#11 Break on through to the other side of PIF

May 8, 2023

Host: Lara Varpio

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Episode article

Verwer, S., & van Braak, M. (2022). Subjectification in Health Professions Education: Why We Should Look Beyond the Idea of Professional Identity Formation. In M. E. L. Brown, M. Veen, & G. M. Finn (Eds.), Applied Philosophy for Health Professions Education: A Journey Towards Mutual Understanding (pp. 23–37). Springer Nature. https://doi.org/10.1007/978-981-19-1512-3_3

In this episode, Lara brings a book chapter to the discussion which asks if we need to think differently about professional identity formation (PIF). The hosts discuss the strengths and weaknesses of current ways of thinking about PIF and they review the concept of subjectification and how this concept might help the field move to new, and exciting new ways of thinking about being a clinician.

Background

For quite some time, the way professional identity formation (PIF) has been discussed in health professions education has been bugging me. It hasn’t been sitting quite right with me. So I searched for a manuscript that might help us think differently about PIF, or at least offer insights into why PIF has been bothering me.

Results/Findings

Case Study methodology

1. ALlows in- depth In this episode, Jason introduces a paper that uses case study methodology to look at complex educational interventions, and why they so often fail.

To date, PIF research has had 2 orientations. The first looks at the unique individuality of each person who is becoming part of the profession. The second looks at the social aspects of PIF, highlighting how identities are co-constructed through interactions in social settings, created through language, and not limited to just the individual’s cognition.

But here’s the problem: Both of these ways of thinking about PIF focus on the individual fitting into the molds that are prescribed and pre-defined by the profession. In both these ways that our field has been thinking about PIF, the autonomous, individual learner is expected to take on the language, the demeanor, the traditions of the profession. They fit our mold.

Subjectification

The radical revision that these authors propose is to refocus our attention to look at subjectification. Subjectification is about the possibilities that are available to the individual who is becoming a doctor. It is what you are free to do. It is about what is not possible for that person. It is what you can’t do as a doctor. If identity is about who am I as a doctor. Then subjectification is about what can I do as a doctor. If identity asks you to take on the role of a doctor and figure out what that means for you, then subjectification asks what is it like to exist as a doctor in the world? What is easy to do? What resistance do you face? If a focus on identity has the learners asking who am I, then subjectification asks how am I, how do I exist as a doctor, what can I do with my identity as a doctor.

This could really change the way we think about becoming a doctor. It asks us to worry less about how our learners fit the mold for a good doctor, worry less about socializing learners to be like one of us. Instead, our role as educators is about teaching students how to act in the world as a doctor. What are you free to do? What responsibilities do you have? What limitations do you need to contend with? What choices will you make?

References and resources

Editors: Brown, M. E. L., Veen, M., & Finn, G. M. (Eds.). (2022). Applied Philosophy for Health Professions Education: A Journey Towards Mutual Understanding. Springer Nature. https://doi.org/10.1007/978-981-19-1512-3

Megan EL Brown, Teaching fellow at Imperial College London. On Twitter @Megan_EL_Brown
Mario Veen, Assistant Professor, Erasmus MC. On Twitter @MarioVeen
Gabrielle Finn, Professor at the University of Manchester. On Twitter @gabs_finn

Other resourses on PIF

Cruess, R. L., Cruess, S. R., & Steinert, Y. (2016). Amending Miller’s Pyramid to Include Professional Identity Formation. Academic Medicine: Journal of the Association of American Medical Colleges, 91(2), 180–185. https://doi.org/10.1097/ACM.0000000000000913

Cruess, S. R., Cruess, R. L., & Steinert, Y. (2019). Supporting the development of a professional identity: General principles. Medical Teacher, 41(6), 641–649. https://doi.org/10.1080/0142159X.2018.1536260

Mount, G. R., Kahlke, R., Melton, J., & Varpio, L. (2022). A Critical Review of Professional Identity Formation Interventions in Medical Education. Academic Medicine: Journal of the Association of American Medical Colleges, 97(11S), S96–S106. https://doi.org/10.1097/ACM.0000000000004904

Yiu, S., Yeung, M., Cheung, W. J., & Frank, J. R. (2022). Stress and conflict from tacit culture forges professional identity in newly graduated independent physicians. Advances in Health Sciences Education. https://doi.org/10.1007/s10459-022-10173-z