Professional Identity Formation in Clinical Medical Education: A Multicenter Narrative Study of Contextual Mediation and Reflective Meaning-Making

Introduction: Understanding how physicians interpret their societal and institutional contexts remains crucial for addressing the complexities of professional identity. This study explores professional identity formation (PIF) in clinical medical education through learners’ narratives and the perspectives of their role models. Methods: Using a multi-center qualitative narrative design, data were collected from clinical-year medical students across accredited state and private medical faculties representing diverse geographical regions. Reflective narrative writing and in-depth interviews were analyzed through a staged contextual qualitative approach. Results: Findings indicate that PIF is shaped through the dynamic interplay between clinical environments, societal and systemic structures, role modelling, and learners’ reflective engagement. Narratives framed professional identity not only in terms of technical competence but also through relational, ethical, and humanistic dimensions. Contextual analysis revealed that tensions between service demands and educational engagement, hierarchy and learner agency, and technical efficiency and humanistic care significantly influenced identity development. Reflection and narrative meaning-making emerged as mediating processes through which learners interpreted and internalized these experiences. Discussion: Drawing on a socio-cultural paradigm informed by activity theory, the study proposes a conceptual framework positioning PIF as a relational and contextually mediated construction shaped by both planned and implicit learning processes. The findings underscore the need for medical education programs to intentionally integrate reflective, narrative, and context-sensitive approaches to support sustainable professional identity development.