These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.

Professional Identity Formation (PIF), the process of internalizing a profession's core values and beliefs, is an explicit goal of medical education. The Professional Identity Essay (PIE), a developmental measure of the extent to which individuals have a complex and self-defined understanding of their professional role, is a tool to both study and scaffold PIF. PIE staging has internal reliability and response process validity and correlates with a validated measure of moral reasoning. In this study, we investigate whether PIF, as measured by PIE, changes during preclerkship training.Medical students in the class of 2019 completed the PIE during orientation to medical school (PIE#1) and 15 months later, during orientation to clerkships (PIE#2), to the same prompts. These written responses are PIF-staged by an expert rater.On average, PIF scores reveal that 46% of the group remained at the same stage as they were on entry to medical school, 42% scored at a higher stage of PIF, and 15% of students scored at a lower stage of PIF after pre-clerkship training.This result suggests that medical students are heterogeneous with respect to the development of their medical PIF early in medical school training.

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Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations. The resurgence of interest in professionalism dates back to the 1980s when health maintenance organizations were formed and proprietary influences in health care increased. Since then, a rich and comprehensive literature has emerged in defining professionalism, including desirable individual attributes and behaviors and how they may be taught, promoted, and assessed. More recently, scholarship has shifted from individual to organizational professionalism. This literature addresses the role that health care organizations can play to establish environments that are conducive to the consistent expression of professionalism by individuals and health care teams. We reviewed interdisciplinary empirical studies from health care effectiveness and outcomes, organizational sciences, positive psychology, and social psychology, finding evidence that organizational and individual professionalism is associated with a wide range of benefits to patients and the organization. We identify actionable organizational strategies and approaches that, if adopted, can foster and promote combined organizational and individual professionalism. In doing so, trust in the medical profession and its institutions can be enhanced, which in turn will reconfirm a commitment to the social compact.

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