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Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education Cover

Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education

Open Access
|Nov 2023

References

  1. Sarraf-Yazdi S, Teo N, How AEH, et al. A scoping review of professional identity formation in undergraduate medical education. J Gen Intern Med. 2021; 36(11): 351121. DOI: 10.1007/s11606-021-07024-9
  2. Mount GR, Kahlke R, Melton J, Varpio L. A critical review of professional identity formation interventions in medical education. Acad Med. 2022; 97(11suppl): S96S106. DOI: 10.1097/ACM.0000000000004904
  3. Sawatsky AP, Huffman BM, Hafferty FW. Coaching versus competency to facilitate professional identity formation. Acad Med. 2020; 95(10): 151114. DOI: 10.1097/ACM.0000000000003144
  4. Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012; 87(9): 118590. DOI: 10.1097/ACM.0b013e3182604968
  5. McGaghie WC, Miller GE, Sajiid AW, Telder TV. Competency-based curriculum development in medical education: an introduction. Public Health Pap. 1978; 68: 1191.
  6. Harden RM, Crosby JR, Davis MH. AMEE Guide No. 14: Outcomes-based education: part 1- an introduction to outcomes-based education. Med Teach. 1999; 21(1): 714. DOI: 10.1080/01421599979969
  7. Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn LT, Corrigan JM, Donaldson MS. (eds.) To err is human: building a safer health system. Washington, DC: National Academies Press (US); 2000. DOI: 10.17226/9728
  8. Dixon-Woods M, Yeung K, Bosk CL. Why is U.K. medicine no longer a self-regulating profession? the role of scandals involving “bad apple” doctors. Soc Sci Med. 2011; 73(10): 145259. DOI: 10.1016/j.socscimed.2011.08.031
  9. Edgar L, McLean S, Hogan SO, Hamstra S, Holmboe ES. The milestones guidebook. Chicago, Illinois: Accreditation Council For Graduate Medical Education (ACGME); 2020. https://www.acgme.org/globalassets/milestonesguidebook.pdf.
  10. Frank JR, Snell LS, Sherbino J. CanMEDS 2015 physician competency framework. Ottawa, Ontario: Royal College of Physicians and Surgeons of Canada; 2017. https://canmeds.royalcollege.ca/en/framework. DOI: 10.1056/NEJMsr1200117
  11. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system: rationale and benefits. N Engl J Med. 2012; 366(11): 105156. DOI: 10.1056/NEJMsr1200117
  12. Cruess SR, Cruess RL. Professionalism must be taught. BMJ. 1997; 315(7123): 167477. DOI: 10.1136/bmj.315.7123.1674
  13. Cruess RL, Cruess SR. Teaching professionalism: general principles. Med Teach. 2006; 28(3): 2058. DOI: 10.1080/01421590600643653
  14. Cruess RL, Cruess SR. Teaching medicine as a profession in the service of healing. Acad Med. 1997; 72(11): 94152. DOI: 10.1097/00001888-199711000-00009
  15. Hodges BD, Ginsburg S, Cruess R, et al. Assessment of professionalism: recommendations from the Ottawa 2010 conference. Med Teach. 2011; 33(5): 35463. DOI: 10.3109/0142159X.2011.577300
  16. Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. Acad Med. 2009; 84(5): 55158. DOI: 10.1097/ACM.0b013e31819fbaa2
  17. Cruess SR, Cruess RL. Teaching professionalism: why, what and how. Facts Views Vis Obgyn. 2012; 4(4): 25965.
  18. Frank JR, Snell LS, ten Cate O, et al. Competency-based medical education: theory to practice. Med Teach. 2010; 32(8): 63845. DOI: 10.3109/0142159X.2010.501190
  19. Englander R, Frank JR, Carraccio C, Sherbino J, Ross S, Snell L, ICBME Collaborators. Towards a shared language for competency-based medical education. Med Teach. 2017; 39(6); 58287. DOI: 10.1080/0142159X.2017.1315066
  20. Hawkins RE, Welcher CM, Holmboe ES, et al. Implementation of competency-based medical education: are we addressing the concerns and challenges? Med Educ. 2015; 49(11): 10861102. DOI: 10.1111/medu.12831
  21. Carraccio CL, Englander R. From Flexner to competencies: reflections on a decade and the journey ahead. Acad Med. 2013; 88(8): 106773. DOI: 10.1097/ACM.0b013e318299396f
  22. Sherbino J, Regehr G, Dore K, Ginsburg S. Tensions in describing competency-based medical education: a study of Canadian key opinion leaders. Adv Health Sci Educ. 2021; 26(4): 127789. DOI: 10.1007/s10459-021-10049-8
  23. Irby DM, Hamstra SJ. Parting the clouds: three professionalism frameworks in medical education. Acad Med. 2016; 91(12): 160611. DOI: 10.1097/ACM.0000000000001190
  24. Cooke M, Irby DM, O’Brien C. Educating physicians: a call for reform of medical school and residency. San Francisco, Calif: Jossey-Bass; 2010.
