234 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 233–235

What was considered to be ‘professional’ was infl uenced by factors such as status, attitudes, behaviour, patient expectations, identity, clinical context, organi-sational context and workplace culture.

This study provides insight into the views of professionalism across three health professions, and highlighted that this is

conceptually complex and that there is no universal defi nition. In the clinical environment, professionalism is required at all levels – individual, interpersonal and societal–organisational – and educators need to ensure that individuals are equipped with the skills to recognise and effectively operate within each of these realms. The authors suggest that providing students

with a range of initiatives that focus on discrete, specifi c skills related to professionalism, including the ability to identify appropriate behaviour, rather than attempting to teach professionalism as a high- level, abstract concept would be a more effective way for clinical educators to achieve this.

doi: 10.1111/tct.12258

Professional identity & professionalism Jill Thistlethwaite, Sydney , NSW , Australia

Wong A, Trollope- Kumar K. Refl ections: an inquiry into medical students’ profes-sional identity formation. Med Educ 2014; 48: 489–501.

Professional identity forma-tion is a topic of interest across health professions education. In this article the authors focus on medical students’ develop-ment of professional identity as they make the transition from trainee to medical doctor. The formation is seen as a crucial component of professionalism. Wong & Trollope- Kumar defi ne professional identity by drawing on a number of sources, with its formation being dependent on acquiring appropriate knowl-edge, skills, attitudes, values and behaviours. They reference the work of Hilton & Slotnick, who devised the term ‘protopro-fessionalism’ to indicate that professional identity formation is a linear progression affected by experience and refl ection, leading to maturity; however, they also discuss the constructivist theo-ries that suggest identity forma-tion is dynamic, negotiated and co- constructed within a person ’ s environment.

The research questions under-lying this study are: what are the key infl uences that contribute to

the professional identity forma-tion of medical students during their fi rst 15 months of training;

The formation [of progessionalidentity] is seen

as a crucialcomponent of

professionalism

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© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 233–235 235

and how do they shape profes-sional identity over this time period? The methodology em-ployed is based on constructivism and the concept of ‘becoming ‘, focusing on how students ac-tively construct their professional identities.

The student participants are based at McMaster University in Canada. In their pre- clerkship (i.e. pre- clinical) programme they undertake a professional competencies (ProComp) course to study professionalism, self- awareness, communication skills and moral reasoning, through small group work. During this time they are required to com-pose 10 narratives focusing on ‘the medical student journey’ and ‘the ProComp moment’. These narratives involve the students refl ecting on their personal development as medical doctors and a compelling clinical incident with a professionalism focus.

It is these refl ective narra-tives that the authors analyse to answer the research ques-tions. They recruited 65 stu-dents (from a total class of

194), resulting in 604 narra-tives. These were thematically analysed longitudinally to fol-low individual students over the 15 months of the pre- clerkship. Five themes emerged: prior ex-periences; role models; patient encounters; curriculum (formal and hidden); and societal experiences.

The fi ndings are discussed in detail with relevant quotes to illustrate the themes, which are similar to published literature in this area. Professional identity for-mation is affected by students’ ex-perience before and during medical school, and negotiation between their prior and emerging identities. They identify both positive and negative role models, highlight-ing once again the importance of faculty members’ and other teach-ers’ behaviours, and the impres-sions that they create. The hidden curriculum is a powerful infl uence, involving the ‘unwritten rules’ of the organisation relating to power imbalances and leading to ethical dilemmas. Students write about their encounters with patients and, in particular, the emotional and physical impact of interacting

with human suffering. In terms of society, students discuss changes in how they come to be perceived and the responsibilities that this brings.

The article includes examples of three narratives to stress the longitudinal, and therefore innovative, nature of the study and the change in students over time. These longer texts sup-port the concept of professional identity formation as a dynamic, evolving and co- constructed process of ‘becoming’. The authors conclude by recom-mending strategies to improve activities related to profession-alism; they stress the impor-tance of the formal curriculum as a vehicle for learning and developing students’ sense of societal responsibility. Faculty member development is impor-tant to support students and ensure positive role modelling. Refl ective writing enhances students’ self- awareness and provides faculty members with insights into student develop-ment and transition.

doi: 10.1111/tct.12250

Faculty member development is importantto support students and ensure positive role modelling

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