A mixed-methods study on the course of professional identity formation in undergraduate medical students.

BACKGROUND

This study explored the development of professional identity formation (PIF) in medical students during clinical rotations, focusing on the relationship between self-perceived development and actual development. It examined feedback and evaluations within the entrustable professional activities (EPA) framework, emphasizing the role of formative feedback in fostering professional growth. By analysing students' perceptions of their professional identity and feedback from online portfolios, this study aimed to enhance understanding of the trajectory of PIF.

METHODS

Conducted at the Radboud University, this study focused on medical students in the Master's programme. Sub-study 1 involved administering the extended Professional Self Identity Questionnaire (PSIQ) to 2,095 students from September 2020 to September 2022. Sub-study 2 analysed data from 240 students, integrating PSIQ responses with feedback from their online portfolios, including assessments and supervisor feedback. Data were analysed using SPSS (sub-study 1) and content analysis (sub-study 2) to explore the relationship between self-perceived PIF and actual performance.

RESULTS

A total of 1,519 students completed the extended PSIQ, with exploratory factor analysis confirming the questionnaire's unidimensional structure and improved reliability after adding three items. A one-way ANOVA showed a significant increase in PSIQ scores across different medical programme episodes. In sub-study 2, data of 240 students from three clerkships were analysed for the correlation between self-perceived PIF and actual performance, with no significant differences in their performance on national tests, assessments, or supervisor ratings. Portfolio analysis revealed that supervisors' feedback centred on collaboration, attitude, self-confidence, and growth toward becoming a physician, with students in later clerkships receiving more detailed feedback.

CONCLUSIONS

The extended PSIQ, which includes questions about EPAs and clerkship transitions, maintains reliability and construct validity, making it suitable for studying PIF within an EPA-based curriculum. Although no significant differences in performance were found, assertiveness emerged as a key factor in the quality and quantity of feedback, with more assertive students receiving better feedback. Narrative feedback, especially process-oriented, is crucial for supporting professional identity formation in medical students.