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Professional Identity Formation and the Clinician-Scientist: A Paradigm for a Clinical Career Combining Two Distinct Disciplines
Abstract
The clinician-scientist role is critical to the future of health care, and in 2010, the Carnegie Report on Educating Physicians focused attention on the professional identity of practicing clinicians. Although limited in number, published studies on the topic suggest that professional identity is likely a critical factor that determines career sustainability. In contrast to clinicians with a singular focus on clinical practice, clinician-scientists combine two major disciplines, clinical medicine and scientific research, to bridge discovery and clinical care. Despite its importance to advancing medical practice, the clinician-scientist career faced a variety of threats, which have been identified recently by the 2014 National Institutes of Health Physician Scientist Workforce. Yet, professional identity development in this career pathway is poorly understood. This Perspective focuses on the challenges to the clinician-scientist's professional identity and its development. First, the authors identify the particular challenges that arise from the different cultures of clinical care and science and the implications for clinician-scientist professional identity formation. Next, the authors synthesize insights about professional identity development within a dual-discipline career and apply their analysis to a discussion about the implications for clinician-scientist identity formation. Although not purposely developed to address identity formation, the authors highlight those elements within clinician-scientist training and career development programs that may implicitly support identity development. Finally, the authors highlight a need to identify empirically the elements that compose and determine clinician-scientist professional identity and the processes that shape its formation and sustainability.
... Aux fins de ce commentaire, nous ne citons que les études les plus importantes. L'analyse de cette littérature, qui ne rapporte pas les résultats selon la spécialité concernée [5][6][7][8][9][10][11][12][13] , permet d'identifier quatre parcours de formation. Seule l'étude de Workman et coll. ...
... En effet, le parcours de formation pour devenir médecin chercheur clinicien est un continuum qui doit permettre, non seulement l'acquisition de compétences spécifiques de recherche, mais le processus de professionnalisation de ces médecins au profil unique, qui intégreront la pratique clinique et la recherche pendant toute leur carrière et qui devront naviguer entre deux mondes, tout aussi exigeants et ayant leurs propres cultures et codes. Le défi est donc l'intégration de la formation clinique et de recherche tout au long de la formation médicale, à la fois conceptuellement et opérationnellement 6,10,11 . Les recherches démontrent que plus les personnes sont exposées tôt à la recherche, plus elles réaliseront leurs aspirations à une carrière de recherche 6,7,11 . ...
... On peut donc conclure que la littérature récente [5][6][7][8][9][10][11][12][13][14] suggère que le premier et le troisième parcours semblent plus prometteurs pour permettre l'intégration de la formation clinique et de recherche et le succès de l'entrée dans la carrière comme médecins chercheurs, bien que cette littérature ne porte pas spécifiquement sur la médecine de famille. Il est intéressant que noter que Doubeni et coll. ...
... Aux fins de ce commentaire, nous ne citons que les études les plus importantes. L'analyse de cette littérature, qui ne rapporte pas les résultats selon la spécialité concernée [5][6][7][8][9][10][11][12][13] , permet d'identifier quatre parcours de formation. Seule l'étude de Workman et coll. ...
... En effet, le parcours de formation pour devenir médecin chercheur clinicien est un continuum qui doit permettre, non seulement l'acquisition de compétences spécifiques de recherche, mais le processus de professionnalisation de ces médecins au profil unique, qui intégreront la pratique clinique et la recherche pendant toute leur carrière et qui devront naviguer entre deux mondes, tout aussi exigeants et ayant leurs propres cultures et codes. Le défi est donc l'intégration de la formation clinique et de recherche tout au long de la formation médicale, à la fois conceptuellement et opérationnellement 6,10,11 . Les recherches démontrent que plus les personnes sont exposées tôt à la recherche, plus elles réaliseront leurs aspirations à une carrière de recherche 6,7,11 . ...
... On peut donc conclure que la littérature récente [5][6][7][8][9][10][11][12][13][14] suggère que le premier et le troisième parcours semblent plus prometteurs pour permettre l'intégration de la formation clinique et de recherche et le succès de l'entrée dans la carrière comme médecins chercheurs, bien que cette littérature ne porte pas spécifiquement sur la médecine de famille. Il est intéressant que noter que Doubeni et coll. ...
... With respect to barriers and facilitators several themes were identified from the medicine-related publications including development of professional identity, training programs, research funding, dedicated research time, mentorship, and sex differences. Awareness and identity formation are considered essential aspects of a CS education/training pathway [66]. A curriculum that combines the values of both a clinician and researcher, fosters professional identity as a CS [66], thus providing CS as a legitimate career choice [75]. ...
... Awareness and identity formation are considered essential aspects of a CS education/training pathway [66]. A curriculum that combines the values of both a clinician and researcher, fosters professional identity as a CS [66], thus providing CS as a legitimate career choice [75]. Likewise, the absence of a CS professional identity has been identified as a potential barrier limiting credentialing and its potential career pathway [66]. ...
... A curriculum that combines the values of both a clinician and researcher, fosters professional identity as a CS [66], thus providing CS as a legitimate career choice [75]. Likewise, the absence of a CS professional identity has been identified as a potential barrier limiting credentialing and its potential career pathway [66]. CSs in rehabilitation describe recognition from other researchers being key to developing credibility [18], and our study suggests that CS professional identity in the rehabilitation sciences has undergone limited development and is currently lacking this credibility. ...
... PTCSs have specialized training as both clinicians and researchers. [1][2][3] This hybrid perspective offers several advantages that strategically position PTCSs to judge the real-world relevance and applicability of research findings, 1-5 act as champions for evidence-based prac tice in the clinical setting, 5,7 and better incorporate clin ical experience into the conduct of research as a valid source of knowledge and innovation (i.e., practice-based research). 8,9 However, PTCSs' true value probably resides in their meta-identity as brokers (i.e., bridges) between the clinical and academic worlds. ...
... Clinician-scientists bring additional value beyond having two sets of professional skills; they have developed boundary-crossing professional compe tencies and insights. [1][2][3]5,6,10 In other words, the whole is greater than the sum of its parts. This has been described as the broker's "vision advantage" or "the ability to select and synthesize different viewpoints and approaches from different unlinked groups on either side." ...
... Thus, this broker vision advantage can help drive inno vation through unique competencies and insights, but also by fostering collaboration. [1][2][3]5,6,10 This leaves PTCSs well positioned to establish collaborative and fruitful rela tionships between clinicians and researchers by facilitat ing a better understanding of each other's perspectives, priorities, and constraints. 4 These close collaborations may improve how innovative practices are incorporated into patient care and facilitate carrying out clinically meaningful research. ...
