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Learning to crawl before one walks

Professional Identity Formation: Creating a Longitudinal Framework through TIME (Transformation in Medical Education). Holden MD et al. Academic Medicine 2015;90(6):1-7.


Reviewed by Michele Haight

What was the study question?
What is the definition of "professional identity formation," (PIF) and what is a framework for effectively integrating and assessing PIF in UME?

How was the study done?
The University of Texas system convened an interdisciplinary task force to investigate the fundamentals of PIF and generate strategies to develop PIF across medical student training. Through ongoing meetings, e-mails and conference calls the task force developed a consensus definition of PIF. Key aspects of PIF were then determined through a modified Delphi technique. An iterative process was used to determine the multiple roles and activities of a practicing physician that better describe the complexities of PIF.

What were the results?
PIF was structured into domains and subdomains. Ten foundational PIF characteristics were identified. These included: adaptable, altruistic, curious, empathic, ethical, honest, reflective, responsible, self-aware and trustworthy. Three developmental states were identified and adapted from the Pediatrics Milestone Project. These included: Phase 1: Transition. Students are interested in medicine but not yet engaged in the field as professionals. Phase 2: Early Developing PIF. Medical students are early in their clerkship rotations and have not yet assumed primary responsibility for patient care. Phase 3: Developed PI. Graduating medical students who understand responsible care, duty and service. PIF phases do not represent time, but depth of responsibility and commitment. Multiple, descriptive, formative assessment modalities were recommended including OSCEs, reflective writing, multisource feedback, surveys and portfolios. PIF is recommended to begin at the premedical level.

What are the implications of these findings?
This TIME framework provides a foundation for the development of PIF in pre and early physician education. The PIF framework is derived from real life professional activities and expectations. PIF aligns with EPAs and reflects knowledge, skills and attitudes necessary for real life practice. There is potential to expand application of the PIF framework to GME, CME and IPE.

Editor's note: As pediatricians, we are well attuned to the concept of development. As educators, we are becoming attuned to the concept of Milestones. Thinking of professional identity as a developmental journey, as this article proposes, will probably resonate well with our membership (SLB).

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