Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-86b6f Total loading time: 0 Render date: 2025-03-07T20:41:39.330Z Has data issue: false hasContentIssue false

3 - Theoretical insights into the nature and nurture of professional identities

from Part II - Theory

Published online by Cambridge University Press:  05 April 2016

By
Lynn V. Monrouxe
Edited by
Richard L. Cruess ,
Sylvia R. Cruess  and
Yvonne Steinert
Lynn V. Monrouxe
Affiliation:
Chang Gung Memorial Hospital, Linkou, Taiwan
Richard L. Cruess
Affiliation:
McGill University, Montréal
Sylvia R. Cruess
Affiliation:
McGill University, Montréal
Yvonne Steinert
Affiliation:
McGill University, Montréal
Get access

Summary

Introduction

The formation of identities is a process. Our own particular identities enable us to understand our place in the world: in other words, identities enable us to identify others and ourselves in any particular context. Furthermore, identity is not a singular, unchanging entity that we possess. Rather, it is a multifaceted and highly subjective concept that, influenced by many environmental factors, evolves over time and is enacted through language and objects in the social world.1,2 Likewise, medical professionalism is contextual and evolving and is conceptualized according to a number of different discourses.3,4 These discourses identify professionalism as an attribute of the individual physician, the interactional exchange, and the wider organizational and social context within which it occurs. Again, professionalism has a temporal aspect, rather than being a static and fixed concept. I will outline a range of theoretical underpinnings for the concept of professional identities that seek to explain its nature (i.e., internal cognitive processes) and its nurture (i.e., external social processes). My aim is to simplify, synergize, and contextualize the often complex, conflicting, and abstract notions of identity, identities, and identification in order to inform the ways in which we might consider the nature and nurture of professional identities in our explicit education of professionals. Furthermore, many of the theoretical approaches to identity, and the subsequent research within these approaches, tend to classify individuals into particular types. By way of a caveat, I am mindful that, while these are useful classifications for understanding the diverse nature and nurture of professional identities, the stereotyping of people according to such classifications is problematic. Although classifications can be positive or negative, they necessarily overlook the complexity of individuals, and as such are neither true nor false.

Identities and social worlds

Before we begin to think about professional identities, it is useful for us to stand back and consider the broader issue of how we conceptualize the human world within which identities and professionalism emerge, along with the process through which identities are developed. Irrespective of our broader cultural environment, we are all, to some extent, both embodied individuals and part of collective worlds, or cultures (e.g., familial, friendship, organizational, national).

