#19 Long Live the Purple Scrunchy!

Episode Host: Lara Varpio

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Episode Article

Bullock, J. L., Sukhera, J., Del Pino‐Jones, A., Dyster, T. G., Ilgen, J. S., Lockspeiser, T. M., Teunissen, P. W., & Hauer, K. E. (2023). ‘Yourself in all your forms’: A grounded theory exploration of identity safety in medical students. Medical Education, medu.15174. https://doi.org/10.1111/medu.15174

Recorded LIVE at AMEE2023 in Glasgow

In this episode, the hosts review a research paper that takes on the challenge of generating a theory of identity safety in the clinical learning environment. This work pushes beyond current notions of psychological safety and so looks not only at how educators can help protect the full breadth of identities that learners bring to medical education, but also the agency that the learners can harness. If you want to foster learning environments where each and every learner is free to be their full selves, then this is a must-listen episode.


We each select papers for the podcast for a variety of reasons. Papers that offer excellent illustrations of a particular research method, or that offer particularly useful teaching points for educators, or that address a topic we’re personally thinking about—these are all reasons a paper might be addressed in the podcast. But, sometimes, we pick a paper because it is a clarion call highlighting a topic that needs more prominence. This paper is one of the latter. This is a topic we all need to consider. The paper addresses identity threat which they define as any form of internal, interpersonal or structural hostility towards one’s identities. Internal and external identity threats can include things like stereotype threat, microaggressions, racism, sexism, ableism, and more. All of us have either personally experienced identity threat or we’ve been educators and have watched while a colleague or a learner struggles with

identity threat. Now we have a language and a theory to help us contend with the issue.


The authors conducted a constructivist grounded theory study harnessing critical pedagogies, specifically critical race and feminist theories. They solicited participation from 3rd and 4th year medical students who had accrued clinical experiences. They used purposive and maximum variation sampling: the purposive sampling was to find participants with minoritized identities, prioritizing across race, gender identities, and immigrant learners; the maximum variation was to find the most diverse set of experiences, to find participants whose narratives would enrich or challenge the team’s thinking.

They recruited across three different medical schools in the US and sent potential participants an 11 item survey. The purpose of this survey was to inform sampling, so it included the racial and gender versions of the Stereotype Vulnerability Scale—a scale that measures awareness of negative stereotypes about one’s identity group. They used the data from the survey to inform their purposive and maximum variation sampling.

Interviews were collected and analyzed in iterative cycles using the constant comparison approach. The authors developed codes and then themes and then synthesized their findings into a theory.


The researcher conducted 16 interviews with a diversity of individuals (see table in paper).

The authors launch their theory by examining identity threat. They describe how an unwelcoming learning environment, pressure to change their personal behavior to fit in, sociopolitical threats, and lack of identity safety were four central concepts they found in their data that constituted identity threat. Learners felt their identity was tokenized, felt pressure to change their identities in order to fit in, felt that the learning environment was unwelcoming, and/or felt that broader sociopolitical situations threatened them.

When identity threat was experienced, participants managed that threat proactively and reactively. The authors called this threat mitigation. Threat mitigation could be carried out by the individual (i.e., safeguarding) or with support from others (i.e., allyship). These were the ways that the individuals who experienced identity threat and sometimes the people around them dampened identity threat. One important point to note here is that the individual experiencing threat and their community can engage in safeguarding and allyship to try to mitigate the identity threat, but mitigation is not elimination.

Finally, the authors address identity safety which is the freedom to be oneself, where a learner existed as their authentic self without worrying about others’ perceptions of their identities. Identity safety arose from three interrelated components: upholding personhood, belonging, and agency to serve.


Identity safety is something we can AND SHOULD all be actively working to support. This paper beautifully articulates key concepts to this theory and offers illustrative examples from the participants’ narratives that will leave you profoundly impacted by their truths.


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