Advertisement

From physiotherapy to the army: negotiating previously developed professional identities in mature medical students

  • Rachel Matthews
  • Kelby Smith-HanEmail author
  • Helen Nicholson
Article

Abstract

Professional identity formation, the process of transformation from lay person to doctor, is at the heart of medical education. Medical student cohorts can include students who enter medicine from a previous career, i.e. with developed professional identities and who are usually older and more mature. Students with previously developed professional identities may have specific challenges in negotiating their new ‘doctor’ identity. This study examined the development of professional identity in mature medical students who had a variety of previous careers prior to entering medical school. A narrative inquiry was undertaken using interviews of mature medical students with backgrounds that included physiotherapy, clinical physiology, public health and nutrition, and the armed forces. A narrative analysis was conducted combining both thematic and structural perspectives using linguistics and positioning theory as interpretive tools. Three main themes emerged that portray the development processes that arise in this cohort as they develop their medical professional identity: holding back aspects of the previous self; foregrounding aspects of the previous self; and developing new aspects towards forming a ‘new’ self. These themes and their implications are discussed in the context of current literature, highlighting some of the specific challenges that this cohort faces in developing their medical identity. We argue that dedicated faculty and student development be offered, exploring how professional identity formation in mature medical students can be facilitated and supported, so staff and students are better equipped to engage and shape mature students’ professional identity in a meaningful way.

Keywords

Professional identity formation Mature medical students Older medical students Narrative research Qualitative research 

Notes

Acknowledgements

The authors are grateful to the medical students for providing their time to participate in this study at a difficult time of the year.