Type
Chapter
Information
Teaching Medical Professionalism
Supporting the Development of a Professional Identity
 , pp. 37 - 53
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Monrouxe, LV. Identity, identification and medical education: why should we care? Med Educ. 2010; 44(1):40–49.Google Scholar
2. Monrouxe, LV. Identity, self and medical education. In Walsh, K, ed. Oxford Textbook of Medical Education. Oxford, UK: Oxford University Press; 2013:113–23.
3. Hafferty, FW, Castellani, B. A sociological framing of medicine's modern-day professionalism movement. Med Educ. 2009; 43(9): 826–28.CrossRefGoogle Scholar
4. Monrouxe, LV, Rees, CE, Hu, W. Differences in medical students’ explicit discourses of professionalism: acting, representing, becoming. Med Educ. 2011; 45(6):585–602.CrossRefGoogle Scholar
5. Jenkins, R. Social Identity. edition. New York, NY: Routledge; 2008.
6. Schwartz, SJ, Luyckx, K, Vignoles, VL, eds. Handbook of Identity Theory and Research. New York, NY: Springer; 2011.
7. Lacan, J. The mirror stage. In du Gay, P, Evans, J, Redman, P, eds. Identity: A Reader. London, UK: SAGE Publications; 2000; 44–50.
8. Goffman, E. The Presentation of Self in Everyday Life. New York, NY: Anchor; 1959.
9. Egan, EA, Parsi, K, Ramirez, C. Comparing ethics education in medicine and law: combining the best of both worlds. Ann Health Law. 2004; 13(1):303–25.Google Scholar
10. Narvaez, D, Lapsley, DK. The psychological foundations of everyday morality and moral expertise. In Lapsley, DK, Power, FC, eds. Character Psychology and Character Education. Notre Dame, IN: University of Notre Dame Press; 2005; 140–65.
11. Kagan, J. Human morality and temperament. In Carlo, G, Pope-Edwards, C, eds. Moral Motivation through the Life Span (Volume 51 of the Nebraska Symposium on Motivation). Lincoln, NE: University of Nebraska Press; 2005; 1–32.
12. Kohlberg, L. Essays on Moral Development, Volume One: The Philosophy of Moral Development. San Francisco, CA: Harper and Row; 1981.
13. Frank, AW. Ethics as process and practice. Intern Med J. 2004; 34(6): 355–57.CrossRefGoogle Scholar
14. Blasi, A. Moral cognition and moral action: a theoretical perspective. Dev Rev. 1983; 3(2):178–210.CrossRefGoogle Scholar
15. Monrouxe, LV, Rees, CE. “It's just a clash of cultures”: emotional talk within medical students’ narratives of professionalism dilemmas. Adv Health Sci Educ Theory Pract. 2012; 17(5):671–701.CrossRefGoogle Scholar
16. Monrouxe, LV, & Rees, CE. Hero, Voyeur, Judge: Understanding medical students’ moral identities through professionalism dilemma narratives. In Kenneth, Mavor, Michael, Platow and Boris, Bizumic (Eds.) Self and Social Identity in Learning and Educational Contexts. Psychology Press; in press.
17. Monrouxe, LV, Rees, CE, Endacott, R, Ternan, E. ‘Even now it makes me angry’: health care students’ professionalism dilemma narratives. Med Educ. 2014; 48(5):502–17.Google Scholar
18. Rees, CE, Monrouxe, LV, Ajjawi, R. Professionalism in workplace learning: understanding interprofessional dilemmas through healthcare student narratives. In Jindal-Snape, D, Hannah, ESF, eds. Exploring the Dynamics of Personal, Professional and Interprofessional Ethics. Bristol, UK: Policy Press; 2014: 295–310.
19. Rees, CE, Monrouxe, LV, McDonald, LA. ‘My mentor kicked a dying woman's bed…’ Analysing UK nursing students’ ‘most memorable’ professionalism dilemmas. J Adv Nurs. 2015; 71(1):169–80.CrossRefGoogle Scholar
20. Hafferty, FW, Franks, R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med. 1994; 69(11):861–71.CrossRefGoogle Scholar
21. Witman, Y. What do we transfer in case discussions? The hidden curriculum in medicine… Perspect Med Educ. 2014; 3(2):113–23.Google Scholar
22. Erikson, EH. Identity: Youth and Crisis. New York, NY: WW Norton; 1968.
23. Marcia, JE. Development and validation of ego-identity status. J Pers Soc Psychol. 1966; 3(5):551–58.Google Scholar
24. Marcia, JE, Waterman, AS, Matteson, DR, Archer, SL, Orlofsky, JL. Ego Identity: A Handbook for Psychosocial Research. New York, NY: Springer; 1993.
25. Berzonsky, MD. The self as theorist: individual differences in identity formation. International Journal of Personal Construct Psychology. 1989; 2(4):363–76.Google Scholar
26. Berzonsky, MD. Self construction across the life-span: a process view of identity development. In Neimeyer, GH, Neimeyer, RA, eds. Advances in Personal Construct Psychology. Greenwich, CT: JAI Press; 1990:155–86.
