#55 – The Toll of the Trolls

Episode host: Jason R. Frank

Dr. Jason R. Frank, portrait.
Jason R. Frank
Photo: Erik Cronberg.

Join the PAPERs Podcast team as they dissect a study on professional identity formation (PIF) in surgical residency. Discover how specific “role model moments” shape the development of surgical residents, influencing their personal and professional identities in profound ways. Our expert hosts dive into the emotional impact of both positive and negative experiences with role models, introducing memorable concepts like “role (troll) model moments.”

Episode article

Bransen, J., Poeze, M., Mak-van der Vossen, M. C., Könings, K. D., & van Mook, W. N. K. A. (2024). ‘Role Model Moments’ and ‘Troll Model Moments’ in Surgical Residency: How Do They Influence Professional Identity Formation?. Perspectives on Medical Education, 13(1), 313–323.

Episode notes


Professional identity formation (PIF) is a popular topic in HPE right now. From the pioneering authors (e.g., the Crueses at McGill, Hafferty in the US) to contemporary thinkers like Adam Sawatsky and Robert Sternzsus, our community has realized that PIF is a critical element of training and worthy of greater emphasis in scholarship and design

While there are many definitions of PIF, a simple one is:

the process of socially constructed learning to integrate personal attributes, norms, behaviours, and values into those of a community of practice.

There has been an extensive body of recent research into PIF which has imported ideas from other fields to help us understand the concepts, processes, and influences of PIF in the health professions.

There has also been a lot of work on role models in HPE, both positive and negative. The authors talk about the potential impact of role models on the formal/intentional level, informal, and via the hidden curriculum.


Wlecome Jeroen Bransen et al from Maastricht university in the Netherlands. “The aim of this study was to explore surgical residents’ experiences with role models and to understand how these contribute to residents’”


The authors said they adopted a social constructivist paradigm in this study.

From previous literature:

  • “Role models” was defined as “excellent clinicians who are displaying a humanistic style of teaching and demonstrating a high degree of professionalism.”
  • “Negative Role Models” were operationalized as teachers who are “uncaring towards patients and unsupportive towards learners”.

Drawing on Bandura’s social learning theory and the theory of communities of practice, the authors focused on the social processes of PIF through interactions with role models, taking into account local situations and context.

Using constructivist grounded theory (CGT), the authors recruited surgical residents from the Maastricht region via email and program directors. Trainees were interviewed using a guide developed from the literature on PIF & role models. Interviewees were primed to think about 3 examples where they were influenced by a role model’s behaviour. The interviews were conducted by an educationalist without any connection to the subjects.

A reflexivity statement was provided ans ethics approval was obtained.

Transcripts were coded iteratively through constant comparison and discussed by the whole team. Analysis was supported by ATLIST.ti. COREQ guidelines were used for reporting. Data was anonymized.


The authors reached sufficiency after interviewing 14 trainees.

Their key findings were:

  • Residents talked “Role Model Moments” that occurred from time to time in a specific context. These moments were memorable, important, and impactful, and led trainees to recognize values and behaviours that they might want to adapt and adopt.
  • Emotions were a major component of these Moments. The emotional tone of the residents’ reaction to a Model mediated the PIF process.
  • Participants found the term ‘negative role model” difficult to use, so the authors proposed to use.
    • Role Model Moments, where trainees identified with role models, felt engaged and supported, and were inspired; and:
    • Troll Model Moments, which instead caused feelings of disgust and detachment from behaviours trainees disliked.
  • Trainees suggested that any supervisor could have either kind of moment.
  • Reflection on was a critical step to the process of PIF and thinking about these Moments.


The idea of discrete everyday emotional events influencing PIF is potentially practice changing. The authors suggest that future PIF interventions should consider focusing on, noticing, and reflecting on these Moments.


Speaking of PIF, when writing an HPE qualitative paper, try to avoid the word “emergence” and the phrase “themes emerged”.

  • This paper is potentially practice and/or terminology changing, signs of impactful research.
  • The Discussion in this paper is a good example of bringing in prior literature.


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