What Does Context Have to Do With Anything? A Study of Professional Identity Formation in Physician-Trainees Considered Underrepresented in Medicine

Abstract

Purpose Research on professional identity formation has largely ignored how race, ethnicity, and the larger sociohistorical context work to shape medical students’ professional identity. Researchers investigated how physician-trainees considered underrepresented in medicine (URM) negotiate their professional identity within the larger sociohistorical context that casts them in a negative light. Method In this qualitative study, 14 black/African American medical students were recruited from the Medical College of Georgia at Augusta University and Emory University College of Medicine between September 2018 and April 2019. Using constructive grounded theory and Swann’s model of identity negotiation, the authors analyzed interview data for how students negotiate their racial and professional identities within medical education. Results The results indicated that URM students were aware of the negative stereotypes ascribed to black individuals and the potential for the medical community to view them negatively. In response, students employed identity cues and strategies to bring the community’s perceptions in line with how they perceived themselves—black and a physician. Specifically, students actively worked to integrate their racial and professional identities by “giving back” to the African American community. Community-initiated mentoring from non-URM physicians helped to reify students’ hope that they could have a racialized professional identity. Conclusions Race, ethnicity, and the larger sociohistorical context is often overlooked in professional identity formation research, and this omission has resulted in an underappreciation of the challenges URM physicians’ experience as they develop a professional identity. Within the context of this study, findings demonstrated that black/African American physicians negotiated the formation of professional identity within a challenging sociohistorical context, which should be given greater consideration in related research.

‘Whispers and shadows’: A critical review of the professional identity literature with respect to minority physicians

“…Our analysis reveals a major gap in the research literature in that although medical education recognises the challenging social and learning environments faced by URM physicians, 128,129 and the need for more robust mentoring programmes, 130,131 the PIF literature has not elucidated the factors that play a role in their PIF. The experiences of URM physicians as portrayed in the PIF literature were represented only in whispers and shadows, and not in ways that shed light on their PIF experiences 7,19 . Additionally, the majority of articles failed to make apparent any critical stance, which suggests that researchers are continuing to build on existing theories without questioning their validity for the study of all physicians.…”

“…The experiences of URM physicians as portrayed in the PIF literature were represented only in whispers and shadows, and not in ways that shed light on their PIF experiences. 7,19 Additionally, the majority of articles failed to make apparent any critical stance, which suggests that researchers are continuing to build on existing theories without questioning their validity for the study of all physicians. The lack of attention to these considerations leaves questions in PIF research unanswered.…”

“…As medical education continues to increase in diversity, post‐colonial theory will be increasingly important to consider in recovering the epistemologies, experiences and shifting identities of marginalised groups, especially in the area of professional identity formation (PIF) 7,19 …”

“…11 As medical education continues to increase in diversity, postcolonial theory will be increasingly important to consider in recovering the epistemologies, experiences and shifting identities of marginalised groups, especially in the area of professional identity formation (PIF). 7,19 Professional identity formation is considered a critical aspect of the socialisation of medical trainees 20,21 and is the foundation for understanding what influences trainees' transformation into physicians.…”

L’antiracisme comme compétence professionnelle: quand la neutralité ne suffit plus

“…Au Canada, les médecins résidents racisés des pro grammes de chirurgie indiquent que leurs compétences sont remises en question plus souvent que celles de leurs pairs de même genre, et ils ont moins confiance de voir appliquer des mesures adéquates s'ils signalent de la discrimination (ce qui, en soi, est souvent considéré comme un geste non profession nel) 8 . Les conclusions d'une récente étude qualitative menée auprès d'étudiants américains appartenant à des groupes sous représentés dans la profession médicale montrent également que les étudiants racisés doivent travailler activement à déman teler les stéréotypes nuisibles pour réussir à faire correspondre leurs identités professionnelle (comme médecin) et raciale 9 .…”