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

Abstract

Objectives: Professional identity formation (PIF) is a growing area of research in medical education. However, it is unclear whether the present research base is suitable for understanding PIF in physicians considered to be under-represented in medicine (URM). This meta-ethnography examined the qualitative PIF literature from 2012 to 2019 to assess its capacity to shine light on the experiences of minoritised physicians. Methods: Data were gathered using a search of six well-known medical education journals for the term 'professional identit*' in titles, keywords, abstracts and subheadings, delineated with the date range of 2012-2019. All non-relevant abstracts were removed and papers were then further reduced to those that focused only on learners' experiences. This left 67 articles in the final dataset, which were analysed using a collaborative approach among a team of researchers. The team members used their professional expertise as qualitative researchers and personal experiences as minoritised individuals to synthesise and interpret the PIF literature. Results: Four conceptual categories were identified as impacting PIF: Individual versus Sociocultural Influences; the Formal versus the Hidden Curriculum; Institutional versus Societal Values; and Negotiation of Identity versus Dissonance in Identity. However, a major gap was identified; only one study explored experiences of PIF in URM physicians and there was an almost complete absence of critical stances used to study PIF. Combined, these findings suggest that PIF research is building on existing theories without questioning their validity with reference to minoritised physicians. Conclusions: From a post-colonial perspective, the fact that race and ethnicity have been largely absent, invisible or considered irrelevant within PIF research is problematic. A new line of inquiry is needed, one that uses alternative frameworks, such as critical theory, to account for the ways in which power and domination influence PIF for URM physicians in order to foreground how larger sociohistorical issues influence and shape the identities of minoritised physicians. | 149 WYATT eT Al.

Professional identity formation, intersectionality and equity in medical education

“…In this issue, Wyatt and colleagues contribute to this discussion by critically reviewing the literature surrounding professional identity formation (PIF) from a post‐colonial perspective 4 . Four key conceptual areas that influence identity formation are revealed: (a) Individual vs Sociocultural; (b) Formal vs Hidden Curriculum; (c) Institutional vs Societal Values; and (d) Negotiation of Identity vs Dissonance in Identity.…”

“…The first reflection surrounds the nature of under‐represented groups in medicine and the multiplicity of issues faced in relation to privilege and discrimination. Wyatt et al 4 focus on race and ethnicity to provide meaningful avenues through which to consider PIF. Building further, we are reminded of intersectionality and its importance for considering how under‐represented groups tackle and negotiate the various barriers they experience throughout medical education.…”

“…Our second reflection arises in relation to the methodological approach taken up by Wyatt et al 4 Systematic reviews, considered in the biomedical world to be the tip of the evidence‐based pyramid, are deeply rooted in positivist principles, which seek to weigh up the evidence in a particular area, but which have shortcomings with respect to being able to synthesise what the findings really mean in practice. Wyatt et al, in contrast, carefully applied a meta‐ethnographic approach aimed at enabling critical appraisal of literature‐based findings.…”

“…Thirdly, the importance of reflexivity is illuminated by Wyatt et al's article as they lead us to critically consider how researchers' own backgrounds may influence identity research. In the article, the authors describe their previous experience and knowledge of PIF and qualitative research, as well as their personal experience as minoritised individuals 4 . Given consideration of intersectionality, we wonder whether any of us could ever fully explicate for readers (or for ourselves as investigators) the extent to which various parts of our identities influence the critical insights we gain during research processes.…”

“…Further research aimed at revealing the experiences of multi‐dimensional, under‐represented groups may help explain the complexities of historical background, social drivers and environmental experiences on PIF. Research team divergence can help to challenge, balance and explore views from multiple perspectives so that Wyatt and colleagues' 4 key finding about the absence of exploration into how race/ethnicity influences PIF does not sadly continue to replicate in the future.…”