... PTCSs have specialized training as both clinicians and researchers. [1][2][3] This hybrid perspective offers several advantages that strategically position PTCSs to judge the real-world relevance and applicability of research findings, 1-5 act as champions for evidence-based prac tice in the clinical setting, 5,7 and better incorporate clin ical experience into the conduct of research as a valid source of knowledge and innovation (i.e., practice-based research). 8,9 However, PTCSs' true value probably resides in their meta-identity as brokers (i.e., bridges) between the clinical and academic worlds. ...
... Clinician-scientists bring additional value beyond having two sets of professional skills; they have developed boundary-crossing professional compe tencies and insights. [1][2][3]5,6,10 In other words, the whole is greater than the sum of its parts. This has been described as the broker's "vision advantage" or "the ability to select and synthesize different viewpoints and approaches from different unlinked groups on either side." ...
... Thus, this broker vision advantage can help drive inno vation through unique competencies and insights, but also by fostering collaboration. [1][2][3]5,6,10 This leaves PTCSs well positioned to establish collaborative and fruitful rela tionships between clinicians and researchers by facilitat ing a better understanding of each other's perspectives, priorities, and constraints. 4 These close collaborations may improve how innovative practices are incorporated into patient care and facilitate carrying out clinically meaningful research. ...
... In an influential publication, Butler referred to this gap as "the valley of death" (Butler 2008) because few research findings ever reach clinical practice. Mending the gap is not easy because research and clinical practice are inherently different in nature, with large socio-cultural differences (Roberts et al. 2012;Rosenblum et al. 2016). Multiple boundaries, professional and institutional, exist between science and clinical practice, which has implications for the social identity of clinician-scientists who work across these boundaries (Rowland and Ng 2017). ...
... Multiple boundaries, professional and institutional, exist between science and clinical practice, which has implications for the social identity of clinician-scientists who work across these boundaries (Rowland and Ng 2017). Clinician-scientists (CSs) are practising clinicians who, in addition, are engaged in scientific research (Rosenblum et al. 2016). By being a member of both fields, they are uniquely positioned to facilitate exchange between research and practice, and as such are deemed vital to the advancement of medical practice (Barry et al. 2019;Lemoine 2008;Vignola-Gagné 2014;Wilson-Kovacs and Hauskeller 2012). ...
... It is not hard to imagine the difficulties for CSs to perform in both worlds and on top of that broker between those worlds. We see an increasing volume of literature showing that their dual position is demanding and not well supported (Roberts et al. 2012;Rosenblum et al. 2016;Yanos and Ziedonis 2006). They often feel they are undervalued by having their output compared to full-time colleagues, whilst their efforts in the second field are not being taken into account (Croft et al. 2015). ...
Clinician-scientists (CSs) are vital in connecting the worlds of research and practice. Yet, there is little empirical insight into how CSs perceive and act upon their in-and-between position between these socio-culturally distinct worlds. To better understand and support CSs’ training and career development, this study aims to gain insight into CSs’ social identity and brokerage. The authors conducted semi-structured, in-depth interviews with 17, purposively sampled, CSs to elicit information on their social identity and brokerage. The CSs differ in how they perceive their social identity. Some CSs described their social identity strongly as either a research or clinical identity (dominant research or clinical identity). Other CSs described combined research and clinical identities, which might sometimes be compartmentalised, intersected or merged (non-dominant-identity). In the types of brokerage that they employ, all CSs act as representatives. CSs with a non-dominant identity mostly act as liaison and show considerable variability in their repertoire, including representative and gatekeeper. CSs with a dominant identity have less diversity in their brokerage types. Those with a dominant research identity typically act as a gatekeeper. Combining lenses of social identity theory and brokerage types helps understand CSs who have a dual position in-and-between the worlds of clinical practice and research. Professional development programs should explicitly address CSs’ professional identities and subsequent desired brokerage. Research and policy should aim to clarify and leverage the position of CSs in-and-between research and practice.
... Maintaining joint clinical and research careers requires physicians to navigate the professional identities of medical practitioner and scientific investigator (Rosenblum et al. 2016;Kluijtmans et al. 2017). These identities are shaped by different tools, languages, practices, aims, and milieu (Loftus 2018) and are subject to conflicting expectations for productivity (Lingard et al. 2017). ...
... Recent exploration of senior physician-scientists' research engagement highlights the importance of investigating more closely the factors that influence long-term sustainment (Lingard et al. 2017;McKinney 2017;Ajjawi et al. 2018), including deepening understanding of physician-scientists' professional identity (Rosenblum et al. 2016;Kluijtmans et al. 2017;Lingard et al. 2017;Weggemans et al. 2019). Early interventions that protect time for research may allow physician trainees to keep their identities as medical practitioner and scientific investigator separate (Harding et al. 2017;Weggemans et al. 2019); physicians' ability to reconcile these competing identities after entering the workforce may determine whether they feel efficacious and motivated as researchers over the long-term (Rosenblum et al. 2016;Harding et al. 2017;Kluijtmans et al. 2017;Weggemans et al. 2019). ...
... Recent exploration of senior physician-scientists' research engagement highlights the importance of investigating more closely the factors that influence long-term sustainment (Lingard et al. 2017;McKinney 2017;Ajjawi et al. 2018), including deepening understanding of physician-scientists' professional identity (Rosenblum et al. 2016;Kluijtmans et al. 2017;Lingard et al. 2017;Weggemans et al. 2019). Early interventions that protect time for research may allow physician trainees to keep their identities as medical practitioner and scientific investigator separate (Harding et al. 2017;Weggemans et al. 2019); physicians' ability to reconcile these competing identities after entering the workforce may determine whether they feel efficacious and motivated as researchers over the long-term (Rosenblum et al. 2016;Harding et al. 2017;Kluijtmans et al. 2017;Weggemans et al. 2019). ...
Theoretical understanding of what motivates clinician researchers has met with some success in launching research careers, but it does not account for professional identification as a factor determining sustained research engagement over the long-term. Deeper understanding of clinicians’ research-related motivation may better foster their sustained research engagement post-training and, by extension, the advancement of medicine and health outcomes. This study used an integrated theoretical framework (Social Cognitive Career Theory and Professional Identity Formation) and appreciative inquiry to explore the interplay of professional identification and research context in shaping post-training research success narratives. To foreground professional identification, 19 research-active clinicians and 17 basic scientists served as interviewees. A multi-institutional, multi-national design was used to explore how contextual factors shape external valuation of research success. The findings suggest that research-active clinicians do not identify as the career scientists implied by the modern physician-scientist construct and the goal of many clinician research-training programs. Their primary identification as care providers shapes their definition of research success around extending their clinical impact; institutional expectations and prevailing healthcare concerns that value this aim facilitate their sustained research engagement. Integrated developmental and organizational interventions adaptive to research context and conducive to a wider range of medical inquiry may better leverage clinicians’ direct involvement in patient care and advance progress toward human health and well-being.
