A qualitative exploration of the impact of the COVID-19 pandemic on personal and professional identity formation in early-stage medical students

Andy Wearn; Rebecca Gandhi; Yan Chen; Nicholas Hoeh; Fiona Moir

doi:10.11157/mhmvmz37

Authors

Andy Wearn The University of Auckland, New Zealand https://orcid.org/0000-0002-4119-234X
Rebecca Gandhi The University of Auckland, New Zealand
Yan Chen The University of Auckland, New Zealand https://orcid.org/0000-0002-1665-9294
Nicholas Hoeh The University of Auckland, New Zealand https://orcid.org/0000-0002-8013-1208
Fiona Moir The University of Auckland, New Zealand https://orcid.org/0000-0001-6585-4136

DOI:

https://doi.org/10.11157/mhmvmz37

Keywords:

medical students, social identification, professionalism, COVID-19, qualitative research

Abstract

Introduction: Professionalism and professional identity formation (PIF) require a range of experiences and opportunities to develop: active in-person learning, role-modelling and authentic clinical experience. The COVID-19 pandemic disrupted these. This study explores the pandemic’s effect on identity formation for early-stage medical students after a disrupted initial year. Existing literature provides some empirical data; our focus was on students who were not yet on clinical placement and on student-derived solutions. Our aim was to identify deficits, experiences that supported development of PIF and how to address disruption.

Methods: Medical student experiences were explored through in-person focus groups, using hermeneutic phenomenology and identity formation as the frameworks. Data were transcribed and analysed using inductive thematic analysis.

Results: Findings intersected well with personal and professional identity formation theories. Students identified that losses of connection, limitations on experiential learning and isolation affected growth. Slippage between stages of personal identity formation was demonstrated in levels of uncertainty, discussions of resilience and expectation and personal wellbeing.

Conclusions: Rapid system change maintained some meaningful academic and social interaction, including authentic virtual role modelling. Students identified communication and support as key factors during disruption. Normalising experience and expectations had potential to reduce anxiety and uncertainty. These findings are likely to be true for future disruptions. Careful and deliberate nurturing of affected cohorts is needed to allow catch-up of lost opportunities, along with proactive monitoring and support for graduates and ongoing study. These students are completing programs or have entered practice and may have delays or variations in developing their identity values.

References

Ardekani, A., Hosseini, S. A., Tabari, P., Rahimian, Z., Feili, A., Amini, M., & Mani, A. (2021). Student support systems for undergraduate medical students during the COVID-19 pandemic: A systematic narrative review of the literature. BMC Medical Education, 21(1), Article 352. https://doi.org/10.1186/s12909-021-02791-9

Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68–73. https://doi.org/10.1111/j.1750-8606.2007.00016.x

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Byram, J. N., Frankel, R. M., Isaacson, J. H., & Mehta, N. (2022). The impact of COVID-19 on professional identity. The Clinical Teacher, 19(3), 205–212. https://doi.org/10.1111/tct.13467

Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89(11), 1446–1451. https://doi.org/10.1097/ACM.0000000000000427

Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2015). A schematic representation of the professional identity formation and socialization of medical students and residents: A guide for medical educators. Academic Medicine, 90(6), 718–725. https://doi.org/10.1097/ACM.0000000000000700

Cruess, R. L., Cruess, S. R., & Steinert, Y. (2018). Medicine as a community of practice: Implications for medical education. Academic Medicine, 93(2), 185–191. https://doi.org/10.1097/ACM.0000000000001826

Cruess, S. R., Cruess, R. L., & Steinert, Y. (2019). Supporting the development of a professional identity: General principles. Medical Teacher, 41(6), 641–649. https://doi.org/10.1080/0142159X.2018.1536260

Cullum, R. J., Shaughnessy, A., Mayat, N. Y., & Brown, M. E. (2020). Identity in lockdown: Supporting primary care professional identity development in the COVID-19 generation. Education for Primary Care, 31(4), 200–204. https://doi.org/10.1080/14739879.2020.1779616

