key: cord-0932673-bq7q40bn
authors: Stetson, Geoffrey V.; Kryzhanovskaya, Irina V.; Lomen‐Hoerth, Catherine; Hauer, Karen E.
title: Professional Identity Formation in Disorienting Times
date: 2020-04-28
journal: Med Educ
DOI: 10.1111/medu.14202
sha: 7071854dc490d3bc3892d4ee5cd80c61e8008104
doc_id: 932673
cord_uid: bq7q40bn

COVID‐19 is a major crisis, disrupting all facets of human life. For medical professionals and trainees, the pandemic creates additional concerns about one’s role in providing care, the effectiveness and limitations of medical care, and personal vulnerability to infection and asymptomatic disease spread. These challenges can shape medical students’ professional identity formation (PIF), defined as how learners come to ‘think, act, and feel like a physician.’(1) Medical students develop their identities as emerging professionals through training, and a crisis such as a pandemic alters, impedes, or accelerates this process. A crisis catalyzes transformative learning by serving as a disorienting dilemma, and educators can harness this opportunity for growth.

transformative learning by serving as a disorienting dilemma, and educators can harness this opportunity for growth.

What was tried? A longitudinal integrated PIF curriculum drawing on the work of Cruess et al. is included in the University of California San Francisco School of Medicine curriculum. The regular 4year curriculum contains eight separate interspersed weeks of "Assessment, Reflection, Coaching, and Health" (ARCH). These fulltime learning experiences highlight factors that influence socialization into medicine-the crux of PIF. With the health system and clinical learning environment rapidly changing in response to COVID-19, classroom curricula transitioning to online platforms, and increased isolation due to social distancing, we revamped PIF content to address these disruptions.

A central component of PIF is acceptance of uncertainty and ambiguity. We emphasize this theme by examining the tensions of personal versus professional duties, rationing and prioritization of resources, and healthcare disparities that have been exacerbated by COVID-19 (see website). Students discuss how they negotiate "playing the role" of physician as friends and family ask about or question whether they should provide care that may elevate their personal risk of infection or of spreading the virus.

To mitigate anxiety, fear, and stress, we provide students links to virtual wellness offerings including physical exercise and mindfulness. To process these emotions, we use small-group-based guided reflection (see website), which is core to PIF, and adapt this strategy for asynchronous-and distancelearning. We increased contact with faculty coaches, many of whom are involved in care for patients with COVID-19, and peers via Zoom small groups to enhance socialization and combat isolation through communities of learning. By using pre-existing small groups, we preserve rituals such as group check-ins that provide comfort and signal membership in a group and the profession.

What lessons were learned? Our experience with PIF curriculum redesign to meet students' learning needs during a crisis is that students are uncertain about their roles, yet eager to contribute, while simultaneously juggling feelings of isolation, helplessness, and fear. Pausing foundational

This article is protected by copyright. All rights reserved science curricula and clinical clerkships to participate in guided PIF content has been mostly met with relief. Providing time for learners to reconnect with role models, has facilitated conscious reflection.

Opportunity to discuss their thoughts and feelings with peers has helped to counteract isolation, normalize their reactions, and reduce students' stress and anxiety.

The rapidly shifting healthcare landscape challenges identities for all providers. Reflecting on this evolution has enabled us to maximize the transformative effect of our current circumstances for students' learning and development.

A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Academic medicine: journal of the Association of

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