  25. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Acad Med. 2014; 89(11): 144651. DOI: 10.1097/ACM.0000000000000427
  26. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015; 90(6): 71825. DOI: 10.1097/ACM.0000000000000700
  27. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge, England: Cambridge University Press; 1991. DOI: 10.1017/CBO9780511815355
  28. Toubassi D, Schenker C, Roberts M, Forte M. Professional identity formation: linking meaning to well-being. Adv Health Sci Educ Theory Pract. 2023; 28(1): 30518. DOI: 10.1007/s10459-022-10146-2
  29. Sternszus R. Developing a professional identity: a learner’s perspective. In: Cruess RL, Cruess SR, Steinert Y (eds). Teaching medical professionalism: supporting the development of a professional identity. 2nd ed. Cambridge, NY: Cambridge University Press; 2016. 2636. DOI: 10.1017/CBO9781316178485.004
  30. Grant J. The incapacitating effects of competence: a critique. Adv Health Sci Educ Theory Pract. 1999; 4(3): 27177. DOI: 10.1023/A:1009845202352
  31. Frost HD, Regehr G. “I am a doctor”: negotiating the discourses of standardization and diversity in professional identity construction. Acad Med. 2013; 88(10): 157077. DOI: 10.1097/ACM.0b013e3182a34b05
  32. Menezes N, Hawa R, Oswald R, Lee EK. Does one size truly fit all? the COUPE undergraduate perspective on competency-based medical education in psychiatry. Can J Psychiatry. 2018; 63(6): 35660. DOI: 10.1177/0706743718758967
  33. Khursigara-Slattery N. ‘Be’ Report - Stakeholder Feedback on Proposed ‘Be’ Template & Content. Dissemination and Feedback on a Proposed Template and Content for the Intern Curriculum Framework. University of Limerick; 2023. Report. DOI: 10.34961/researchrepository-ul.22269448.v1
  34. Torre DM, Daley BJ, Sebastian JL, Elnicki DM. Overview of current learning theories for medical educators. Am J Med. 2006; 119(10): 90307. DOI: 10.1016/j.amjmed.2006.06.037
  35. ten Cate O. Competency-based medical education. In: Cockerham WC, Dingwall R, Quah SR (eds.), The Wiley-Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Hoboken, NJ: John Wiley & Sons, Ltd; 2014.132935. DOI: 10.1002/9781118410868.wbehibs331
