Evidencing Professional Identity Formation as a Complex Adaptive System in a Structured Mentoring Programme in Singapore

Background Care of the dying precipitates ethical dilemmas, moral distress and compassion fatigue amongst physicians. If unsupported, the cost of caring negatively impacts a physician’s wellbeing and changes how they think, feel and act as a professional, or their professional identity formation (PIF). Poorly shepherded PIF hinders patient interactions, care and safety and compromises interprofessional working. With the costs of caring an evolving, complex and unpredictable notion that often requires timely, personalised and longitudinal support, I evaluate the possibility of using combined novice, e- and peer-mentoring (CNEP) to attend to the unique needs and experiences of medical students and threats to their PIF. This posit is premised on mentoring steering the closely linked notions of self-concepts of identity and personhood influenced by shifts in belief systems as a result of experiences with the cost of caring. To determine the viability of this premise, I study the ability of CNEP mentoring to shepherd belief systems, PIF and personhood amongst mentees and peer-mentors in a structured CNEP mentoring-based research programme—the Palliative Medicine Initiative. Assuming research experiences will shift belief systems and reshape PIF and personhood, I venture the research question, ‘How does the structured mentoring experience in the Palliative Medicine Initiative shape the professional identity formation of mentees and peer-mentors?’. Methodology To ensure an evidence-based, reproducible and trustworthy approach that will enhance appreciation of this unique mentoring approach and platform its adoption, I employ the Systematic Evidence-Based Approach (SEBA) methodology to guide my reviews and studies. The SEBA methodology’s constructivist ontological and relativist epistemological position guides the synthesis of 34 published and submitted SEBA-guided reviews and studies carried out during the tenure of this PhD. It also platforms the SEBA-guided narrative reviews (NRs in SEBA) that combine the various study and review findings with the design of semi- structured interviews and mentoring diaries based on the Krishna-Pisupati Model for Professional Identity Formation (KPM) (henceforth tools). The tools seek to frame mentee and peer-mentor experiences in the PMI. Results My interviews with 12 PMI mentees and 12 PMI peer-mentors and concurrent evaluation of the reflective diaries of 17 mentees and 12 peer-mentors revealed the complex interplay of contextual and stakeholder influences on PIF. Evidencing the impact of CNEP mentoring on PIF and the mentoring relationships, the NRs in SEBA also inspire the notion that PIF and the mentoring relationships that underpin it are complex adaptive systems (CAS). Conclusion Addressing its primary research question, my thesis reveals that when appropriately supported by trained mentors, CNEP mentoring nurtures PIF amongst engaged mentees and peer-mentors within a structured programme. This approach promotes the development of an internal ii compass or combination of belief systems, competencies and shared programme identity that guides navigation of cost of caring-related experiences that challenge belief systems and reveal CAS-like characteristics. To guide effective use of CNEP mentoring to address the cost of caring, I advance the dual theory of CAS and the CAS-guided Containment-Influence/Infusion-Support-Adapt (CISA) framework to operationalise a mentor training programme. I believe that success of these contributions will enhance medical student wellbeing and steer their PIF