Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Med Educ. 2023 Nov;57(11):1092-1101. doi: 10.1111/medu.15142. Epub 2023 Jun 3.
To enter a profession is to take on a new identity. Professional identity formation can be difficult, with medical learners struggling to adopt professional norms. The role of ideology in medical socialisation may offer insight into these tensions experienced by medical learners. Ideology is the system of ideas and representations that dominates the minds of individuals or social groups and calls individuals into certain ways of being and acting in the world. In this study, we use the concept of ideology to explore residents' experiences with identity struggle during residency.
We conducted a qualitative exploration of residents in three specialties at three academic institutions in the United States. Participants engaged in a 1.5-hour session involving a rich picture drawing and one-on-one interview. Interview transcripts were coded and analysed iteratively, with developing themes compared concurrently to newly collected data. We met regularly to develop a theoretical framework to explain findings.
We identified three ways that ideology contributed to residents' identity struggle. First was the intensity of work and perceived expectations of perfectionism. Second were tensions between the developing professional identity and pre-existing personal identities. Many residents perceived messages regarding the subjugation of personal identities, including the feeling that being more than physicians was impossible. Third were instances where the imagined professional identity clashed with the reality of medical practice. Many residents described how their ideals misaligned with normative professional ideals, constraining their ability to align their practice and ideals.
This study uncovers an ideology that shapes residents' developing professional identity-an ideology that creates struggle as it calls them in impossible, competing or even contradictory ways. As we uncover the hidden ideology of medicine, learners, educators and institutions can play a meaningful role in supporting identity development in medical learners through dismantling and rebuilding its damaging elements.
进入一个职业就是接受一个新的身份。专业身份的形成可能很困难,医学学习者在努力接受专业规范时会感到挣扎。意识形态在医学社会化中的作用可能为我们理解医学学习者所经历的这些紧张关系提供了一些启示。意识形态是主导个人或社会群体思想的观念和表象体系,它要求个人以某种方式在世界上存在和行动。在这项研究中,我们使用意识形态的概念来探索住院医师在住院期间身份斗争的经历。
我们对美国三所学术机构的三个专业的住院医师进行了定性探索。参与者参加了一个 1.5 小时的环节,包括一幅丰富的图画和一对一的访谈。对访谈记录进行了迭代编码和分析,同时对新收集的数据进行了比较。我们定期开会,以制定一个理论框架来解释研究结果。
我们确定了意识形态对住院医师身份斗争的三种影响方式。首先是工作强度和对完美主义的期望。其次是正在发展的专业身份与预先存在的个人身份之间的紧张关系。许多住院医师感到,个人身份必须服从,甚至觉得超越医生是不可能的。第三是想象中的专业身份与医疗实践的现实发生冲突的情况。许多住院医师描述了他们的理想与规范的专业理想不一致的情况,这限制了他们将自己的实践和理想保持一致的能力。
这项研究揭示了一种塑造住院医师发展中的专业身份的意识形态——一种在召唤他们时创造出挣扎的意识形态,这种召唤以不可能、相互竞争甚至矛盾的方式进行。随着我们揭示医学的隐藏意识形态,学习者、教育者和机构可以通过拆除和重建其破坏性元素,在支持医学学习者的身份发展方面发挥有意义的作用。