  36. Erikson EH. The lifecycle completed. New York, NY: Norton; 1982.
  37. Kegan R. The evolving self: problems and process in human development. Cambridge, Mass: Harvard University Press; 1982. DOI: 10.4159/9780674039414
  38. Wald HS, Anthony D, Hutchinson TA, Liben S, Smilovitch M, Donato AA. Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Acad Med. 2015; 90(6): 75360. DOI: 10.1097/ACM.0000000000000725
  39. Chandran L, Iuli RJ, Strano-Paul L, Post SG. Developing «a way of being»: deliberate approaches to professional identity formation in medical education. Acad Psychiatry. 2019; 43(5): 52127. DOI: 10.1007/s40596-019-01048-4
  40. Barnhoorn PC, Nierkens V, Numans ME, Steinert Y, van Mook WNKA. “What kind of doctor do you want to become?”: clinical supervisors’ perceptions of their roles in the professional identity formation of general practice residents. [published online ahead of print Oct 26, 2022]. Med Teach. DOI: 10.1080/0142159X.2022.2137395
  41. Sternszus R, Boudreau JD, Cruess RL, Cruess SR, Macdonald ME, Steinert Y. Clinical teachers’ perceptions of their role in professional identity formation. Acad Med. 2020; 95(10): 159499. DOI: 10.1097/ACM.0000000000003369
  42. Holden MD, Buck E, Luk J, et al. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). Acad Med. 2015; 90(6): 76167. DOI: 10.1097/ACM.0000000000000719
  43. Finn G, Garner J, Sawdon M. ‘You’re judged all the time!’ students’ views on professionalism: a multicenter study. Med Educ. 2010; 44(8): 81425. DOI: 10.1111/j.1365-2923.2010.03743.x
  44. Brainard AH, Brislen HC. Viewpoint: learning professionalism: a view from the trenches. Acad Med. 2007; 82(11): 101014. DOI: 10.1097/01.ACM.0000285343.95826.94
  45. Hamstra SJ, Woodrow SI, Mangrulkar RS. Feeling pressure to stay late: socialisation and professional identity formation in graduate medical education. Med Educ. 2008; 42(1); 79. DOI: 10.1111/j.1365-2923.2007.02958.x
  46. Alexis, DA, Kearney, MD, Williams JC, Xu C, Higginbotham EJ, Aysola J. Assessment of perceptions of professionalism among faculty, trainees, staff, and students in a large university-based health system. JAMA Netw Open. 2020; 3(11): e2021452. DOI: 10.1001/jamanetworkopen.2020.21452
  47. Volpe RL, Hopkins M, Geathers J, Smith CW, Cuffee Y. Negotiating professional identity formation in medicine as an ‘outsider’: the experience of professionalization for minoritized medical students. SSM Qual Res Health. 2021; 1: 100017. DOI: 10.1016/j.ssmqr.2021.100017
  48. Machado MB, Ribeiro DL, de Carvalho Filho MA. Social justice in medical education: inclusion is not enough-it’s just the first step. Perspect Med Educ. 2022; 11(4): 18795. DOI: 10.1007/S40037-022-00715-X
  49. Santivasi WL, Nordhues HC, Hafferty FW, et al. Reframing professional identity through navigating tensions during residency: a qualitative study. Perspect Med Educ. 2022; 11(2): 93100. DOI: 10.1007/S40037-022-00709-9
  50. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. 2019; 111(4): 38392. DOI: 10.1016/j.jnma.2019.01.006
  51. LaVeist TA, Pierre G. Integrating the 3Ds: social determinants, health disparities, and health-care workforce diversity. Public Health Rep. 2014; 129(suppl 2): 914. DOI: 10.1177/00333549141291S204
  52. Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health affairs. 2002; 21(5): 90102. DOI: 10.1377/hlthaff.21.5.90
  53. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008; 300(10): 113545. DOI: 10.1001/jama.300.10.1135
  54. ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ. 2017; 34(5): Doc69. DOI: 10.3205/zma001146
  55. Batt AM, Tavares W, Williams B. The development of competency frameworks in healthcare professions: a scoping review. Adv in health sci educ. 2020; 25(4): 91387. DOI: 10.1007/s10459-019-09946-w
  56. Bates J, Schrewe B, Ellaway RH, Teunissen PW, Watling C. Embracing standardisation and contextualisation in medical education. Med Educ. 2019; 53(1): 1524. DOI: 10.1111/medu.13740
  57. Teunissen PW, Watling CJ, Schrewe B, et al. Contextual competence: how residents develop competent performance in new settings. Med Educ. 2021; 55(9): 110009. DOI: 10.1111/medu.14517
  58. Veen M, de la Croix A. How to grow a professional identity: philosophical gardening in the field of medical education. Perspect Med Educ. 2023; 12(1): 1219. DOI: 10.5334/pme.367
