How to Grow a Professional Identity: Philosophical Gardening in the Field of Medical Education

Abstract

In this philosophical reflection, we – following the philosopher Heidegger - introduce two farmers who represent different ways in which one can develop growth (see https://www.youtube.com/watch?v=g7jZigyfKHI for instructional video). One is a traditional farmer who entrusts the seeds to the soil and cultivates them with care and trust. The other is a modern farmer who takes an industrialized approach and positions the seeds and ‘challenges-forth’ the crops to show themselves in a certain way. We use these farmers as an analogy for the ways in which we as medical educators can and should relate to those we ‘care’ for: medical students and trainees. Taking a philosophical stance, and accounting for our own positionality and involvement in the analysis, we focus on ‘Professional Identity Formation’ and its operationalization in the field of medical education. We identify three main approaches medical education has taken to identity: as an individual trait, as a set of behaviors, and as a socialization process. All these approaches have at their root a similar assumption, namely that all inner processes can be made visible. We challenge this representational paradigm and use ‘philosophical gardening’ to raise awareness of what can and cannot be measured and controlled. Finally, we suggest educational approaches that leave space for diversity in students’ experiences, learning approaches, and growth. We share good practices of brave teachers and curriculum designers whose interventions are characterized by less control and fewer measurements of personal growth, but more trust and free spaces for authentic learning.

On acknowledging silence within medical education

“…Whilst exploration is ongoing to explore the nuances of silence, and how we might untangle the positive and negative impacts of silence within curricula, we would suggest there are ways in which educators might attune their learners to the complexity and depth of silence within existing educational approaches. These suggestions align with Veen and de la Croix 23 'philosophical gardening' approach to medical education, where educators are encouraged to step back from traditional approaches to education which assume that a student's performance can be taken as a representation of their inner qualities or experiences and think deeply about the concepts they are teaching-in our case, silence and acknowledgement.…”

Combining Support and Assessment in Health Professions Education: Mentors’ and Mentees’ Experiences in a Programmatic Assessment Context

“…Requiring a minimum number of reflections in a portfolio potentially increases the risk of artificial reflections and other strategic behavior of mentees towards mentors to pass the assessment. These mentees appear to engage in true reflection, but behave like "reflective zombies" [48][49][50] so that the portfolio no longer reflects their actual knowledge, skills, and attitudes, but rather operates as a form of impression management [16]. Developmental support and programmatic assessment should be implemented in such a way that they do not objectify mentees or prescribe standardized ways of reflection, but embrace diverse approaches to reflection [47,48], so that mentees are able to reflect authentically.…”

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

“…The results of the above-mentioned study imply that supporting contextualized competence requires curricula to explicitly attend to the process of socialization. Doing so requires a shift from an isolated focus on discrete learning experiences (i.e., multiple rotations in multiple contexts with multiple supervisors) to also considering experiences that foster longitudinal relationships and allow time and space for reflection on belonging [58]. Examples could include the incorporation of longitudinal mentorship groups focused on the experience of integrating into the community of practice, or periodic, guided reflections with a mentor on one's professional identity development and experiences, both positive and negative, that have been the most influential.…”