INTRODUCTION
METHODS
Stage 1: Systematic Approach
Stage 2: Split Approach
Stage 3: Jigsaw Perspective
Stage 4: Funnelling
Stage 5: Analysing Data from Research and Non-research-based Sources
RESULTS
Intrinsic enablers | Extrinsic enablers | Barriers | |
---|---|---|---|
Medical student is able to: | Learning environment enables: | Student perceives or experiences: | |
Societal Ring | • Acknowledge societal expectations pertaining to professional role, responsibilities and codes of conduct 10,67,72,73,101,105,118,119 • Exhibit professional behaviour in daily practice 74 | • Meaningful professional relationships with multidisciplinary healthcare teams 5,8‐10,54,64,65,71,72,74,82,84,89,93,96,97,99,102‐104,107,124 • Clarity of role within team and wider healthcare system 9 • Formal curriculum to foster holistic, longitudinal knowledge acquisition and clinical education 2,5‐7,10,54,62‐65,67,69,71‐74,76‐79,81‐84,88,89,91,93‐97,100‐105,109,110,118‐132 | • Tensions between personal values and broader professional identity instigated by challenging encounters 4,7,65,81 • Negative portrayal of profession by mainstream media or glamorization of traits such as cynicism 68,99,124 • Difficulty navigating or fitting into new clinical environments 7 |
Relational Ring | • Challenging relationships with team member, patients or peers 88 | ||
Individual Ring | • Exposure to challenging clinical experiences such as death and suffering 118 |
Strategies adopted by medical schools to support PIF | References | |
---|---|---|
Formal ethics and professionalism instruction | Prioritizing principles of professionalism and professional identity formation consistently through curricular goals (professional roles, codes of practice, patient-centred care, ethics instruction, cultural sensitivity, clinical reasoning, communication skills, interprofessional education) using relevant instructional methods (e.g. didactic classroom learning, online modules, seminars, lectures, tutorials, group projects, small-group discussions, reflective writing, experiential learning, community care), and including a system for timely and appropriate feedback to help students improve in clinical capabilities Performing formative and summative assessment of professionalism as opportunities for learning, remediation, and in extreme cases, exclusion if a student severely violates codes of conduct | |
Informal and hidden curriculum | Acknowledging the significant influence of informal interactions with the medical community, role models and patients during profound life moments such as birth, death or suffering on student learning, values, attitudes, behaviours, specialty choice or perceived suitability for medicine | |
Learning environment | Establishing guidelines to ensure safe and open learning environments in which learner confidentiality is maintained, student behaviours such as competing, comparing, interrupting, prescribing and speaking on behalf of another are mitigated; open and non-judgmental discourse supported; and professional behaviour reinforced as an indicator of future conduct | |
Symbolic socialization | Conducting contextually appropriate symbolic events such as White Coat Ceremony to foster socialization into the profession | |
Medical humanities | Formally incorporating humanities with modules as outlets for creative release and emotional expression through art and stories that support empathy, compassion, tolerance of uncertainty and critical thinking on issues such as ethics and social justice | |
Reflective practice | Enabling deliberate and guided reflection strategies using discourse and small-group discussions with feedback throughout students’ medical education to help them uncover assumptions, explore different perspectives, make sense of challenging encounters, grapple with ethical quandaries, manage difficult emotions or conflict, and construct and deconstruct values and identity through comparisons between lived experiences and prevailing narratives of meaning, all aiming to inform future actions and decisions | |
Stories and storytelling | Offering opportunities for students to recollect and verbalize stories of patient encounters, make meaning as events are recalled and structured (i.e. “storied”), shape a personal framework of caring, and develop a coherent physician ideal through critical reflection | |
Mentorship | Providing formal, purposeful, accessible, inclusive and longitudinal mentorship, as one-on-one or group mentoring models, with qualified faculty aware of power dynamics of interactions with students and equipped with appropriate mentoring skills including feedback to guide students reflect on experiences, navigate professional life, and assimilate knowledge into clinical practice | |
Role models | Cultivating positive role models (e.g. doctors, near-peers, residents, faculty, inter-professional team members) who support students’ psychological well-being, encourage reflection, support learning, and demonstrate decision-making and professional values and attitudes in clinical and non-clinical contexts | |
Non-medical influences | Acknowledging the role of family, prior experiences, medical dramas and societal perceptions on students’ personal values vs. professional expectations, and supporting students to mitigate dissonance and enhance alignment between professional development (e.g. professional attitudes, roles and behaviours) and internal bearings and identity (e.g. personal values), which if left unaddressed could lead to anxiety, frustration, and feelings of inadequacy |