Dyrbye, L. N., Thomas, M. R., Power, D. V., Durning, S., Moutier, C., Massie, F. S., Jr., Harper, W., Eacker, A., Szydlo, D. W., & Sloan, J. A. (2010). Burnout and serious thoughts of dropping out of medical school: A multi-institutional study. Academic Medicine, 85(1), 94–102. https://doi.org/10.1097/ACM.0b013e3181c46aad

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2005). Medical student distress: Causes, consequences, and proposed solutions. Mayo Clinic Proceedings, 80(12), 1613–1622. https://doi.org/10.4065/80.12.1613

Eley, D. S., Bansal, V., & Leung, J. (2020). Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students. Medical Teacher, 42(11), 1301–1307. https://doi.org/10.1080/0142159X.2020.1805101

Erikson, E. H. (1968). Identity, youth and crisis. WW Norton & company. https://doi.org/10.1002/bs.3830140209

Fenwick, T. (2014). Social media and medical professionalism: Rethinking the debate and the way forward. Academic Medicine, 89(10), 1331–1334. https://doi.org/10.1097/ACM.0000000000000436

Findyartini, A., Anggraeni, D., Husin, J. M., & Greviana, N. (2020). Exploring medical students’ professional identity formation through written reflections during the COVID-19 pandemic. Journal of Public Health Research, 9(Suppl. 1), Article 1918. https://doi.org/10.4081/jphr.2020.1918

Goldie, J. (2012). The formation of professional identity in medical students: Considerations for educators. Medical Teacher, 34(9), e641–e648. https://doi.org/10.3109/0142159X.2012.687476

Halperin, S. J., Henderson, M. N., Prenner, S., & Grauer, J. N. (2021). Prevalence of anxiety and depression among medical students during the COVID-19 pandemic: A cross-sectional study. Journal of Medical Education and Curricular Development, 8. https://doi.org/10.1177/2382120521991150

Henderson, R. R., Adams, C. A., Thomas, L., Gundersen, E., Zaidi, Z., & Hagen, M. (2023). COVID as a catalyst: A qualitative study of professional identity formation among U.S. medical students during COVID-19. Teaching and Learning in Medicine, 36(5), 601–612. https://doi.org/10.1080/10401334.2023.2240774

Hilton, S. R., & Slotnick, H. B. (2005). Proto-professionalism: How professionalisation occurs across the continuum of medical education. Medical Education, 39(1), 58–65. https://doi.org/10.1111/j.1365-2929.2004.02033.x

Lingard, L., Garwood, K., Schryer, C. F., & Spafford, M. M. (2003). A certain art of uncertainty: Case presentation and the development of professional identity. Social Science & Medicine, 56(3), 603–616. https://doi.org/10.1016/S0277-9536(02)00057-6

Maile, E., McKimm, J., & Till, A. (2019). Exploring medical leader identity and its formation. Leadership in Health Services, 32(4), 584–599. https://doi.org/10.1108/LHS-12-2018-0066

Marcia, J. E. (2002). Identity and psychosocial development in adulthood. Identity: An International Journal of Theory and Research, 2(1), 7–28. https://doi.org/10.1207/S1532706XID0201_02

Medical Deans Australia and New Zealand (MDANZ). (2021). Professionalism and professional identity of our future doctors. https://medicaldeans.org.au/md/2021/02/Professionalism-and-professional-identity-of-our-future-doctors-2021-FEB.pdf

Mittal, R., Su, L., & Jain, R. (2021). COVID-19 mental health consequences on medical students worldwide. Journal of Community Hospital Internal Medicine Perspectives, 11(3), 296–298. https://doi.org/10.1080/20009666.2021.1918475

Moir, F., Patten, B., Yielder, J., Sohn, C. S., Maser, B., & Frank, E. (2023). Trends in medical students’ health over 5 years: Does a wellbeing curriculum make a difference? International Journal of Social Psychiatry, 69(3), 675–688. https://doi.org/10.1177/00207640221133944

Moir, F., Usher, K., & Wilson, H. (2024). New Zealand: The power of connection: Perspectives on medical student wellbeing in New Zealand. In A. Molodynski, S. M. Farrell, & D. Bhugra (Eds.), The mental health of medical students: Supporting wellbeing in medical education (pp. 218–236). Oxford University Press. https://doi.org/10.1093/oso/9780192864871.003.0019

