Council on Medical Student Education in Pediatrics

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Becoming a physician
Competency is not enough: Integrating identity formation into the medical education discourse. Jarvis-Selinter S et al. Academic Medicine 2012;87(9):1185-1190.
Reviewed by Janice Hanson


What was the study question?
How do social theories about identify formation inform conversation about competency-based education/assessment and the development of professionalism?

How was the study done?
The authors completed a review of "salient literature," synthesized the literature on identity formation and discussed implications for medical education.

What were the results?
Competencies are "the cluster of skills, abilities, behaviors, and performances that are currently the emphasis of the competency movement." Role is "the 'social title' of an individual."Identity "represents the process by which people seek to integrate their various statuses and roles [and] experiences into a coherent image of self." Identify formation is a developmental process that occurs in qualitatively different stages, rather than a linear process of steps that make a whole. Medical learners move through stages that relate to their social roles in medical school, residency, and medical practice, learning new roles while forming a sequence of identities. They learn the roles and behaviors and assume the identities of medical student, clerk, resident, and then physician. Their roles are shaped by the social environments in which they learn and develop competence, as they come to understand the expectations of their teachers and observe the roles and behaviors of their role models.

What are the implications of these findings?
Competencies alone are inadequate to facilitate and evaluate the progress of medical students and residents. Medical educators must also understand the social contexts through which learners progress, the sequence of roles they learn to fill, and the internalized identities they develop. Researchers should study how the various contexts in which students and residents progress shape not only their competence but also their professional identity. Meaningful evaluation in medical education must include evaluation of emerging professional identity during each phase of medical education.

Editor's note: This intriguing paper argues that we should reframe medical education from "an exclusive focus on 'doing the work of a physician' toward a broader focus that also includes 'being a physician'". They suggest that identify formation should be considered alongside the competencies we know so well (SLB).

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