... The clinician-researcher or clinician-scientist career pathway hold marked potential for improving institutional research capacity and the embeddedness of research. 7,8 It is one avenue with targeted awareness and support at the trainee and early career levels in Canada, the United States and the Netherlands, for instance, as exemplified through funding and training opportunities provided by the Canadian Child Health Clinician Scientist and Training Upcoming Leaders in Pediatric Science programs, for example. The clinician-scientist career pathway is considered by some to be indispensable to the future of evidence-informed healthcare, particularly in light of collaborative and interdisciplinary necessities. ...
... 7 While Brown et al 1 identified that clear clinicianresearcher career pathways are critical to attaining the goal of becoming a leading hospital research institute, threats to the physician-researcher pipeline have been reported, and the pathways for allied-health clinician scientists remain notably underdeveloped. 7,9 Investments for clinician-scientists must acknowledge the prolongation and intensity of training required to gain both clinical and research proficiency, the personal work/life demands accompanying the training and career pathways, and the importance of mentorship for alliedhealth and physician-scientists, which are often at a shortfall due to a shortage of comparable faculty to prepare the next generation. 9 Leadership in health systems needs to think creatively and with a sense of urgency about these career pathways, as well as the impact of mentorship on research capacity. ...
Brown et al show that research investments in an organization with a research and translation mandate can make important gains for research impact across domains, including quality of care and patient outcomes. Their multi-stage mixed methods evaluation provides insight into research capacity development in rural health systems in Australia and draws attention towards persistent geographic inequities. In extension of this important contribution, here, a focus on the "what and the why" of embedded research is offered. Specific attention is paid to the sustainability potentials of systematized data capture systems, funding-operational mandate alignments, researcher-scientist career pathways, and networked approaches to mentorship.
... Professional identity in physicians has been defined as a set of characteristics, values and norms which become internalised over time; eventually the individual thinks, acts and feels like a physician [15]. Understanding professional identity and how it is formed requires an exploration of key attributes and determinants of success or failure [15,16], although this only forms part of the picture. Competency frameworks have been developed which show a more rounded view of the work of clinical academics [17], however, there remains a gap in the knowledge on how clinical academics develop a professional identity which integrates the dual disciplines of research and clinical practice, and what the critical determinants of success or failure are. ...
... Competency frameworks have been developed which show a more rounded view of the work of clinical academics [17], however, there remains a gap in the knowledge on how clinical academics develop a professional identity which integrates the dual disciplines of research and clinical practice, and what the critical determinants of success or failure are. Describing the personal and environmental factors that support a successful clinical academic career will contribute to the understanding of the professional identity of clinical academics, which may be a critical determinant of career stability; further, a greater understanding of the professional identity of clinical academics may inform selection criteria for recruitment and promotion and the development of education and training strategies to support the clinical academics of the future [16]. ...
Background
Clinicians who divide their time between clinical work and research have contributed to some of the most fundamental breakthroughs in medicine in recent history, yet their role is not always well-understood or valued. Understanding the factors which contribute to career success for clinical academics is critical for supporting this workforce. Social Cognitive Career Theory (SCCT) provides a conceptual framework for career success, incorporating personal and environmental factors.
Purpose
The aim of this study is to explore clinical academics’ construal of successful clinical academic practice and to contribute to a holistic view of the professional identity of the clinical academic.
Methodology
Using a constructivist technique, repertory grid, the authors interviewed ten clinical academics at different career stages in one-to-one structured interviews conducted virtually between November 2020 and April 2021. Data from the interviews were analysed qualitatively and quantitatively. Common themes were identified, analysed, and ranked according to importance with respect to successful clinical academic practice. Using SCCT as a framework, constructs were categorised as personal factors, organisational factors, competencies and person-environment fit. A differential analysis between established/trainee and female/male participants was carried out.
Summary of results
One hundred and thirty-three constructs were elicited and categorised into 20 themes (constructs). There was consensus among participants that 6 were of high importance with respect to successful clinical academic practice, 8 of intermediate and 4 of low importance, with no consensus on 2 constructs. Personal factors of high importance include innovation and integrity. Competencies including research and teaching skills are highly important, and ability to collaborate is also considered central to successful clinical academic practice. Female participants expressed greater concerns about the impact of familial responsibilities on career progression.
Discussion and conclusions
This study highlights the importance of interactions between the person and environment, and characterises the important attributes of successful clinical academics including personal factors such as integrity and innovation.
... Critical discussions with senior researchers and other postdocs raised my awareness of how viewing a problem through the lens of another discipline could strengthen nursing research. 8,11 Frequently, our discussions would center on how we could apply our leadership skills in research or practice in our respective communities. Senior researchers were also available to serve as mentors for the postdocs. ...
... The goals of a postdoctoral fellowship were to produce a deliverable that could be leveraged to attain a tenure-track position, develop leadership skills, and grow your research networks. 11 The deliverable could be negotiated, either as a published manuscript, a funded research proposal, or a mentored scholarship opportunity. The fellowship strategically positioned one for a future career through increased professional networks, additional training in statistics, and classes on how to apply for an NIH grant. ...
... The formation of identity as a physician-scientist is a vital element in career persistence. Sustaining that identity can be fragile in environments that cater strictly either to research or to clinical service (10). Many conferences that highlight research and clinical victories convey the value of executing the physician-scientist role successfully. ...
... This iterative process saw new codes linked to prior ones, ensuring that fresh themes were derived directly from the raw data without any pre-existing groupings [88]. [14], attitudes, emotions, experience, skills, goals, demographic [15,16], socio-cultural [17][18][19] and psycho-emotional features [15] • The physician's meaningmaking on the background of their belief systems, adaptation, and development; the importance placed on an interaction or specific incident; level of resilience and psychoemotional status [11,20]; and the available support that impact their responses [21][22][23] • The mentoring programme's setting in a formal or informal curriculum, working hours [24], rules [25], disciplinary consequences [26], programmes [27,28], attention to PIF [29][30][31], administrative support [33], faculty training and evaluation [32,33], access to personalised support and communication networks, hidden curriculum [30,[34][35][36][37][38][39][40][41][42][43], prevailing discourses [38,[44][45][46][47], daily activities [36,48,49], and rites of passage [1,41,43,[50][51][52][53][54][55] (curricula determined by host organisations). ...
Background
The promise that enduring and personalised mentoring relationships shape how mentees think, feel and act as professionals, or their professional identity formation (PIF), and thus how they interact, care and support patients and families has garnered significant interest. However, efforts to marshall these elements have been limited due to a lack of effective understanding. To address this lacunae, a systematic scoping review was carried out to map current knowledge on mentoring relationships and its impact on PIF.
