A dynamic framework of professional identity formation in trainees for low-resource settings: a qualitative study

Professional Identity Formation (PIF) is a dynamic and context-dependent socialisation process; while existing research identifies various influencing factors, there is a paucity of cohesive frameworks that capture the stage-related internalisation of identity elements within practice. This gap is particularly salient in low-resource settings, such as China’s Rural-Streamed Medical Education Programme (RMEP), where substantial turnover and tenuous professional identity among trainees present significant challenges. Drawing upon the Ring Theory of Personhood (RToP) as a theoretical lens, this study aims to construct a dynamic framework for understanding PIF among RMEP trainees, thereby offering insights to enhance PIF for healthcare professionals in low-resource settings. Informed by a pragmatic paradigm, nine focus groups were conducted with 42 RMEP trainees across various training stages in China. Drawing upon the RToP as a sensitising concept, data were analysed using inductive thematic analysis to construct a dynamic framework. A framework comprising 11 themes was constructed across three dimensions: the Societal Domain, encompassing working conditions, policies, attitudes of others, formal teaching and discipline development; the Relational Domain, including relationships with role models, close ones, patients, and peers; and the Individual Domain, incorporating reflective experience, personal character and values. This framework emphasises the dynamic interaction of these themes and the stage-related shifts of PIF, highlighting a shift from external to internal elements while also acknowledging the prominent influence of early external experiences in low-resource settings. By proposing a dynamic framework that maps PIF across different training stages, this study extends existing conceptualizations and provides valuable insights for strengthening it among healthcare professionals in low-resource settings.