References

  1. Andrews, M., Squire, C., & Tamboukou, M. (Eds.). (2013). Doing narrative research. London: Sage.Google Scholar
  2. Atkinson, P. (1995). Medical talk and medical work. London: Sage.Google Scholar
  3. Bamberg, M. (1997). Positioning between structure and performance. Journal of Narrative and Life History,7(1), 335–342.CrossRefGoogle Scholar
  4. Bamberg, M. (2003). Positioning with Davie Hogan—Stories, tellings and identities. In C. Daiute & C. Lightfood (Eds.), Narrative analysis: Studying the development of individuals in society (pp. 135–158). London: Sage.Google Scholar
  5. Bamberg, M., & Georgakopoulou, A. (2008). Small stories as a new perspective in narrative and identity analysis. Text & Talk,28, 377–396.CrossRefGoogle Scholar
  6. Bleakley, A., Bligh, J., & Browne, J. (2011). Medical education for the future: Identity, power and location. London: Springer.CrossRefGoogle Scholar
  7. Bold, C. (2012). Using narrative in research. London: Sage.CrossRefGoogle Scholar
  8. Caldas-Coulthard, C., & Iedema, R. (Eds.). (2008). Identity trouble. Hampshire: Palgrave Macmillan.Google Scholar
  9. Chur-Hansen, A. (2003). Mature-aged medical students: A qualitative study. Learning in Health and Social Care,2(3), 159–168.CrossRefGoogle Scholar
  10. Clandinin, D., & Cave, M. T. (2008). Creating pedagogical spaces for developing doctor professional identity. Medical Education,42(8), 765–770.  https://doi.org/10.1111/j.1365-2923.2008.03098.x.CrossRefGoogle Scholar
  11. Cooke, M., Irby, D. M., & O’Brien, B. C. (2010). Educating physicians: A call for reform of medical school and residency. Stanford, CA: Jossey-Bass.Google Scholar
  12. Costello, C. (2005). Professional identity crisis: Race, class, gender, and success at professioanl schools. Nashville, TN: Vanderbuilt Univeristy Press.Google Scholar
  13. 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, 1446–1451.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. Davies, B., & Harré, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour,20(1), 43–63.CrossRefGoogle Scholar
  16. De Fina, A. (2013). Positioning level 3. Connecting local identity displays to macro-social processes. Narrative Inquiry,23(1), 40–61.CrossRefGoogle Scholar
  17. De Fina, A., Shiffrin, D., & Bamberg, M. (2006). Discourse and identity. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  18. Finlay, G., & Gough, B. (2003). Reflexivity: A practical guide for researchers in health and social sciences. Oxford: Blackwell.CrossRefGoogle Scholar
  19. Gallagher, P., & Hoare, K. (2015). Transition: Health professionals as medical students. The Clinical Teacher, 16, 223–226.Google Scholar
  20. Goldie, J. (2012). The formation of professional identity in medical students: Considerations for educators. Medical Teacher,34(9), e641–e648.CrossRefGoogle Scholar
  21. Goodwin, E. (2016). ED, board slated after death of young girl. Otago Daily Times. Retrieved February 2, 2017 from https://www.odt.co.nz/news/dunedin/health/ed-board-slated-after-death-young-girl.
  22. Gubrium, J. F., & Holstein, J. A. (1997). The new language of qualitative method. Oxford: Oxford Univeristy Press.Google Scholar
  23. Jarvis-Selinger, S., Pratt, D. D., & Regehr, G. (2012). Competency is not enough: Integrating identity formation into the medical education discourse. Academic Medicine,87(9), 1185–1190.CrossRefGoogle Scholar
  24. Jenkins, R. (2008). Social identity (4th ed.). London: Routledge.Google Scholar
  25. Jurjus, R. A., Butera, G., Abdelnabi, M., & Krapf, J. M. (2017). Comparing the experience of mature-aged and traditional medical students in the clinical setting: A qualitative approach. Journal of Academic Development and Education,7, 8–28.Google Scholar
  26. Kay, J., & Blythe, M. (1984). Professionalization of the older medical student. Academic Medicine,59(7), 559–566.CrossRefGoogle Scholar
  27. Kick, S., Adams, L., & O’Brien-Gonzales, A. (2000). Unique issues of older medical students. Teaching and Learning in Medicine,12(3), 150–155.CrossRefGoogle Scholar
  28. Kusurkar, R., Kruitwagen, C., ten Cate, O., & Croiset, G. (2010). Effects of age, gender and educational background on strength of motivation for medical school. Advances in Health Sciences Education,15(3), 303–313.CrossRefGoogle Scholar
  29. Labov, W. (1997). Some further steps in narrative analysis. Journal of Narrative and Life History,7, 395–415.CrossRefGoogle Scholar
  30. Lemke, J. (2008). Identity, developement and desire: Critical questions. In C. Caldas-Coulthard & R. Iedema (Eds.), Identity trouble: Critical discourse and contested identities. Palgrave: Hampshire.Google Scholar
  31. Mathers, J., & Parry, J. (2010). Older mature students’ experiences of applying to study medicine in England: An interview study. Medical Education,44(11), 1084–1094.CrossRefGoogle Scholar