Methods
Guided by PRISMA guidelines and the Systematic Evidence-Based Approach (SEBA) to ensure a consistent and reproducible review, independent searches and appraisals of relevant articles published between 1st January 2000 and 4th December 2024 on PubMed, Embase, ERIC and Scopus databases were performed. Data from included articles were content and thematically analysed. Related themes and categories were combined using the SEBA methodology.
Results
248 articles were identified across four databases and snowballing of key articles. A total of 27 articles were included. The domains identified were: (1) the mentoring ecosystem; (2) mentoring dynamics; (3) shifts in belief systems and professional identity; and (4) complex adaptive systems.
Conclusions
The mentoring programme can be seen as a mentoring ecosystem, functioning as a community of practice and supporting the socialisation process within its boundaries and along the mentoring trajectory. The culture and structure of the mentoring ecosystem help inculcate the shared belief systems and programme identity. It also nurtures stakeholder investment and commitment, as well as their internal compass which is key to contending with the complex array of influences upon their development. Through the lens of a complex adaptive system, it is also possible to appreciate transitions between roles and responsibilities and the notion of being and becoming. These findings underline the evolving nature of practice and the need for personalised and longitudinal mentoring support.
... • Belief systems [51] • Discernment: Willingness, judgment and balancing [51,52] • Narratives: Working styles, opportunities [53], attitudes, emotions [54], experience, skills and goals, as well as demographic [54,55], socio-cultural [56][57][58], ideological, contextual, and psycho-emotional features • Coping strategies: Psycho-emotional well-being and the adoption of reflective practice [59][60][61], as well as personal coping strategies [62][63][64][65][66][67][68], including level of resilience [21,69] and the ability to cope with emotionally-rich experiences [70], failures [71], moments of crisis [72], disorienting experiences [73] and transitions [71,[74][75][76][77][78][79][80] • Developing competencies: Skills, knowledge, levels of engagement, decision-making and practice • Maturing relationship: Nature, quality, setting and progress of patient interactions • Meaning-making and psycho-emotional state: Reflections, insights, adaptation, development [81,82] and available support [83] • The formal curriculum, or "the actual course of study, the planned content, teaching, evaluation methods, syllabi, and other materials used in any educational setting, formal policy statements, regulations, expectations, and competencies for every educational cohort conceivable" [51,84] • Clear 'membership' criteria [85] • Competency-based mentoring stages [85] • Curricula: Hidden, formal and informal curriculum [76,[86][87][88][89][90][91][92][93][94][95], working hours [96], rules [97], disciplinary consequences [98], programmes [99,100], attention to PIF [95,101,102], administrative support [103], faculty training and evaluation [103,104], access to personalised support and communication networks [72,90,[105][106][107] • Desired characteristics: Organisational, training, professional and speciality expectations on norms, skills, values, objectives, support and assessment systems [3, 108] ...
Background
Mentoring’s success in nurturing professional identity formation (PIF) has been attributed to its ability to build personalised and enduring mentoring relationships. However, beyond functioning as communities of practice (CoPs) supporting socialisation processes, how mentoring integrates programme values and instils a shared identity amongst mentees remains unclear. The need for personalised guidance and timely attention to a mentee’s unique needs in evolving mentoring relationships point to the critical role of support mechanisms (‘mentoring support’). We conducted a systematic scoping review (SSR) studying “What is known about mentoring support’s role in nurturing PIF?”.
Methods
Adopting PRISMA-ScR guidelines, this SSR was guided by the Systematic Evidence-Based Approach (SEBA). Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2023 in PubMed, Embase, ERIC and Scopus databases. The Split Approach saw concurrent, independent thematic and content analyses of the included articles. The Jigsaw Perspective combined complementary themes and categories, creating broader themes/categories. The subsequent Funnelling Process formed key domains that platformed the synthesis of the discussion.
Results
Two thousand three hundred forty-one abstracts were reviewed, 323 full-text articles were appraised and 151 articles were included and analysed. The key domains identified were (1) definitions and roles; (2) personalisation; (3) shepherding; and (4) PIF.
Conclusion
The success of mentoring in PIF lies in its ability to blend role modelling, supervision, mentoring, coaching and teaching, with self-care, guided reflection, apprenticeship and assessment to meet the individual needs of the mentee and their changing circumstances. Blending the contents of the mentoring umbrella emphasises the critical role of the mentor and host organisation in supporting mentor training, communications, support and assessment mechanisms. Mentee engagement and its active role in support measures complement the CoP-like mentoring programme’s use of blending mentoring support to advance the socialisation process. These insights reflect a complex interactive process scaffolding the development of mentoring relationships and PIF. The effect of the mentoring umbrella on clinical practice requires further study.
... Some studies shed light on the reasons behind this [16], but more should be done. Overall, few works exist on factors towards CPD selection and attendance and on the concept of identity among physician-scientists, and there is 'a lack of evidence about the specific determinants of clinician-scientist professional identity development' [50]. ...
Background
Almost 40% of the Nobel-Prize-winning discoveries in medicine are made by physician-scientists, who are a driving force in the evolving medical, academic and research landscape. However, their training has few defined milestones. To be effective clinicians, educators and researchers, they need to maintain and hone skills, often via continuous professional development (CPD) activities covering different domains. They have recurrently been described as an endangered species. Yet, warnings and recommendations across several decades did not stop the declining number of physician-scientists, which is now a chronic issue. This is further exacerbated by a lack of resources and support, especially after the COVID-19 pandemic.
Methods
We administered a questionnaire called Positive and Negative Affect Schedule (PANAS-GEN) to get an initial emotional snapshot before performing individual semi-structured interviews with five physician-scientists in neurology working in the United Kingdom. We explored the key factors they balance before selecting CPD activities, along with their views on compulsory CPD events and assessments. We investigated their general feelings towards compulsory and non-compulsory CPD, how they felt the night before and the morning of the events, and the perceived consequences attending these have on their learning.
Results
In our study, physician-scientists tend to choose training in their area of expertise but would enjoy exploring more if they had more time. The CPD choice was chiefly driven by speakers and topics, followed by learning needs. They disputed the utility of the current assessments, which are often seen as box-ticking exercises. While frustration, hostility and negative feelings were voiced for the compulsory ones, other CPD activities were welcomed with excitement, curiosity and a sense of adventure. Enthusiasm and excitement were felt the night before and the morning of the non-compulsory ones. CPD events were perceived to positively affect further learning, with the most immediate consequences being reading an article, networking or interacting with the speakers.
