Professional Identity Formation in medical school: One measure reflects changes during pre-clerkship training.

This article was migrated. The article was marked as recommended. Professional Identity Formation (PIF), the process of internalizing a profession's core values and beliefs, is an explicit goal of medical education. The Professional Identity Essay (PIE), a developmental measure of the extent to which individuals have a complex and self-defined understanding of their professional role, is a tool to both study and scaffold PIF. PIE staging has internal reliability and response process validity and correlates with a validated measure of moral reasoning. In this study, we investigate whether PIF, as measured by PIE, changes during pre-clerkship training. Medical students in the class of 2019 completed the PIE during orientation to medical school (PIE#1) and 15 months later, during orientation to clerkships (PIE#2), to the same prompts. These written responses are PIF-staged by an expert rater. On average, PIF scores reveal that 46% of the group remained at the same stage as they were on entry to medical school, 42% scored at a higher stage of PIF, and 15% of students scored at a lower stage of PIF after pre-clerkship training. This result suggests that medical students are heterogeneous with respect to the development of their medical PIF early in medical school training.

Measuring professional identity formation early in medical school.

AIM: To assess the feasibility and utility of measuring baseline professional identity formation (PIF) in a theory-based professionalism curriculum for early medical students. METHODS: All 132 entering students completed the professional identity essay (PIE) and the defining issues test (DIT2). Students received score reports with individualized narrative feedback and wrote a structured reflection after a large-group session in which the PIF construct was reviewed. Analysis of PIEs resulted in assignment of a full or transitional PIF stage (1-5). The DIT2 score reflects the proportion of the time students used universal ethical principles to justify a response to 6 moral dilemma cases. Students' reflections were content analyzed. RESULTS: PIF scores were distributed across stage 2/3, stage 3, stage 3/4, and stage 4. No student scores were in stages 1, 2, 4/5, or 5. The mean DIT2 score was 53% (range 9.7?76.5%); the correlation between PIF stage and DIT score was ρ = 0.18 (p = 0.03). Students who took an analytic approach to the data and demonstrated both awareness that they are novices and anticipation of continued PIF tended to respond more positively to the feedback. CONCLUSIONS: These PIF scores distributed similarly to novice students in other professions. Developmental-theory based PIF and moral reasoning measures are related. Students reflected on these measures in meaningful ways suggesting utility of measuring PIF scores in medical education.

Medical students' ability to care for lesbian, gay, bisexual, and transgendered patients.

BACKGROUND AND OBJECTIVES: Our objective was to assess medical students' ability to care for lesbian, gay, bisexual, and transgender (LGBT) patients and to identify potential deficiencies in medical school curricula pertaining to this care. METHODS: Between March 1 and April 15, 2004, third- and fourth-year medical students at a metropolitan medical school were sent an e-mail requesting participation in a confidential on-line survey of 64 quantitative questions designed to assess their ability to care for LGBT patients. RESULTS: A total of 248 of 320 (77.5%) students responded. Medical students with greater clinical exposure to LGBT patients reported more frequent sexual history taking with LGBT patients, had more positive attitude scores, and possessed higher knowledge scores than students with little or no clinical exposure. Overall, on the 13-item attitude survey, the mean was 4.15 (5 = most positive, SD = .55, range 1.86-5.00), indicating a desire and willingness to provide health care to LGBT patients. The mean score on the 14-item knowledge test was 60% (SD = .12) correct. CONCLUSIONS: Medical students with increased clinical exposure to LGBT patients tended to perform more comprehensive histories, hold more positive attitudes toward LGBT patients, and possess greater knowledge of LGBT health care concerns than students with little or no clinical exposure.