  32. McLean, M. (2017). From being a nurse to becoming a ‘different’ doctor. Advances in Health Sciences Education,22(3), 667–689.  https://doi.org/10.1007/s10459-016-9700-y.CrossRefGoogle Scholar
  33. Meadows, L., & Dodendorf, D. (1999). Data management and interpretation using computers to assist. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research. Thousand Oaks, CA: Sage.Google Scholar
  34. Monrouxe, L. V. (2009a). Negotiating professional identities: Dominant and contesting narratives in medical students’ longitudinal audio diaries. Current Narratives,1(1), 41–59.Google Scholar
  35. Monrouxe, L. V. (2009b). Solicited audio diaries in longitudinal narrative research: A view from inside. Qualitative Research,9(1), 81–103.CrossRefGoogle Scholar
  36. Monrouxe, L. V. (2010). Identity, identification and medical education: Why should we care? Medical Education,44(1), 40–49.CrossRefGoogle Scholar
  37. Monrouxe, L. V., & Sweeny, K. (2013). Between two worlds: Medical students narrating identity tensions. In C. Figley, P. Huggard, & C. E. Rees (Eds.), First do no self-harm: Understanding and promoting physician stress resilience. Oxford: Oxford University Press.Google Scholar
  38. O’Flynn, S., Power, S., Horgan, M., & O’Tuathaigh, C. M. P. (2014). Attitudes towards professionalism in graduate and non-graduate entrants to medical school. Education for Health,27(2), 200.CrossRefGoogle Scholar
  39. Otago Medical School. (2018). Medicine: Guidelines for admission. Retrieved February 2, 2017 from https://www.otago.ac.nz/healthsciences/students/professional/medicine/index.html.
  40. Patterson, W. (2013). Narrative of events: Labovian narrative analysis. In M. Andrews, C. Squire, & M. Tamboukou (Eds.), Doing narrative events (pp. 27–46). London: Sage.CrossRefGoogle Scholar
  41. Patton, M. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks: Sage.Google Scholar
  42. Ricoeur, P. (1992). Oneself as another. Chicago: University of Chicago Press.Google Scholar
  43. Riessman, C. (1993). Narrative analysis. Newbury Park, CA: Sage.Google Scholar
  44. Riessman, C. K. (2003). Performing identities in illness narrative: Masculinity and multiple sclerosis. Qualitative Research,3(1), 5–33.CrossRefGoogle Scholar
  45. Riessman, C. (2008). Narrative methods for the human sciences. Thousand Oaks: Sage.Google Scholar
  46. Salmon, P., & Riessman, C. (2013). Looking back on narrative research: An exchange. In M. Andrews, C. Squire, & M. Tamboukou (Eds.), Doing narrative research (pp. 197–204). London: Sage.CrossRefGoogle Scholar
  47. Samuel, R., Shuen, A., Dendle, C., Kotsanas, D., Scott, C., & Stuart, R. (2012). Hierarchy and Hand Hygiene: Would medical students speak up to prevent hospital-acquired infection? Infection Control, Hospital Epidemiology,33(8), 861–863.  https://doi.org/10.1086/666634.CrossRefGoogle Scholar
  48. Schwartz, S., Luyckx, K., & Vignoles, V. (Eds.). (2011). Handbook of identity theory and research: Volume 1 structures and processes. New York: Springer.Google Scholar
  49. Shacklady, J., Holmes, E., Mason, G., Davies, I., & Dornan, T. (2009). Maturity and medical students’ ease of transition into the clinical environment. Medical Teacher,31(7), 621–626.CrossRefGoogle Scholar
  50. Sharpless, J., Baldwin, N., Cook, R., Kofman, A., Morley-Fletcher, A., Slotkin, R., et al. (2015). The becoming: Students’ reflections on the process of professional identity formation in medical education. Academic Medicine,90(6), 713–717.CrossRefGoogle Scholar
  51. Steier, F. (1991). Research and reflexivity. London: Sage.Google Scholar
  52. van Ryn, M., Burgess, D., Malat, J., & Griffin, J. (2006). Physicians’ perceptions of patients’ social and behavioral characteristics and race disparities in treatment recommendations for men with coronary artery disease. American Journal of Public Health,96(2), 351–357.CrossRefGoogle Scholar
  53. van Ryn, M., & Burke, J. (2000). The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science and Medicine,50(6), 813–828.  https://doi.org/10.1016/S0277-9536(99)00338-X.CrossRefGoogle Scholar
  54. Warmington, S., & McColl, G. (2017). Medical student stories of participation in patient care-related activities: The construction of relational identity. Advances in Health Sciences Education,22(1), 147–163.  https://doi.org/10.1007/s10459-016-9689-2.CrossRefGoogle Scholar
  55. Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. New York: Cambridge University Press.CrossRefGoogle Scholar
  56. Wong, A., & Trollope-Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education,48(5), 489–501.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anatomy, School of Biomedical SciencesUniversity of OtagoDunedinNew Zealand

Personalised recommendations