Discussion
This is the first study exploring the key factors driving a group of physician-scientists while selecting CPD activities and investigating their feelings and emotions related to CPD attendance. More engaging and less box-ticking CPD should be on the cards, along with an adequate evaluation of these activities. It is essential to increase enthusiasm, which can facilitate engagement, and decrease frustration surrounding compulsory CPD activities. We still know too little about the role of emotions in learning, especially about CPD. Future studies should investigate the emotional side of learning across different career stages to restore the leaky pipeline and create a tailored environment with benefits for each of the three sides of the physician-scientist’s identity: the clinical, the research, and the academic.
... Participating in this course can be a valuable experience for some students to develop an identity as a researcher. The course activities are composed of important elements to develop professional identities, such as mentoring, reflection, feedback, and role modeling [16]. The reflection component is particularly important as it enhances students' critical thinking and decision-making by processing and applying their experiences to both scientific research and medical practice. ...
Background and Need for Innovation
Teaching and learning approaches can support medical students in developing the research skills necessary to be adept consumers of scientific research. Despite various influencing factors, existing literature on effective strategies in undergraduate medical education remains limited.
Goal of Innovation
Using a spiraled curriculum, we created and evaluated a longitudinal course to enhance medical students’ research abilities.
Steps Taken for Development and Implementation of Innovation
During a recent curriculum renewal at one medical school, a three-year longitudinal course on the principles of research was developed and implemented. The innovation of this course includes the sequential nature and deliberate redundancy of curriculum content, how new knowledge is linked to prior learning, and the progressive level of difficulty in knowledge application and skill development.
Evaluation of Innovation
The authors analysed faculty members’ and students’ satisfaction and their perceptions of each session of the course using program evaluation data collected between 2019 and 2021. Both faculty members and students recognized the benefits of revisiting concepts and highlighted learning outcomes like improved synthesis of information, explaining findings to patients, and enhanced critical thinking.
Critical Reflection
The adoption of a spiraled curriculum in undergraduate medical education offers a systematic approach for developing students’ research skills. The positive reception of this innovation underscores its potential to help future health professionals form a professional identity as adept researchers. However, its implications demand careful consideration and ongoing evaluation to ensure that the desired outcomes are sustained.
... Clinician-scientists in registries play a central role in bridging the gap between research evidence and clinical care. 23 They equip students pursuing healthcare and research careers with the ability to critically assess and apply scientific findings in realworld healthcare settings. ...
Health registries are organized systems that collect data on individuals with a particular disease, condition or exposure. The aim of this narrative review was to provide an integrated perspective from the Research Department at the Hospital Italiano de Buenos Aires, Argentina, on how health registries can be used as a bridge between healthcare, research, education, innovation and development while addressing ethical challenges. The review includes a description of the experience of a registry implemented at our institution, which has provided healthcare for 170 years, and is committed to support, education and research. We focus on the potential of health registries to provide better value healthcare by reducing healthcare costs and improving health outcomes and quality of care, and to improve medical knowledge. However, we also acknowledge and discuss the challenges that accompany these achievements, such as that of ethical issues. Through effective collaboration and integration with other healthcare stakeholders, health registries can be a powerful tool to promote better health.
... While a number of studies on professional identity formation have examined the process by which clinicians [12][13][14][15] or scientists [16,17] take on an educator identity in medical education, the process of shifting from one educator type to another within medical education (e.g. lecture-based educator to active-learning educator) is unclear. ...
Purpose
Curricular change is becoming a standard feature of medical schools as they respond to learners’ evolving needs. Implementing change is not always straightforward, however, especially when it directly shifts the expected roles of faculty educators. The authors investigated how faculty educators navigated a significant transition to the Active, Competency-Based, and Excellence-Driven (ACE) curriculum at one state medical school.
Method
The authors employed a qualitative descriptive design and conducted thematic analysis. From June 2018 to January 2019, the authors conducted individual, in-depth interviews with faculty educators and administrators involved in first-year medical student education. Data were analyzed inductively to identify the sensemaking process for faculty.
Results
Twenty-one faculty educators participated in interviews averaging 58 min. Four phases were identified among educators as they moved through the change: (1) Making Sense of the Change; (2) Grieving the Lecturer Educator Role; (3) Risking an Active Learning Educator Role; and (4) Identifying the Rewards of Active Learning-based Teaching.
Conclusion
Faculty buy-in is an essential component of successful curricular change implementation. While most faculty in this study reported eventual enjoyment from the new interactional teaching that fostered critical thinking, navigating the change was not always smooth. This study suggests faculty development around curricular change should be tailored to address the varying faculty concerns relevant to the four phases that were identified. Effective and optimal faculty support during large-scale curricular change must take into account not just new skills but also the grief and risk faculty may experience as their roles shift.
... As such, the challenge is in integrating clinical and research training throughout their entire medical education, both conceptually and operationally. 6,10,11 The research shows that the more individuals are exposed to research early on, the more likely they are to successfully enter a career in research. 6,7,11 While a PhDlevel education may seem preferable to an MSc, some research suggests shortening foundational research training and placing greater emphasis on fellowships and postgraduate clerkships that encourage the development of skills and expertise specific to a research area of interest. ...
... When applied to students, these stages involve: 1) gaining an understanding of the chosen profession, its norms, values and expectations; 2) using critical thinking and reflection, question disciplinary knowledge and practice; and 3) immersion into the chosen profession, collaborating with others and actively contributing to new ways of work (Jackson, 2016(Jackson, , 2019. At a practical level, activities including wearing a uniform, role plays and debates, role modelling and guided reflection, mentorship, and immersion into authentic, work integrated learning experiences are proposed to facilitate the development of pre-professional identity (Hodge et al., 2009;Jackson, 2019;Ronfeldt & Grossman, 2008;Rosenblum et al., 2016). ...
Pre-professional identity (PPI) aims to provide an understanding of, and connection to, the skills and knowledge contained in a degree and the intended profession of the student. Investigation into PPI is of importance to higher-education institutions as it provides a means of understanding a student’s orientation and motivation behind degree and career selection. Developing learning activities that capitalise on these motivations is proposed to increase student engagement, reduce attrition, and enhance employability. Using the growing, but relatively new profession of Exercise Science as an example, this study describes a workshop based on theoretical models relating to the concept of PPI, adult learning and self-reflective practices that can be integrated into programs to enhance students’ understanding of their professional identity. One hundred and seventy-three final year Exercise Science students participated in and evaluated the workshop. The workshop was evaluated using a theoretical framework specifically designed for the evaluation of training activities. The combination of the evaluation and feedback from students were synthesised to develop a model for the application of PPI activities across a three-year undergraduate degree.
... The importance of the professional identity formation increased with the 2010 report of Carnegie Foundation [8,15]. The Carnegie Foundation for the Advancement of Teaching considered the professional identity formation the main goal of medical education [7,[16][17][18][19]. Also, this foundation considers it important to facilitate the professional identity formation in learners by faculty members and planning for its promotion and growth during the educational period [7]. ...