  59. Brown MEL, Whybrow P, Kirwan G, Finn GM. Professional identity formation within longitudinal integrated clerkships: a scoping review. Med Educ. 2021; 55(8): 91224. DOI: 10.1111/medu.14461
  60. Boudreau DJ, Cruess SR, Cruess RL. Physicianship: educating for professionalism in the post- Flexnerian era. Perspect Biol Med. 2011; 54(1): 89105. DOI: 10.1353/pbm.2011.0000
  61. Snell L. Teaching professionalism and fostering professional values during residency: the McGill experience. In Cruess RL, Cruess SR, Steinert Y (eds.), Teaching medical professionalism. Cambridge, NY: Cambridge University Press; 2009: 24663. DOI: 10.1017/CBO9780511547348.016
  62. Ten Cate O, Khursigara-Slattery N, Cruess RL, Hamstra SJ, Steinert Y, Sternszus R. Medical competence as a multilayered construct. Med Educ. 2023 Jul 16. DOI: 10.1111/medu.15162
  63. Volpe RL, Hopkins M, Haidet P, Wolpaw DR, Adams NE. Is research on professional identity formation biased? early insights from a scoping review and metasynthesis. Med Educ. 2019; 53(2): 11932. DOI: 10.1111/medu.13781
  64. Wyatt TR, Rockich-Winston N, Taylor TR, White D. What does context have to do with anything? a study of professional identity formation in physician-trainees considered underrepresented in medicine. Acad Med. 2020; 95(10): 158793. DOI: 10.1097/ACM.0000000000003192
  65. Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010; 32(8): 67682. DOI: 10.3109/0142159X.2010.500704
  66. Lockyer J, Carraccio C, Chan MK, et al. ICBME Collaborators. Core principles of assessment in competency-based medical education. Med Teach. 2017; 39(6): 60916. DOI: 10.1080/0142159X.2017.1315082
  67. Schumacher DJ, Michelson C, Winn AS, Turner DA, Elshoff E, Kinnear B. Making prospective entrustment decisions: knowing limits, seeking help and defaulting. Med Educ. 2022; 56(9): 892900. DOI: 10.1111/medu.14797
  68. ten Cate O, Carraccio C, Damodaran A, et al. Entrustment decision making: extending miller’s pyramid. Acad Med. 2021; 96(2): 199204. DOI: 10.1097/ACM.0000000000003800
  69. Cruess RL, Cruess SR, Steinert Y. Amending miller’s pyramid to include professional identity formation. Acad Med. 2016; 91(2): 18085. DOI: 10.1097/ACM.0000000000000913
  70. Niemi PM. Medical students’ professional identity: self-reflection during the preclinical years. Med Educ. 1997; 31(6): 40815. DOI: 10.1046/j.1365-2923.1997.00697.x
  71. Kalet A, Buckvar-Keltz L, Harnik V, et al. Measuring professional identity formation early in medical school. Med Teach. 2017; 39(3): 25561. DOI: 10.1080/0142159X.2017.1270437
  72. Buck E, West C, Graham L, Frye AW, Teal CR. Challenges to assessing professional identity in medical students: a tale of two measures. Med Educ Online. 2019; 24(1): 1649571. DOI: 10.1080/10872981.2019.1649571
  73. Garza KB, Moseley LE, Ford CR. Assessment of professional identity formation: challenges and opportunities. New Dir Teach Learn. 2021; 168: 14751. DOI: 10.1002/tl.20476
  74. Norcini J, Shea J. Assessment of professionalism and progress in the development of a professional identity. In: Cruess RL, Cruess SR, Steinert Y (eds.) Teaching medical professionalism: supporting the development of a professional identity. 2nd ed. Cambridge, NY: Cambridge University Press; 2016. 15568. DOI: 10.1017/CBO9781316178485.013
  75. Soleas E, Dagnone D, Stockley D, Garton K, van Wylick R. Developing academic advisors and competence committees members: a community approach to developing CBME faculty leaders. Can Med Educ J. 2020; 16: 11(1): e46e56. DOI: 10.36834/cmej.68181
  76. Regehr G, Ginsburg S, Herold J, Hatala R, Eva K, Oulanova O. Using “standardized narratives” to explore new ways to represent faculty opinions of resident performance. Acad Med. 2012; 87(4): 41927. DOI: 10.1097/ACM.0b013e31824858a9
  77. Ginsburg S, van der Vleuten CPM, Eva KW. The hidden value of narrative comments for assessment: a quantitative reliability analysis of qualitative data. Acad Med. 2017; 92(11): 161721. DOI: 10.1097/ACM.0000000000001669
DOI: https://doi.org/10.5334/pme.1027 | Journal eISSN: 2212-277X
Language: English
Submitted on: Apr 22, 2023
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Accepted on: Oct 24, 2023
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Published on: Nov 6, 2023
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2023 Robert Sternszus, Natasha Khursigara Slattery, Richard L. Cruess, Olle ten Cate, Stanley J. Hamstra, Yvonne Steinert, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.