27. McAdams, DP. The Stories We Live By: Personal Myths and the Making of the Self. New York, NY: Guildford Press; 1993.
28. Chaytor, AT, Spence, J, Armstrong, A, McLachlan, JC. Do students learn to be more conscientious at medical school? BMC Med Educ. 2012; 12:54.Google Scholar
29. Clancy, SM, Dollinger, SJ. Identity, self, and personality: I. Identity status and the five-factor model of personality. J Res Adolesc. 1993; 3(3):227–45.Google Scholar
30. Lillevoll, KR, Kroger, J, Martinussen, M. Identity status and locus of control: a meta-analysis. Identity: An International Journal of Theory and Research. 2013; 13(3):253–65.Google Scholar
31. Jespersen, K, Kroger, J, Martinussen, M. Identity status and moral reasoning: a meta-analysis. Identity: An International Journal of Theory and Research. 2013; 13(3):266–80.CrossRefGoogle Scholar
32. Bacanli, F. An examination of the relationship amongst decision-making strategies and ego identity statuses. Education and Science. 2012; 37(163):17–18.Google Scholar
33. Ryeng, MS, Kroger, J, Martinussen, M. Identity status and authoritarianism: a meta-analysis. Identity: An International Journal of Theory and Research. 2013; 13(3):242–52.CrossRefGoogle Scholar
34. Niemi, PM, Vainiomäki, PT, Murto-Kangas, M. “My future as a physician” – professional representations and their background among first-day medical students. Teach Learn Med. 2003; 15(1):31–39.CrossRefGoogle Scholar
35. Beran, T Hecker, K, Coderre, S, Wright, B, Woloschuk, W, McLaughlin, K. Ego identity status of medical students in clerkship. Can Med Educ J. 2011; 2(1):e4–e10.Google Scholar
36. In Schwartz, SJ, Luyckx, K, Vignoles, VL, eds. Berzonsky, M. D. A social-cognitive perspective on identity construction. Handbook of Identity Theory and Research. New York, NY: Springer; 2011:55–76.
37. Kelly, GA. The Psychology of Personal Constructs. New York, NY: WW Norton; 1955.
38. Berzonsky, MD, Sullivan, C. Social-cognitive aspects of identity style: need for cognition, experiential openness, and introspection. J Adolesc Res. 1992; 7(2):140–55.CrossRefGoogle Scholar
39. Dollinger, SMC. Identity styles and the five-factor model of personality. J Res Pers. 1995; 29(4):475–79.CrossRefGoogle Scholar
40. Dollinger, SJ, Dollinger, SMC. Individuality and identity exploration: an autophotographic study. J Res Pers. 1997; 31(3):337–54.Google Scholar
41. Berzonsky, MD, Kuk, LS. Identity style, psychosocial maturity, and academic performance. Pers Individ Dif. 2005; 39(1):235–47.CrossRefGoogle Scholar
42. Hejazi, E, Shahraray, M, Farsinejad, M, Asgary, A. Identity styles and academic achievement: mediating role of academic self-efficacy. Soc Psychol Educ. 2009; 12(1):123–35.CrossRefGoogle Scholar
43. Seaton, CL, Beaumont, SL. Individual differences in identity styles predict proactive forms of positive adjustment. Identity: An International Journal of Theory and Research. 2008; 8(3):249–68.CrossRefGoogle Scholar
44. Jakubowski, TG, Dembo, MH. The relationship of self-efficacy, identity style, and stage of change with academic self-regulation. Journal of College Reading and Learning. 2004; 35(1):7–24.CrossRefGoogle Scholar
45. Soenens, B, Berzonsky, MD, Vansteenkiste, M, Beyers, W, Goossens, L. Identity styles and causality orientations: in search of the motivational underpinnings of the identity exploration process. Eur J Pers. 2005; 19(5):427–42.CrossRefGoogle Scholar
46. Duriez, B, Soenens, B. Personality, identity styles and authoritarianism: an integrative study among late adolescents. Eur J Pers. 2006; 20(5):397–417.CrossRefGoogle Scholar
47. Harré, R. Public sources of the personal mind: social constructionism in context. Theory Psychol. 2002; 12(5):611–23.CrossRefGoogle Scholar
48. Monrouxe, LV. Negotiating professional identities: dominant and contesting narratives in medical students’ longitudinal audio diaries. Current Narratives. 2009; 1(1):41–59.Google Scholar
49. Whitehead, CR. The Good Doctor in Medical Education 1910–2010: A Critical Discourse Analysis. Toronto, ON: Leslie Dan Faculty of Pharmacy, University of Toronto, 2011.
50. Frost, HD, Regehr, G. “I am a doctor”: negotiating the discourses of standardization and diversity in professional identity construction. Acad Med. 2013; 88(10):1570–77.CrossRefGoogle Scholar
51. Rees, CE, Monrouxe, LV. ‘Is it alright if I-um-we unbutton your pyjama top now?’ Pronominal use in bedside teaching encounters. Commun Med. 2008; 5(2):171–82.CrossRefGoogle Scholar