Background
Learning about the formation and development of professional identity and its principled planning in universities play an essential role in the development of the identity of individuals in educational and professional environments. Although the formation and development of identity is the main goal of Health Profession Education, due to the complexity of this process and its multidimensional nature, appropriate measurement and evaluation criteria are not readily available. To address this gap, a scoping review was conducted to explore current knowledge in assessing professional identity and map directions for future research.
Methods
The present scoping review was conducted based on the five-step framework of Arksey and O'Malley. At first, the research question was formulated. Then, PubMed, Eric, ProQuest, Scopus databases and Google scholar search engine were systematically searched until September 2022. The two authors independently selected all articles based on screening eligibility criteria and charted the data. Finally, the eligible articles were analyzed using descriptive analysis of studies on the characteristics and psychometrics of the tools and their underlying theories.
Results
After extensive searching 9,924 studies were identified. 162 studies were selected for full-text review of which 17 articles were eligible to be included. More than half of the articles were from England and Japan. Most of the target group was studies on nursing and medical students. In 14 studies included, tools and psychometric properties were mentioned. Several theories were used to develop professional identity assessment tools. Identity theories were the basis for designing or developing most tools. In identity theories, social identity theory and Kagan's constructive-developmental theory were used more than others.
Conclusions
The results of this scoping review will help researchers to choose or develop reliable and valid tools in accordance with clear conceptual and theoretical frameworks to measure and evaluate the formation and development of professional identity in Health Profession Education. Developing comprehensive tools that underpin the appropriate conceptual framework provides the possibility of evaluating the continuous and nonlinear process of the formation and development of professional identity which can be implemented at a large scale.
... Besides individual enthusiasm, commitment and motivation, it is important to support young scientifically interested clinicians with mentors, collaborators, accessible infrastructure and structured institutional (funding) support in the very early phase of their careers [1,13,25,26]. For more experienced clinicians, it was suggested that measures to protect research time might be a possibility to keep up the professional identity of clinicians as researchers, thereby improving their motivation to also work as scientists over the long term [5,16,27,28]. There is clear evidence from diverse studies and daily life experience that all these aforementioned steps to positively influence research activities in (orthopaedic) trauma surgery will be more easily achieved with a team approach [1,6,24]. ...
Background
An increasing clinical workload and growing financial, administrative and legal burdens as well as changing demands regarding work-life balance have resulted in an increased emphasis on clinical practice at the expense of research activities by orthopaedic trauma surgeons. This has led to an overall decrease in the number of scientifically active clinicians in orthopaedic trauma surgery, which represents a serious burden on research in this field. In order to guarantee that the clinical relevance of this discipline is also mirrored in the scientific field, new concepts are needed to keep clinicians involved in research.
Methods
Literature review and discussion of the results of a survey.
Results/conclusion
An interdisciplinary and -professional team approach involving clinicians and basic scientists with different fields of expertise appears to be a promising method. Although differences regarding motivation, research focuses, funding rates and sources as well as inhibitory factors for research activities between basic scientists and clinicians exist, successful and long-lasting collaborations have already proven fruitful. For further implementation of the team approach, diverse prerequisites are necessary. Among those measures, institutions (e.g. societies, universities etc.) must shift the focus of their support mechanisms from independent scientist models to research team performances.
... AMCs are dynamic nonprofit organizations operating in uncertain environments with physician scientists struggling to balance multiple competing/dialectic roles while working very hard to achieve institutional success and develop their own identities (Rosenblum, Kluijtmans, & Ten Cate, 2016). Hirschtritt, Heaton, & Insel (2018) called this an evolving research ecosystem in which physician scientists must prepare for in order to understand human health and disease. ...
This study investigated factors influencing success of physician scientists in Academic Medical Centers. These organizations and individuals drive healthcare in the United States. Translation of scientific discovery to medical practice moves at an astoundingly slow and ineffective rate. We must understand what contributes to physician scientist success to speed up translation. Through a lens of dialectic process theory, a grounded theory approach identified emergent factors from lived experiences of 31 individuals, at various experience levels, with MD and PhD degrees. Role balance, autonomy, organizational support, teamwork, life-cycle mentorship, and relational capacity were relevant factors impacting success. Role balance was important for success. Teamwork, organizational support, and life-cycle mentorship helped individuals grow, achieve balance, and respect, but relational capacity emerged as a critical driver for realizing both individual and organizational success. One person cannot execute these complex roles on their own, but development of deep and meaningful relationships through teamwork, collaboration, and life-cycle mentorship are essential for life satisfaction and success.
... Professional identity formation [45] as a physicianscientist may be challenging to MD-PhD students, as MD-PhD training requires development of dual identities as a physician and scientist [46], with constant tension between each identity [47]. Challenging and negative experiences during transitions between training phases can affect the process of professional identity formation due to unsatisfying socializing experiences with peers and faculty in each phase [3]. ...
Background
Acceptance into U.S. MD-PhD dual-degree programs is highly competitive, and the lengthy training program requires transitioning between multiple phases (pre-clinical-, PhD-research-, and clinical-training phases), which can be stressful. Challenges faced during MD-PhD training could exacerbate self-doubt and anxiety. Impostor phenomenon is the experience of feeling like a fraud, with some high-achieving, competent individuals attributing their successes to luck or other factors rather than their own ability and hard work. To our knowledge, impostor phenomenon among MD-PhD trainees has not been described. This study examined impostor phenomenon experiences during MD-PhD training and reasons trainees attributed to these feelings.
Methods
Individuals in science and medicine fields participated in an online survey that included the 20-item Clance Impostor Phenomenon Scale (CIPS); higher scores (range 20–100) indicate more frequent impostor phenomenon. Some respondents who reported experiencing impostor phenomenon also voluntarily completed a semi-structured interview, sharing experiences during training that contributed to feelings of impostor phenomenon. Interview transcripts were coded and analysed using the constant comparative method and analytic induction to identify themes.
Results
Of 959 survey respondents (students and professionals in science and medicine), 13 MD-PhD students and residents completed the survey, nine of whom (five male, four female; four white, five other race-ethnicity) also completed an interview. These participants experienced moderate-to-intense scores on the CIPS (range: 46–96). Four themes emerged from the interview narratives that described participants’ experiences of IP: professional identity formation, fear of evaluation, minority status, and, program-transition experiences. All reported struggling to develop a physician-scientist identity and lacking a sense of belonging in medicine or research.
