PROFESSIONAL IDENTITY ESSAYS IDENTIFY CHALLENGES FOR ENTERING MEDICAL STUDENTS

ABSTRACT

BACKGROUND: Professional identity formation (PIF) is a critical part of medical education. PIF among medical students has been shown to vary as measured by the Professional Identity Essay (PIE), an assessment based on Kegan's theory of adult development and Bebeau's developmental model of professional identity. The PIE consists of written responses to nine prompts designed to elicit what students understand to be expectations from themselves, the profession, and society, as well as potential challenges in meeting these expectations. We sought to identify what themes arise for incoming medical students considering how to develop a strong professional identity. METHODS: Students at NYU complete the PIE as part of an ongoing professionalism curriculum. We examined the PIEs of 93 students entering NYU Grossman SOM in 2019, all who consented to using educational data as part of a medical education registry. Two independent readers conducted a thematic analysis of these PIEs. RESULTS: Six overarching domains were identified “Challenges/Conflicts,” “Current and Future Personal Skills and Resources,” “Professional Norms/ Values/Ideals,” “Sources of Information About Ideal Physician,” “Emotions Expressed,” and “Emotional Tone.” Mental health is commonly expressed as an anticipated challenge. Students aspire to build resilience, yet they enter medical school with little experience of failure “In high school/college (and especially as a premed), failure was essentially not an option.” Students rarely identify their colleagues as a source of advice and support. While students recognize the importance of self-care, there is less certainty around incorporating it into a busy schedule “It has often been an issue for me to forego my physical and emotional health in the pursuit of my goals and responsibilities.” In addition, this fear of failure is most often associated with the challenge of a global “loss of trust” in medicine. Students fear that making a mistake will lead to an overall loss of trust in physicians, causing further mental health challenges and consequences for their career such as derailment, termination, or criminal or civil litigation. CONCLUSIONS: Given that mental health issues have been exacerbated since 2019 by the COVID-19 pandemic, educators must be aware of and address the conflict between demanding medical school expectations and the individual expectation that students maintain their mental health through selfcare. Further, students often enter medical school with a strong reliance on their individual competency. Thus, the pandemic may also represent an opportunity for medical schools to emphasize the importance of teamwork, the need for system improvements, and leadership capacity among physicians. Medical educators should actively build peer support and community to cultivate resilient physicians.