Drawing the ARC: How medical students shape their professional selves

Challenges with developing a strong professional identity can have adverse consequences like burnout and misconduct. While conceptual models describe how medical students internalize the attitudes, behaviors and norms ascribed to physicianhood, a comprehensive catalog of the processes students employ to drive PIF is lacking. This study aimed to use qualitative evidence to deconstruct and codify so-called ‘mechanisms’ for professional identity formation (PIF) and generate a practical construct for educators. We undertook a cross-sectional qualitative multi-institutional study of 52 graduating medical students from four U.S. medical schools to explore their experiences during medical school. Pairs of investigators coded semi-structured interview transcripts identifying passages relevant to PIF with audit by a third coder for additional validation. Excerpts were reviewed to identify mechanisms and characterize patterns. Analysis of 52 transcripts identified 20 discrete mechanisms that despite overlap, could primarily be categorized into one of three domains: action (experiencing/role enactment, observing, learning from role models, experimenting, acting with agency, isolating oneself, and stepping back), reflection (metacognition/reflection, self-evaluation, evaluation/feedback from others, turning negatives into learning, compartmentalization, and imagining/visualizing) and connection (having support, talking, attachments to others, being trusted, trusting others, teaching, and asking). Students used multiple mechanisms to develop their professional identities with interplay across domains. Discrete mechanisms actively employed by medical students to develop their professional identities can be categorized within domains of action, reflection, and connection (ARC). The ARC construct helps validate existing theories and could be used by educators and advisors to systematize and optimize interventions for PIF.