Conclusions
Impostor experiences that MD-PhD participants attributed to bias and micro-aggressions in social interactions with peers, faculty, and patients challenged their professional identity formation as physician-scientists. It is important to further examine how MD-PhD-program structures, cultures, and social interactions can lead to feelings of alienation and experiences of impostor phenomenon, particularly for students from diverse and underrepresented populations in medicine.
... Nurses who were willing to participate in supporting Hubei had higher professional identity than those who were unwilling to go. Professional identity is a positive psychological attitude for career development (de Lasson et al., 2016;Rosenblum et al., 2016). Nurses who were willing to support showed a higher sense of professional achievement and morality. ...
Aim:
To investigate the professional identities and the willingness of nurses to respond to the call for support during the COVID-19 epidemic.
Background:
The COVID-19 epidemic has resulted in nearly 300 million cases worldwide, causing more than five million deaths. However, the professional identities and the willingness of nurses to provide support during the COVID-19 epidemic in China remain unclear.
Methods:
A total of 1,505 eligible nurses from 120 hospitals during the COVID-19 outbreak in China were included. Questionnaires were used to evaluate the willingness of these nurses to participate in epidemic control efforts. The Nurses' Professional Identity Scale was used to measure their sense of professional identity.
Results:
About 90% of the nurses were willing to lend support in Hubei Province during the epidemic. The most common reason (93.84%) was found to be their beliefs as medical personnel in helping others in need. Nearly 10% of the nurses were unwilling to go to Hubei, primarily due to family reasons. The average total score of the Professional Identity Scale for all nurses reached a moderate to high level as indication of professional identity (116-125). Nurses who were willing to go to Hubei had a significantly higher total score than those who were not.
Conclusions:
The professional identity of nurses in China improved during the epidemic, and those with higher professional identities were more likely to respond to calls for support during the epidemic.
... Professional identity relates to how an individual defines himself or herself in his professional life. This identity develops throughout life continuously through the dynamic integration of professional norms, values, and behaviors that are intertwined with one's own personal identity [14,15]. ...
Online professional communities based on sharing under open licenses have become a new way of building knowledge, learning and professional development of the participants who build and expand their professional identity in the new global space. These new dynamics of cyberculture are not being sufficiently explored in the training of vocational students. However, open pedagogy models can foster pre-professional identity, influence academic success and self-perception, as well as contribute to the commons. In this study, we have investigated from the anthropological perspective, the impact of a training program based on an open pedagogy model. Specifically, we have investigated the effect on the pre-professional identity and the academic results of vocational students, as well as on the development of the commons of their profession. Methodologically, we have combined the bibliographic review with the empirical, quantitative, and qualitative data, collected in the ethnographic fieldwork carried out during two academic years on 77 students of “Microcomputer Systems and Networks”, in a vocational center located in the Community of Valencia (Spain). The results indicate that this methodology promotes, among students, the development of pre-professional identity, a better understanding of copyright and open licenses, appreciation of the documentation processes of their tasks, and the value of their works for society.
... These are practitioners fluent in two disciplines, clinical medicine and science, who bridge the gap between the clinic and discovery through translational research. [6,7] The surgeon-scientist is a category of clinician-scientist that merits consideration owing to the particular challenges that come with surgery. As the number of clinician-scientists increases, forming a necessary bridge to medical progress in rapidly evolving fields, we need to ensure that a career in surgery is a viable option for them, and address barriers that may impede this. ...
Since completion of the Human Genome Project at the turn of the century, there have been significant advances in genomic technologies together with genomics research. At the same time, the gap between biomedical discovery and clinical application has narrowed through translational medicine, so establishing the era of personalised medicine. In bridging these two disciplines, the clinician-scientist has become an integral part of modern practice. Surgeons and surgical diseases have been less represented than physicians and medical conditions among clinician-scientists and research. Here, we explore the possible reasons for this and propose strategies for moving forward. Discovery-driven personalised medicine is both the present and the future of clinical patient care worldwide, and South Africa is uniquely placed to build capacity for biomedical discovery in Africa. Diverse engagement across clinical disciplines, including surgery, is necessary in order to integrate modern medicine into a developing-world contextualised perspective.
... Earlier studies describe how fulfilling different roles has impact on professional identities, stressing the importance of developing an integrated meta-identity as "knowledge brokers." Knowledge brokers are able to move from one context to another to transfer and synthesize new knowledge, advance innovation and enhance collaboration (Duffy, 2013;Kluijtmans et al., 2017;Long et al., 2013;Rosenblum et al., 2016). A striking finding of our study, however, is that this strong nursing identity was not dependent on the PNs working in clinical practice. ...
Background
Postdoctoral nurses have an important role in advancing nursing by generating knowledge and building networks in research, practice, and education which requires effective leadership. Therefore, the Leadership Mentoring in Nursing Research programme for postdoctoral nurses was developed.
Purpose
This study was to evaluate expectations, experiences, and perceived influence of the leadership mentoring programme on leadership and professional development, professional identity, and research productivity of postdoctoral nurses.
Methods
A longitudinal mixed-method study with a concurrent triangulation design was used with data collected through semistructured interviews and online surveys.
Findings
The leadership mentoring programme was found to be valuable by the participants who described strengthened leadership and professional development and development of professional identities. Participants showed increased research productivity and many moved to new/higher positions.
Discussion
The leadership mentoring programme was found to enhance the leadership and professional development of postdoctoral nurses and support them in their academic careers.
... [4][5][6] In addition to obtaining foundational clinical training, pediatric physician-scientist trainees across the continuum have additional goals of academic and research productivity in the form of presentations and publications, obtaining funding, and integrating a dual professional identity as a clinician and a scientist. 7,8 As all of these areas are threatened by the COVID-19 pandemic, promoting the development and success of the pediatric physician-scientist workforce requires new strategies. The National Pediatric Physician-Scientist Collaborative Workgroup is a collaborative committee of physician-scientists, graduate medical education leaders, pediatric department chairs, and trainees with the goal of sustaining and strengthening the pediatric physicianscientist pipeline to advance improvement in child health. ...
The COVID-19 pandemic will leave an indelible mark on the careers of current medical trainees. Given the disruptions to medical education, economic impact on institutions, and the uncertainties around future job prospects, trainees are facing unprecedented challenges. This situation is especially concerning for futures of pediatric physician-scientist trainees, where concerns regarding maintaining the pipeline were well documented prior to the emergence of COVID-19. In this Perspectives article, we leverage the unique expertise of our workgroup to address concerns of physician-scientist trainees and to provide suggestions on how to navigate career trajectories in the post-COVID-19 era. We identified and addressed four major areas of concern: lack of in-person conferences and the associated decrease access to mentors and networking activities, decreased academic productivity, diminished job prospects, and mental health challenges. We also suggest actions for trainees, mentors and educational leaders, and institutions to help support trainees during the pandemic, with a goal of maintaining the pediatric physician-scientist pipeline.