Monrouxe, L. (2016). Theoretical insights into the nature and nurture of professional identities. In R. L. Cruess, S. R. Cruess, & Y. Steinert (Eds.), Teaching medical professionalism (pp. 37–53). Cambridge University Press. https://doi.org/10.1017/CBO9781316178485.005

Monrouxe, L. V., Bullock, A., Tseng, H., & Wells, S. E. (2017). Association of professional identity, gender, team understanding, anxiety and workplace learning alignment with burnout in junior doctors: A longitudinal cohort study. BMJ Open, 7(12), Article e017942. https://doi.org/10.1136/bmjopen-2017-017942

Monrouxe, L. V., & Rees, C. E. (2015). Theoretical perspectives on identity: Researching identities in healthcare education. In J. Cleland & S. J. Durning (Eds.), Researching medical education (pp. 129–140). Wiley. https://doi.org/10.1002/9781118838983.ch12

Moss, J. M., Gibson, D. M., & Dollarhide, C. T. (2014). Professional identity development: A grounded theory of transformational tasks of counselors. Journal of Counseling & Development, 92(1), 3–12. https://doi.org/10.1002/j.1556-6676.2014.00124.x

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2

Olson, K., Marchalik, D., Farley, H., Dean, S. M., Lawrence, E. C., Hamidi, M. S., Rowe, S., McCool, J. M., O'Donovan, C. A., & Micek, M. A. (2019). Organizational strategies to reduce physician burnout and improve professional fulfillment. Current Problems in Pediatric and Adolescent Health Care, 49(12), Article 100664. https://doi.org/10.1016/j.cppeds.2019.100664

Rees, C. E., & Monrouxe, L. V. (2018). Who are you and who do you want to be? Key considerations in developing professional identities in medicine. Medical Journal of Australia, 209(5), 202–203. https://doi.org/10.5694/mja18.00118

Rose, S. (2020). Medical student education in the time of COVID-19. JAMA, 323(21), 2131–2132. https://doi.org/10.1001/jama.2020.5227

Smith, M. M., Sherry, S. B., Saklofske, D. H., & Mushqaush, A. R. (2017). Clarifying the perfectionism–procrastination relationship using a 7-day, 14-occasion daily diary study. Personality and Individual Differences, 112, 117–123. https://doi.org/10.1016/j.paid.2017.02.059

Stetson, G. V., Kryzhanovskaya, I. V., Lomen-Hoerth, C., & Hauer, K. E. (2020). Professional identity formation in disorienting times. Medical Education, 54(8), 765–766. https://doi.org/10.1111/medu.14202

Tolsgaard, M. G., Cleland, J., Wilkinson, T., & Ellaway, R. H. (2020). How we make choices and sacrifices in medical education during the COVID-19 pandemic. Medical Teacher, 42(7), 741–743. https://doi.org/10.1080/0142159X.2020.1767769

Wald, H. S. (2015). Professional identity (trans) formation in medical education: Reflection, relationship, resilience. Academic Medicine, 90(6), 701–706. https://doi.org/10.1097/ACM.0000000000000731

Walters, M., Alonge, T., & Zeller, M. (2022). Impact of COVID-19 on medical education: Perspectives from students. Academic Medicine, 97(3S), S40–S48. https://doi.org/10.1097/ACM.0000000000004525

Williams-Yuen, J., Shunmugam, M., Smith, H., Jarvis-Selinger, S., & Hubinette, M. (2022). COVID as a catalyst: Medical student perspectives on professional identity formation during the COVID-19 pandemic. Canadian Medical Education Journal, 13(3), 13–21. https://doi.org/10.36834/cmej.73444

Wurth, S., Sader, J., Cerutti, B., Broers, B., Bajwa, N. M., Carballo, S., Escher, M., Galetto-Lacour, A., Grosgurin, O., & Lavallard, V. (2021). Medical students’ perceptions and coping strategies during the first wave of the COVID-19 pandemic: Studies, clinical implication, and professional identity. BMC Medical Education, 21(1), Article 620. https://doi.org/10.1186/s12909-021-03053-4