52. Bamberg, M. Stories: big or small. Why do we care? Narrat Inq. 2006; 16(1):139–47.Google Scholar
53. Bamberg, MGW, De Fina, A, Schiffrin, D Selves and Identities in Narrative and Discourse. Amsterdam, the Netherlands: John Benjamins; 2007.
54. Davies, R, Harré, R. Positioning: the discursive production of selves. J Theory Soc Behav. 1990; 20(1):43–63.CrossRefGoogle Scholar
55. Monrouxe, LV, Rees, CE, Bradley, P. The construction of patients’ involvement in hospital bedside teaching encounters. Qual Health Res. 2009; 19(7):918–30.CrossRefGoogle Scholar
56. Elsey, C, Monrouxe, LV, Grant, A. The reciprocal nature of trust in bedside teaching encounters. In Pelsmaekers, K, Jacobs, G, Rollo, C, eds. Trust and Discourse: Organizational Perspectives. Amsterdam, the Netherlands: John Benjamins; 2014:45–70.
57. Rizan, C, Elsey, C, Lemon, T, Grant, A, Monrouxe, LV. Feedback in action within bedside teaching encounters: a video ethnographic study. Med Educ. 2014; 48(9):902–20.CrossRefGoogle Scholar
58. Watson, C. Small stories, positioning analysis, and the doing of professional identities in learning to teach. Narrat Inq. 2007; 17(2):371–89.Google Scholar
59. Monrouxe, LV, Sweeney, K. Between two worlds: medical students narrating identity tensions. In Figley, C, Huggard, P, Rees, CE, eds. First Do No Self-Harm: Understanding and Promoting Physician Stress Resilience. Oxford, UK: Oxford University Press; 2013:44–66.
60. Monrouxe, LV, Rees, CE. Theoretical perspectives on identity: researching identities in healthcare education. In Cleland, A, Durning, SJ, eds. Researching Medical Education. Oxford, UK: Wiley Blackwell; 2015:129–40.
61. Monrouxe, LV. Solicited audio diaries in longitudinal narrative research: a view from inside. Qual Res. 2009; 9(1):81–103.CrossRefGoogle Scholar
62. Swick, HM. Toward a normative definition of medical professionalism. Acad Med. 2000; 75(6):612–16.CrossRefGoogle Scholar
63. Finlay, SE, Fawzy, M. Becoming a doctor. Med Humanit. 2001; 27(2):90–92.Google Scholar
64. Beagan, BL. Neutralizing differences: producing neutral doctors for (almost) neutral patients. Soc Sci Med. 2000; 51(18):1253–65.CrossRefGoogle Scholar
65. Buckley, A. Does becoming a professional mean I have to become white? J Am Indian Educ. 2004; 43(2):19–32.Google Scholar
66. Geraci, AP. Earring etiquette in medical school. JAMA. 1994; 271.(9):716.Google Scholar
67. Monrouxe, LV, Sweeney, K. Contesting narratives: medical professional identity formation amidst changing values. In Pattison, S, Hannigan, B, Thomas, H, Pill, R, eds. Emerging Values in Health Care: The Challenge for Professionals. London, UK: Jessica Kingsley; 2010:61–77.
68. Cruess, SR, Cruess, RL, Steinert, Y. Role modelling—making the most of a powerful teaching strategy. BMJ. 2008; 336(7646):718–21.CrossRefGoogle Scholar
69. Rees, CE, Monrouxe, LV, McDonald, LA. Narrative, emotion and action: analysing ‘most memorable’ professionalism dilemmas. Med Educ. 2013; 47(1):80–96.CrossRefGoogle Scholar
70. Hudon, C, Fortin, M, Haggerty, JL, Lambert, M, Poitras, ME. Measuring patients’ perceptions of patient-centered care: a systematic review of tools for family medicine. Ann Fam Med. 2011; 9(2):155–64.Google Scholar
71. Mead, N, Bower, P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000; 51(7):1087–1110.CrossRefGoogle Scholar
72. Elsey, C, Monrouxe, LV, Grant, A. Role-Modelling Patient-Centredness within Bedside Teaching Encounters: A Video Ethnographic Study. Association for the Study of Medical Education annual scientific meeting: Brighton, UK; 2012.
73. Rees, CE, Ajjawi, R, Monrouxe, LV. The construction of power in family medicine bedside teaching: a video observation study. Med Educ. 2013; 47(2):154–65.CrossRefGoogle Scholar
74. Benwell, B, Stokoe, E. Discourse and Identity. Edinburgh, UK: Edinburgh University Press; 2006.
75. Haslam, SA, Ellemers, N. Identity processes in organizations. In Schwartz, SJ, Luyckx, K, Vignoles, VL, eds. Handbook of Identity Theory and Research. New York, NY: Springer; 2011:715–44.
76. Tajfel, H, Turner, JC. The social identity theory of intergroup behavior. In Jost, JT, Sidanius, J, eds. Political Psychology: Key Readings. New York, NY: Psychology Press; 2004:367–90.
77. Turner, JC, Hogg, MA, Oakes, PJ, Reicher, SD, Wetherell, MS, eds. Rediscovering the Social Group: A Self-Categorization Theory. Oxford, UK: Blackwell; 1987.
