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1.
J Youth Adolesc ; 2024 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-38949674

RESUMEN

Schools in the United States are increasingly offering ethnic studies classes, which focus on exploring students' ethnic-racial identities (ERI) and critical analysis of systemic racism, to their diverse student bodies, yet scant research exists on their effectiveness for students of different ethnic-racial backgrounds in multiracial classrooms. A policy change to require all high school students in one school district to take an ethnic studies class facilitated a natural experiment for comparing the effects of quasi-random assignment to an ethnic studies class (treatment) relative to a traditional social studies class (control; e.g., U.S. Government, Human Geography). Student surveys and school administrative data were used to compare students' ERI development, well-being, and academic outcomes across ethnic studies and control classes. Participants (N = 535 9th graders; 66.1% ethnic studies) had diverse ethnic-racial (33.5% non-Latine White, 29.5% Black, 21.1% Latine, 10.7% biracial, 2.8% Asian, 2.2% Native American) and gender identities (44.7% female, 7.1% non-binary). Ethnic studies students reported marginally higher ERI exploration and resolution than controls, and sensitivity analyses showed a statistically significant effect on ERI among participants with complete midpoint surveys. Higher resolution was associated with better psychological well-being for all students and higher attendance for White students. Students with low middle school grades (GPA < 2.0) had better high school grades in core subjects when enrolled in ethnic studies than the control class. Overall, the results of this natural experiment provide preliminary support for ethnic studies classes as a method for promoting ERI development, well-being, attendance, and academic achievement for students from diverse ethnic-racial backgrounds.

2.
Front Psychol ; 15: 1409217, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38952822

RESUMEN

Narrative identity allows individuals to integrate their personal experiences into a coherent and meaningful life story. Addictive disorders appear to be associated with a disturbed sense of self, reflected in problematic and disorganized self-narratives. In recent literature, a growing body of research has highlighted how narrative approaches can make a dual contribution to the understanding of addiction: on the one hand, by revealing crucial aspects of self structure, and, on the other, by supporting the idea that addiction is a disorder related to unintegrated self-states in which dissociative phenomena and the resulting sense of 'loss of self' are maladaptive strategies for coping with distress. This conceptual review identified the main measures of narrative identity, i.e., narrative coherence and complexity, agency, and emotions, and critically examines 9 quantitative and qualitative studies (out of 18 identified in literature), that have investigated the narrative dimension in people with an addictive disorder in order to provide a synthesis of the relationship between self, narrative and addiction. These studies revealed a difficulty in the organization of narrative identity of people with an addictive disorder, which is reflected in less coherent and less complex autobiographical narratives, in a prevalence of passivity and negative emotions, and in a widespread presence of themes related to a lack of self-efficacy. This review points out important conceptual, methodological and clinical implications encouraging further investigation of narrative dimension in addiction.

3.
Int Nurs Rev ; 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38953437

RESUMEN

AIMS: To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. BACKGROUND: There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. METHODS: Using a cross-sectional design, third- and fourth-year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. RESULTS: The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (ß = 0.18, p = 0.043) and financial incentives (ß = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (ß = -0.12, p = 0.038) and clinical learning environment perception (ß = -0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. CONCLUSION: Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

4.
Curr Opin Plant Biol ; 81: 102589, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38955094

RESUMEN

Inflorescence architecture is highly variable across plant lineages yet is critical for facilitating reproductive success. The capitulum-type inflorescence of the Asteraceae is marked as a key morphological innovation that preceded the family's diversification and expansion. Despite its evolutionary significance, our understanding of capitulum development and evolution is limited. This review highlights our current perspective on capitulum evolution through the lens of both its molecular and developmental underpinnings. We attempt to summarize our understanding of the capitulum by focusing on two key characteristics: patterning (arrangement of florets on a capitulum) and floret identity specification. Note that these two features are interconnected such that the identity of florets depends on their position along the inflorescence axis. Phytohormones such as auxin seemingly determine both pattern progression and floret identity specification through unknown mechanisms. Floret morphology in a head is controlled by differential expression of floral symmetry genes regulating floret identity specification. We briefly summarize the applicability of the ABCE quartet model of flower development in regulating the floret organ identity of a capitulum in Asteraceae. Overall, there have been promising advancements in our understanding of capitula; however, comprehensive functional genetic analyses are necessary to fully dissect the molecular pathways and mechanisms involved in capitulum development.

