edu/from-nurse-to-doctor-the-career-path-less-encouraged/.
Levinson, D. J. (1981). loc. cit.
Lopez, K. A., & Willis, D. G. (2004). Descriptive versus interpretative phenomenology: Their contributions to nursing knowledge. Qualitative Health Research, 14(5), 726–735.
MacLeod, A. (2011). Caring, competence and professional identities. Advances in Health Sciences Education, 16, 375–394.
Mathews, B., & Bismark, M. M. (2015). Sexual harassment in the medical profession: Legal and ethical responsibilities. Medical Journal of Australia, 203(4), 189–192.
McKay, K. A., & Narasimhan, S. (2012). Bridging the gap between doctors and nurses. Journal of Nursing Education and Practice, 2(4), 52–55.
McLean, M., Johnson, P., Sargeant, S., & Green, P. (2015a). Simulated patients’ perspectives of and role in medical students’ professional identity development. Simulation in Health Care, 10(2), 85–91.
McLean, M., Johnson, P., Sargeant, S., & Green, P. (2015b). More than just teaching procedural skills: How RN clinical tutors perceive they contribute to medical students’ professional identity development. Australasian Medical Journal, 8(4), 122–131.
Monrouxe, L. V. (2009). Negotiating professional identities: Dominant and contesting narratives in medical students’ longitudinal audio diaries. Current Narratives, 1, 41–59.
Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education, 44(1), 40–49.
Niemi, P. M. (1997). Medical students’ professional identity: Self-reflection during the preclinical years. Medical Education, 31, 408–415.
Pietkiewicz, I., & Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychological Journal, 20(1), 7–14.
Pratt, M. G., Rockmann, K. W., & Kaufmann, J. B. (2006). Constructing professional identity: The role of work and identity learning cycles in the customization of identity amongst medical residents. Academy of Management Journal, 492, 235–262.
Pringle, J., Drummond, J., McLaffferty, E., & Hendry, C. (2011). Interpretative phenomenological analysis: A discussion and critique. Nurse Researcher, 18(3), 20–24.
Roccas, S., & Brewer, M. S. (2002). Social identity complexity. Personality and Social Psychology Review, 6(2), 88–106.
Romano, C. A., & Pangaro, L. N. (2014). What is a doctor and what is a nurse? A perspective for future practice and education. Academic Medicine, 89(7), 970–972.
Sarukkai, S. (2015). Challenges for STEM education in India. In O. Renn, N. C. Karafyllis, A. Hohlt, & D. Taube (Eds.), International science and technology education. Exploring culture, econonomy and social perceptions (pp. 69–84). New York: Routledge.
Scott, K. M., Caldwell, P. H. Y., Barnes, E. H., & Barrett, J. (2015). Teaching by humiliation and mistreatment of medical students in clinical rotations: A pilot study. Medical Journal of Australia, 203(4), 185. doi:10.5694/mja15.00189.
Sims, D. (2008). Reconstructing professional identity for professional and interprofessional practice: A mixed methods study of joint training programmes in learning disability nursing and social work. Journal of Interprofessional Care, 25, 265–271.
Slay, H. S., & Smith, D. A. (2011). Professional identity construction: Using narrative to understand the negotiation of professional and stigmatized cultural identities. Human Relations, 64(1), 85–107.
Smith, J. A., & Osborn, M. (2008). Interpretive phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to methods (2nd ed.). London: Sage Publications.
Stryker, S., & Burke, P. J. (2000). The past, present, and future of an identity theory. Social Psychology Quarterly, 63(4), 284–297.
ten Hoeve, Y., Jensen, G., & Roodbool, P. (2014). The nursing profession: Public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70(2), 295–309.
Trede, F. (2012). Role or work-integrated learning in developing professionalism and professional identity. Asia-Pacific Journal of Cooperative Education, 1(3), 159–167.
Trede, F., Macklin, R., & Bridges, D. (2012). Professional identity development: A review of the higher education literature. Studies in Higher Education, 37(3), 365–384.
Vågan, A. (2011). Towards a sociocultual perspective on identity formation in education. Mind, Culture, Activity, 18, 43–57.
Wald, H. S. (2015). Professional identity (trans)formation in medical education: Reflection, relationship, resilience. Academic Medicine, 90(6), 701–706.
Wald, H. S., Anthony, D., Hutchinson, T. A., Liben, S., Smilovitch, M., & Donato, A. A. (2015). Professional identity formation in medical education for humanistic, resilient physicians: Pedagogic strategies for bridging theory and practice. Academic Medicine, 90(6), 753–760.
Walton, M. M. (2015). Sexual equality, discrimination and harassment in medicine: it’s time to act. Medical Journal of Australia, 203(4), 167–169.
Weller, J. (2012). Shedding light on tribalism in health care. Medical Education, 46, 132–142.
Wenger, E. (1998). Communities of practice: Learning, meanings and identity. New York: Cambridge University Press.
Wilson, I., Cowin, L. S., Johnson, M., & Young, H. (2013). Professional identity in medical students: Pedagogical challenges to medical education. Teach and Learning in Medicine, 25(4), 369–373.
Wong, A., & Trollope-Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education, 48, 489–501.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
Ethics approval for the professional identity study was obtained from the University’s Human Research Ethics Committee (RO1537).
Rights and permissions
About this article
Cite this article
McLean, M. From being a nurse to becoming a ‘different’ doctor. Adv in Health Sci Educ 22, 667–689 (2017). https://doi.org/10.1007/s10459-016-9700-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-016-9700-y