78. Zabarenko, RN, Zabarenko, L. Doctor Tree: Developmental Stages in the Growth of Physicians. Pittsburgh, PA: University of Pittsburgh Press; 1978.
79. Tajfel, H, ed. Differentiation between Social Groups: Studies in the Social Psychology of Intergroup Relations. London, UK: Academic Press; 1978.
80. Rudland, JR, Mires, GJ. Characteristics of doctors and nurses as perceived by students entering medical school: implications for shared teaching. Med Educ. 2005; 39(5):448–55.Google Scholar
81. Whetten, DA. Albert and Whetten revisited: strengthening the concept of organizational identity. Journal of Management Inquiry. 2006; 15(3):219–34.CrossRefGoogle Scholar
82. Kramer, RM, Brewer, MB, Hanna, BA. Collective trust and collective action: the decision to trust as a social decision. In Kramer, RM, Tyler, TR, eds. Trust in Organizations: Frontiers of Theory and Research. Thousand Oaks, CA: SAGE; 1996:357–89.
83. Monrouxe, LV, Rees, CE, Dennis, I & Wells, SE (2015) Professionalism dilemmas, moral distress and the healthcare student: Insights from two online UK-wide questionnaire studies. BMJ Open. 5(5).Google Scholar
84. Chiu, PP, Hilliard, RI, Azzie, G, Fecteau, A. Experience of moral distress among pediatric surgery trainees. J Pediatr Surg. 2008; 43(6):986–93.CrossRefGoogle Scholar
85. Førde, R, Aasland, OG. Moral distress among Norwegian doctors. J Med Ethics. 2008; 34(7):521–25.Google Scholar
86. Kälvemark, S, Höglund, AT, Hansson, MG, Westerholm, P, Arnetz, B. Living with conflicts-ethical dilemmas and moral distress in the health care system. Soc Sci Med. 2004; 58(6):1075–84.CrossRefGoogle Scholar
87. Lomis, KD, Carpenter, RO, Miller, BM. Moral distress in the third year of medical school; a descriptive review of student case reflections. Am J Surg. 2009; 197(1):107–12.Google Scholar
88. Mobley, MJ, Rady, MY, Verheijde, JL, Patel, B, Larson, JS. The relationship between moral distress and perception of futile care in the critical care unit. Intensive Crit Care Nurs. 2007; 23(5):256–63.Google Scholar
89. Sundin-Huard, D, Fahy, K. Moral distress, advocacy and burnout: theorizing the relationships. Int J Nurs Pract. 1999; 5(1):8–13.CrossRefGoogle Scholar
90. ABIM Foundation, American Board of Internal Medicine; ACP-ASIM Foundation, American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136(3):243–46.CrossRef
91. Ho, MJ. Culturally sensitive medical professionalism. Acad Med. 2013; 88(7):1014.CrossRefGoogle Scholar
92. Maleki, A, de Jong, M. A proposal for clustering the dimensions of national culture. Cross Cult Res. 2014; 48(2):107–43.CrossRefGoogle Scholar
93. Triandis, HC. Individualism and Collectivism. Boulder, CO: Westview Press; 1995.
94. Tafarodi, RW, Lo, C, Yamaguchi, S, Lee, WWS, Katsura, H. The inner self in three countries. J Cross Cult Psychol. 2004; 35(1):97–117.Google Scholar
95. English, T, Chen, S. Culture and self-concept stability: consistency across and within contexts among Asian Americans and European Americans. J Pers Soc Psychol. 2007; 93(3):478–90.CrossRefGoogle Scholar
96. Peng, K, Nisbett, RE. Culture, dialectics, and reasoning about contradiction. Am Psychol. 1999; 54(9):741–54.CrossRefGoogle Scholar
97. Chiu, CY, Hong, YY, Dweck, CS. Lay dispositionism and implicit theories of personality. J Pers Soc Psychol. 1997; 73(1):19–30.CrossRefGoogle Scholar
98. Yuki, M. Intergroup comparison versus intragroup relationships: a cross-cultural examination of social identity theory in North American and East Asian cultural contexts. Soc Psychol Q. 2003; 66(2):166–83.CrossRefGoogle Scholar
99. Ho, MJ, Yu, KH, Hirsh, D, Huang, TS, Yang, PC. Does one size fit all? Building a framework for medical professionalism. Acad Med. 2011; 86(11):1407–14.CrossRefGoogle Scholar
100. Chandratilake, M, McAleer, S, Gibson, J. Cultural similarities and differences in medical professionalism: a multi-region study. Med Educ. 2012; 46(3):257–66.Google Scholar
101. Schwartz, SH. A theory of cultural values and some implications for work. J Appl Psychol. 1999; 48(1):23–47.Google Scholar
102. Bandura, A. Social Learning Theory. New York, NY: General Learning Press; 1973.
103. Monrouxe, LV. When I say… intersectionality in medical education research. Med Educ. 2015; 49(1):21–22.CrossRefGoogle Scholar
104. Skorikov, VB, Vondracek, FW. Occupational identity. In Schwartz, SJ, Luyckx, K, Vignoles, VL, eds. Handbook of Identity Theory and Research. New York, NY: Springer; 2011:693–714.

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×