5.
Cell Metab ; 2024 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-38959897

RESUMEN

A mechanistic connection between aging and development is largely unexplored. Through profiling age-related chromatin and transcriptional changes across 22 murine cell types, analyzed alongside previous mouse and human organismal maturation datasets, we uncovered a transcription factor binding site (TFBS) signature common to both processes. Early-life candidate cis-regulatory elements (cCREs), progressively losing accessibility during maturation and aging, are enriched for cell-type identity TFBSs. Conversely, cCREs gaining accessibility throughout life have a lower abundance of cell identity TFBSs but elevated activator protein 1 (AP-1) levels. We implicate TF redistribution toward these AP-1 TFBS-rich cCREs, in synergy with mild downregulation of cell identity TFs, as driving early-life cCRE accessibility loss and altering developmental and metabolic gene expression. Such remodeling can be triggered by elevating AP-1 or depleting repressive H3K27me3. We propose that AP-1-linked chromatin opening drives organismal maturation by disrupting cell identity TFBS-rich cCREs, thereby reprogramming transcriptome and cell function, a mechanism hijacked in aging through ongoing chromatin opening.

6.
Psychol Sport Exerc ; : 102697, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38960347

RESUMEN

Elite athletes often make large personal sacrifices to pursue excellence, but there is insufficient support for them when they leave elite sport. Identity loss is central to athletes' transition trajectories and hence the management of identity change is a crucial area for support. The More Than Sport (MTS) program is a novel digital intervention that aims to provide this support-helping athletes manage identity change in the process of leaving elite sport. The present research aims to study elite athletes' experiences with the MTS program and their perceptions of its usefulness in managing the transition away from elite sport. We undertook a qualitative study with athletes (N=25) from three countries (the United Kingdom, Australia and Belgium) using reflexive thematic analysis to explore their experiences of the program and their feedback on program content. We identified three key themes and eight subthemes. The first key theme was Value of the Program, and this was underpinned by four sub-themes that centred on Program importance and novelty, how Positive and confronting experiences afford insight, the Value of developing shared understanding, and Realising the value of social groups. The second key theme was Engagement with Program Elements and here participants commented on Program content and Delivery format. The final key theme was Time and Place for Identity Management Programs which included the sub-themes of Optimal timing and Additional program beneficiaries. Overall, the results highlight the value of MTS specifically, and identity management efforts more broadly, to help elite athletes adjust successfully to life beyond sport.

7.
Br J Clin Psychol ; 2024 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-38946045

RESUMEN

OBJECTIVES: Characterization of psychotherapy as the "talking cure" de-emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance. METHODS: University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social-psychological variables, and well-being. RESULTS: Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice. CONCLUSIONS: Listening quality enhances alliance and well-being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy.

8.
Data Brief ; 55: 110557, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38966666

RESUMEN

Whole genome sequencing (WGS) and data concerning identity and safety for Saccharomyces cerevisiae CBS 493.94 are reported. This strain was isolated from a British brewery in 1958 and deposited at the CBS culture collection Westerdijk Fungal Biodiversity Institute under the accession number CBS 493.94. The long-reads sequencing data, obtained via PacBio Sequel, and short-reads data, via Illumina NovaSeq 6000, were deposited at NCBI under accession number PRJNA1044661. The hybrid assembly was made publicly available via Zenodo and NCBI. For strain identification, data from 18S rRNA, ANI dendrogram and Core Genome single nucleotide polymorphism (SNP) Tree showed that the present isolate belongs to the genus Saccharomyces, species cerevisiae. The potential genes of concern, e.g. antimycotic resestance genes, were not detected. This strain is commonly used as a feed additive for animal health improvement and the present data summarise the unambiguous identity and strain's FKS1 gene does not code for any amino acid variants of concern.

