Identifying as an intensivist: The transition from failure to success in a high-stakes medical specialist exam

Failing high-stakes examinations in specialist medical training has devastating effects on trainees, both personally and professionally, with some trainees requiring multiple attempts. Factors enabling the transition from failure to success are under-explored. This study aims to understand how intensive care trainees, taking multiple attempts at the final high-stakes exam for progression to specialist, made the transition from failure to success, and their lived experience of the journey. This qualitative study applied grounded theory design, conducting 11 in-depth interviews. All participants had had two or more failed attempts before achieving success in the final high-stakes examination, a critical hurdle in achieving Fellowship with the College of Intensive Care Medicine. Additional data included exam reports, an external review of the exam processes, and research notes. To achieve exam success participants needed to reconstruct their sense of self, develop a growth mindset and identify as a competent intensivist. The constructed theory, 'Identifying as an intensivist', relates to professional identity formation and 'thinking, acting and feeling' as an intensivist. 'Identifying as an intensivist' was integral to overcoming exam failure for intensive care trainees. Professional identity formation as an aspect of remediation for high-stakes assessments in medical specialty training has not been well described. Furthermore, assessment processes should be constructed to align with a professional identity reflecting the values and diversity of the specialty.