Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Perspect Med Educ. 2024 Nov 11;13(1):540-552. doi: 10.5334/pme.1549. eCollection 2024.
Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training.
We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles.
We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance.
This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms.
医学培训传统上持一种决定论的观点，即许多医学学习者在构建专业身份时都感到困难。先前的研究表明，造成身份斗争的不健全规范和相互冲突的意识形态不成比例地影响着女性和医学领域代表性不足的个人。符号互动论可以帮助解释身份斗争，强调社会背景因素对身份构建的影响。本研究旨在探讨住院医师在住院医师培训期间如何应对身份斗争。
我们在美国的三所学术机构的三个专业中对 12 名住院医师进行了定性探索。参与者进行了丰富的图片绘制，然后进行了一对一的访谈。我们对转录数据进行了编码，并定期开会，以确定与住院医师应对专业身份斗争的经验相关的主题。
我们确定了三个主要主题来探讨应对身份斗争：身份工作的重要性、身份工作的孤立性以及与社会背景潮流一起和与之对抗的导航。住院医师将身份工作描述为在海上航行的船只。这项工作感觉很繁重，有时甚至让人不知所措，而且住院医师通常觉得无法与他人讨论自己的身份斗争。住院医师利用自己的权力来顺应潮流，朝着可以接受的——尽管不完美的——前进道路前进，或者试图逆流而上，通过抵抗开辟新的道路。
这项研究强调了背景如何使身份构建变得可行和受限，背景限制如何在身份之间造成不和谐，以及协调不和谐和构建专业身份所需的巨大努力。需要调整培训计划、增强住院医师支持和文化转变，以维持住院医师的身份工作。医疗专业人员应该通过解决功能失调的文化规范，参与集体身份工作，重新构想该专业的身份。