9.
J Genet Genomics ; 2024 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-38969261

RESUMEN

Genetic genealogy provides crucial insights into the complex biological relationships within contemporary and ancient human populations by analyzing shared alleles and chromosomal segments that are identical by descent, to understand kinship, migration patterns, and population dynamics. Within forensic science, forensic investigative genetic genealogy (FIGG) has gained prominence by leveraging next-generation sequencing technologies and population-specific genomic resources, opening new investigative avenues. In this review, we synthesize current knowledge, underscore recent advancements, and discuss the growing role of FIGG in forensic genomics. FIGG has been pivotal in revitalizing dormant inquiries and offering new genetic leads in numerous cold cases. Its effectiveness relies on the extensive SNP profiles contributed by individuals from diverse populations to specialized genomic databases. Advances in computational genomics and the growth of human genomic databases have spurred a profound shift in the application of genetic genealogy across forensics, anthropology, and ancient DNA studies. As the field progresses, FIGG is evolving from a nascent practice into a more sophisticated and specialized discipline, shaping the future of forensic investigations.

10.
Front Psychol ; 15: 1340769, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38962223

RESUMEN

Introduction: Ethical voice is a valuable ethical behavior that enables organizations to promptly recognize and rectify unethical issues and practices, thus preventing severe dilemmas and crises. Despite its importance, the extant literature has yet to fully explore the impact of a leader's ethical voice on subordinate outcomes. This study bridges this gap by integrating social identity theory and social exchange theory to scrutinize the process by which a leader's ethical voice affects subordinate task performance. Methods: We employ a serial mediation model to explore the mechanisms by which a leader's ethical voice enhances subordinates' task performance. Our theoretical framework is empirically validated using a dataset that includes 449 subordinate-leader pairings from Chinese enterprises. Results: The survey results demonstrate that a leader's ethical voice has a significant positive impact on subordinate task performance. Subordinate identification with leader and leader-member exchange not only individually mediate the effects of a leader's ethical voice on subordinate task behavior but also jointly serve as a chain-mediated mechanism in the influence of a leader's ethical voice on subordinate task behavior. Discussion: These findings illuminate the substantial effects that ethical leadership behaviors exert on employee performance and offer fresh perspectives on the intricate dynamics that govern this influence.

11.
Front Psychol ; 15: 1407742, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38962238

RESUMEN

Introduction: In the aftermath of the COVID-19 pandemic, the reintegration of Chinese international student returnees intersects with China's critical effort to combat a significant brain drain of highly skilled talents, highlighting an unprecedented psychological battleground. This convergence underscores the urgent need for nuanced research to navigate the uncharted territory of their mental health. Methods: Employing Bayesian analysis supported by Markov Chain Monte Carlo (MCMC) algorithms, this study examined depression prevalence and associated factors among 1,014 Chinese returnees. The sample comprised 44.87% male participants (455), 51.58% female participants (523), and 3.55% identifying as "Others" (36), with an age distribution of 61.74% aged 18-30 (626), 28.80% aged 31-40 (292), and 9.47% aged 41-50 (96). The mean age of participants was 29.6 years, ranging from 18 to 50 years. PHQ-9 diagnoses revealed alarming levels of depression, with 47.9% exhibiting a moderately severe degree of depressive disorder. Results: Our findings highlight the intricate interplay between identity clusters- "homestayers" (those leaning towards a Chinese cultural identity), "navigators" (those with a bicultural identity), and "wayfarers" (those leaning towards a foreign cultural identity)-and the likelihood of depression. Specifically, homestayers showed a clear and strong negative association, navigators demonstrated a positive association, and wayfarers had a positive yet unclear correlation with depression levels. Furthermore, acculturation, age, and gender showed no significant effects, whereas education mildly mitigated depression. Discussion: Based on these findings, we suggest the implementation of better-tailored mental health support and policies to facilitate smoother reintegration.

12.
Artículo en Inglés | MEDLINE | ID: mdl-38963771

RESUMEN

To understand the theoretical impact of racial and gender identities on counselor selection, an online experiment was conducted with 527 participants in which both the race and gender of a perspective counselor's online profile were manipulated. Results showed that participants had a higher intention to seek counseling when the counselor was from the same racial and/or gender group. These preferences existed above and beyond other identity-based evaluative metrics, such as those tied to group stereotypes (e.g., warmth and competence). The results advocate for the development and evaluation of culturally tailored digital health interventions and underscore the importance of further formative research in this area to enhance the accessibility and effectiveness of healthcare resources for all.

13.
Br J Health Psychol ; 2024 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-38965643

RESUMEN

INTRODUCTION: Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. METHODS: A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. RESULTS: A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. CONCLUSIONS: A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.

