Professional identity development during transitions in medical training

Professional identity is an area of ongoing debate and interest in medical training. It is recognised that fostering a sense of identity as a doctor is linked to improved wellbeing and workforce retention. Research to date has focused on the professional identity transition of becoming a doctor on completion of medical school. This thesis explores professional identity development during various transitions across the spectrum of medical training including becoming a doctor, joining a specialty and transitioning into a senior role with increased responsibility. This thesis applies three overarching and overlapping perspectives to frame the qualitative studies included: educational, social and psychological. It also presents a study that intersects these perspectives. A total of four publications are included, each with an individual empirical chapter to present the underpinning conceptual framework, the implications and a critical reflection of the work. The findings describe how simulation-based education can result in perspective change and a recognition of the importance of non-technical skills for final year medical students as they transition to clinical practice. Moving to postgraduate training, the social identity perspective offers insight into doctors’ socialisation in the workplace when committing to a hospital specialty including an expectation of conflict between specialties and negative perceptions of outgroups. Developing a specialty identity is a double-edged sword promoting a sense of belonging for the ingroup, whilst othering outgroups which can lead to stereotyping and conflict. Considering transition to senior roles, narrative analysis is used to explore how professional identity transitions can result in identity dissonance and how a sense of agency can prompt positive reflection during transitions. The transition to the role of medical registrar is multifaceted and includes interacting social identities. Conceptualised as a Rubik’s cube, the transition involves rotations between the facets of ‘doing’ and ‘being,’ until these align reducing dissonance between competence and identity. This includes the interaction of social identities such as gender and country of origin, adding further barriers to navigate during this transition. The overarching findings of this programme of research support specific implications for practice to consider. Civility and perspective taking in the learning environment is advocated to prevent or mitigate outgroup derogation and conflict. Narrative reflection for transitions, for example through coaching, should be encouraged to support identity development. Improving learner agency during transitions through clearer role and rota expectations could reduce identity dissonance. Simulation-based education provides an opportune environment to promote perspective change and support identity development during medical training.