14.
Z Kinder Jugendpsychiatr Psychother ; 52(4): 238-247, 2024 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-38967057

RESUMEN

When Old People Suffer Because of the Sex of the Young: A Commentary on Korte, A. & Tschuschke, V. (2023). The Media's Stranglehold on Sturm und Drang - The Sorrows of Generation Z Regarding Sex and Gender Abstract: In their article "Sturm und Drang im Würgegriff der Medien - Die Leiden der jungen Generation am eigenen Geschlecht" in the Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (volume 51, issue 5), our colleagues Korte and Tschuschke address the question of the extent to which the increase in gender identity deviations among adolescents "also results from upheavals the cultural landscape and, above all, in media technology." The authors look critically at the planned German "Self-Determination Law," the social transition of children and adolescents, the so-called puberty blockade, and hormone therapy in adolescents and justify their preference for a gender-critical over a transaffirmative therapy approach. Although the article introduces some interesting hypotheses from the perspective of cultural studies and philosophy (among others), it may contribute to uncertainty among colleagues in treating trans*people because of its trans-critical tone. This stems from linguistic devices, misleading and erroneous quotations, and incomplete or incorrect descriptions of facts. This contribution therefore takes a critical look at the article by Korte and Tschuschke, using critical linguistic analysis and examining the facts, data, and sources cited by the authors. It encourages our colleagues to engage in a joint, participatory, trans*respectful treatment process with gender-dysphoric children and adolescents while exploring the sizeable intermediate area between "gender-critical" and "transaffirmative" attitudes, which the authors Korte and Tschuschke barely touch on in their article.


Asunto(s)
Identidad de Género , Humanos , Adolescente , Femenino , Masculino , Alemania , Niño , Medios de Comunicación de Masas , Anciano , Disforia de Género/psicología , Disforia de Género/terapia , Autonomía Personal , Transexualidad/psicología
15.
Soc Sci Med ; 353: 117039, 2024 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-38971112

RESUMEN

Since the depathologisation movement in 2007 to challenge the pathologisation of trans identities in Western psychiatry, significant developments have occurred, including revisions to Standards of Care and diagnostic criteria such as ICD-11's gender incongruence and DSM-5's gender dysphoria, acknowledging gender diversity as an expected part of human development. This paper argues that Japanese medical models reflect global issues but also have unique aspects shaped by cultural and linguistic nuances. Using critical discourse analysis, this paper examines how depathologisation discourses are perceived in the Japanese medical community, focusing on the term seidouitsusei-syogai (gender identity disorder), presenting three ways in which seidouitsusei-syogai is used: psychiatric disorder, syogai/sikkan (impairment/disability/disorder), and diagnostic category. These uses are influenced by legal and social reforms, healthcare access and alignment with international classifications, while the medical profession's authority remains unexamined. Reflecting the structural challenges of diagnostic models in trans medicine, the interpretation of seidouitsusei-syogai differs from the English phrase 'gender identity disorder' due to the specific connotations of syogai in the Japanese context. By examining Japan's approach to depathologisation and medicalisation, this paper enriches the understanding of trans medicine and the impact of depathologisation discourse in Japan.

16.
Artículo en Inglés | MEDLINE | ID: mdl-38972031

RESUMEN

One of the main goals of medical education is to facilitate the development of a professional identity. As part of this effort, trainees are exposed to the values and cultures of the profession in a process known as socialization. Learners must then negotiate incongruent aspects between their preexisting identities and nascent professional identities. Individuals from historically underrepresented ethnic groups often undergo more significant changes due to their values and culture not being as prevalent within the dominant ideology of medicine. This transformative process can lead to identity dissonance and manifest as an internal discomfort resulting from perceived contradictions between one's existing identity and the required professional identity. Identity dissonance may be traumatic and pose a threat to the academic performance and professional integration of trainees. These detrimental effects harm the medical workforce by depriving it of a group crucial in addressing health inequities. Educators tasked with facilitating the professional development of learners must consider their implicit expectations about professionalism, explore the distinct challenges experienced by individuals from underrepresented backgrounds in their professional development, and work to develop strategies to help trainees navigate identity dissonance. Subjectification, an education philosophy that focuses on compelling individuals to explore the new possibilities and responsibilities imparted to them by their education, provides a theoretical framework to help educators guide learners through identity dissonance.

17.
Cannabis ; 7(2): 163-176, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38975593

RESUMEN

Introduction: Despite cannabis use disparities among sexual minority (SM; vs. heterosexual) young adults (SMYAs), little research has explored social influences contributing to these disparities. This study examined sexual identity subgroup differences in parenting behaviors and associations among parenting behaviors and cannabis use behaviors among YA subgroups. Methods: Participants were female (N=416; 44.7% bisexual, 7.2% lesbian) and male (N=228; 11.0% bisexual, 13.2% gay) YAs (ages 18-29) recruited via social media from 6 US cities. Bivariate analyses examined differences in perceived parenting (psychological control, behavioral control, knowledge, autonomy support, warmth, communication, cannabis disapproval), any past-month (current) cannabis use, and current cannabis use frequency across sexual identity subgroups. Multivariable regression examined associations among sexual identity and parenting behaviors with cannabis use outcomes. Results: Among female YAs, bisexual (vs. heterosexual) YAs had greater odds of cannabis use, reported more frequent use, and reported greater parental psychological control and less behavioral control, autonomy support, warmth, and communication; greater psychological control was associated with both outcomes; less autonomy support was associated with current use; and less warmth and communication were associated with use frequency. Among male YAs, gay and bisexual (vs. heterosexual) YAs had greater odds of current use and reported more frequent use and greater psychological control; gay (vs. heterosexual) YAs reported greater behavioral control and less autonomy support, warmth, and communication; and greater psychological control and less warmth and communication were associated with both outcomes. Conclusions: Cannabis prevention/cessation programs should target specific parenting behaviors that differentially impact cannabis use outcomes among specific SMYA subgroups.

18.
Cult Health Sex ; : 1-14, 2024 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-38975779

RESUMEN

The role played by activists' sexual orientation and gender identity in their involvement and commitment to LGBT movements is an understudied area in the Chinese context. Using identity and dramaturgical theory, this qualitative study explored how activists' work and commitment toward promoting LGBT rights and services is shaped and influenced by their identities. The study draws on data from life history interviews conducted with 20 long-time LGBT activists in Yunnan, China. The findings indicate that their sexual orientation and gender identities were, in the long run, seen as assets by the activists that shaped their work and commitment in the LGBT movement. Despite initial challenges in establishing identity-based connections with co-workers/clients, the emergence of sense of inclusiveness through recognition of activists' efforts, particularly when working with diverse gender and sexual minorities, stands out as a prominent theme in this context. This dynamic is important in bolstering the longevity of activists' commitment and building the continued momentum of LGBT movements in the region and internationally.

19.
20.
J Healthc Leadersh ; 16: 263-276, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38974334

RESUMEN

Introduction: Despite the development of national recommendations and training programs for effective leadership, junior and senior medical leaders often find themselves ill-prepared to take on these new responsibilities. This study aimed to explore physicians' perceptions, feelings, and beliefs regarding leadership and to provide recommendations regarding appropriate training and institutional post-training support. Methods: We conducted a qualitative study at the Geneva University Hospitals. A purposeful sample of residents (R), fellows (F), attending physicians (A), and chairpersons (CP) were invited to participate in focus groups (or semi-structured interviews) between April and June 2021. We investigated their understanding of leadership, self-perception as leaders, difficulties, and paths to improvement in their leadership skills. Focus groups were transcribed verbatim and analyzed both inductively and deductively using Fishbein's model of behavior prediction and Irby's professional identity formation framework. Results: We conducted ten focus groups (R=3; F=4, A=2, and CP=1) and one interview (CP). Physicians expressed poor self-efficacy at all hierarchical levels: feelings of insecurity and confusion (R and F), frustration (A), and feeling stuck between divisional and institutional governance (CP). Such negative feelings were nurtured by personal beliefs with an intuitive and idealized representation of leadership. Beliefs focused more on personal characteristics rather than on skills, processes, or perceived institutional norms. Unclear expectations regarding physicians' role as leaders, overemphasis on academic achievement, and silo professional organizations fueled their feelings. Participants reported developing their leadership through trial and error, observing role models, and turning to personal resources rather than formal training. Conclusion: Our results show that physicians' leadership skills are still mainly acquired intuitively and that institutional norms do not encourage clarification of leadership roles and processes. Physician training in leadership skills, together with more explicit and clear institutional processes, may help to improve physicians' self-efficacy and develop their identity as leaders.

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