... A list of Goals and Objectives was constructed to include the most common items within established curricula (15,17,18,31). In addition, the development of the fellow's professional identity as a clinician-scientist was considered an essential component for success (32,33). ...
Rationale and Objectives
Education research has been undervalued in radiology, with few radiology journals having dedicated space for such research and barriers to production including dedicated time, resources, grant funding, and mentorship. As radiologists, we have an opportunity to study education in our unique learning environments and create more effective ways to teach that are grounded in established education theory, solid assessment methodologies, and a focus on merit as well as worth.
Materials and Methods
The growth of education research in our field requires a two-pronged approach; We must cultivate leaders in education research from within our specialty, and continue to submit high quality work to radiology journals to increase exposure of the reviewers and readership to education methodologies.
Results
We have created the first radiology education research fellowship to this end. This manuscript details the fellowship creation process, the first education research fellow experience, and in-depth analysis of the inaugural year via a qualitative program review.
Conclusion
We were successful in supporting an inaugural fellow in attaining the knowledge and skills to become a productive education researcher. Beyond this, the fellowship experience was a catalyst in developing her unique professional identity as an education master which will further raise the status of education research in pediatric radiology.
... For example, Kegan's stages of psychological development have been evoked to equate stage four as the autonomous professional self who is "capable of authoring his or her own principles and values within the professional practice context," having internalized and personalized the values and expectations of the profession (35,37). Socialization is the process through which a trainee moves through these various stages (27,30,32,33,35,36,42,(44)(45)(46)(47). Holden and colleagues point out that through socially-situated learning, which is typical of medical education, individuals come to experience themselves as accepted and competent in the 'community of practice,' and can then assume their professional identities (37). ...
The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation.
A critical challenge in contemporary healthcare is the global shortage of high-level medical talent equipped to drive the rapid advancements in science and technology. To address this, well-defined, scientific, and objective evaluation methods are needed to identify and nurture promising individuals. This study systematically reviewed and compared Chinese high-level medical talent evaluation models with international physician-scientist assessment instruments to explore the applicability of existing evaluation models to the global healthcare system and make evidence-based recommendations for the improvement of the high-level medical talent pipeline. Nine Chinese models with twelve sub-scales and thirteen international instruments with twenty-three sub-scales were analyzed. While both systems emphasized Research, Clinical Ability, Team Science, and Teaching, key differences emerged. Notably, Chinese models focused on Basic Quality, while international instruments prioritized Responsible Conduct of Research (RCR) & Ethics and Career & Personal Development. Variations were also observed in sub-scale numbers and weightings. These findings offer promising tools for a more integrated, global assessment of high-level medical talent, potentially shaping future healthcare talent development strategies. Further research is required to refine and validate these evaluation instruments.
Faculty members who are heavily engaged in research face several challenges in developing their careers and preparing for academic promotion. It is important to consider all available research-oriented track options and investigate the conditions and requirements for each. Tenure-eligible tracks require achievements in several academic domains within a specified time period. Nontenure tracks have time-limited contracts and may be contingent on availability of funding. Faculty time allocations must be clarified and ensured, especially protected research time. Startup packages and arrangement for ongoing financial support and resources should be negotiated during recruitment. Faculty should have the support of a research community as well as several mentors and advisors in the institution and through national organizations. Multiple resources are available for developing clinician-researchers through federal agencies, national organizations, and foundations. Academic development plans for research faculty require regular review and updates. National Institutes of Health (NIH) funding awards are traditional milestones for developing researchers (K awards) and becoming established (R awards) but are increasingly difficult to obtain. For promotion, faculty should aim for principal investigator status on grants and contracts, first authorship on papers in prestigious journals, and lead presenter position at important conferences. Traditional measures of research quality have been criticized as unsatisfactory for promotion assessments, especially regarding team science and collaborative activities.
This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International license https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. Abstract Due to the complexity and multidimensional nature of professional identity assessment in health professions education, it is essential to establish appropriate criteria. Therefore, we conducted a scoping review to explore the current knowledge in this process and map the directions for future research. The present review was based on the five-step framework of Arksey and O'Malley. Eligible articles were examined using descriptive analysis of studies on the characteristics and psychometrics of the tools for professional identity assessment and their underlying theories. After an extensive search, 9,924 studies were identified, 162 of which were selected for full-text review, and finally, 17 articles qualified for inclusion in the study. For the most part, the target group consisted of studies on nursing and medical students. In 14 of the included studies, tools and psychometric properties were mentioned. Most professional identity assessment tools were designed or developed based on identity theories, particularly the social identity theory and Kagan's constructive-developmental theory, which were used more often than others. This scoping review will help researchers to choose or develop reliable and valid tools under clear conceptual and theoretical frameworks to assess the formation and development of professional identity in health professions education.
Introduction
Respiratory therapists (RTs) must apply competencies to address the health care needs of the public. Although all competencies are deemed essential, scholarly practice requires that professionals critically assess their practices, integrate evidence-based literature, and enhance the care they deliver to patients. Though scholarly practice is also associated with professional empowerment, role satisfaction, and improved patient care, it is rarely measured. The purpose of this study was to develop, pilot, and generate preliminary validity evidence of a tool designed to measure scholarly practice among RTs.
Methods
We used DeVellis' nine-step scale development process and exploratory factor analysis to develop the tool. The results of a scoping review and qualitative study were used to generate an item pool and pilot test it with 81 RTs across Canada. The refined tool was tested on a larger sample (n = 832) and analyzed using exploratory factor analysis.
Results
Using principal axis factoring with Promax rotation, we retained 18 items across 4 factors, explaining 56.7% of the variance in the data (31.7%, 10.2%, 8.6%, 6.2%): (Factor 1) professional development and credibility, (Factor 2) elements supporting scholarly practice, (Factor 3) the perceived impact of scholarly activities on practice, and (Factor 4) s cholarly practitioner identity and ability. Internal consistency of the final 18-item scale was suitable overall (Cronbach alpha = 0.879) and for each factor (F1 = 0.888; F2 = 0.774; F3 = 0.842; F4 = 0.746).
Discussion
Our results provide preliminary evidence for a scholarly practice tool that can encourage self-reflection and/or foster peer-based reflection. Using the tool with other health care professionals and conducting confirmatory factor analysis could generate additional validity evidence.
Clinician-scientists, physicians who conduct research, may fulfil a bridging role in networks of health care researchers and practitioners. Within clinician-scientists’ networks, knowledge sharing is thought to play a vital role in the continuing professional development of themselves and their colleagues. However, little is known about networks of clinician-scientists and how this impacts continuing professional development. Rooted in social capital theory, this study provides a mixed methods exploration of clinician-scientists’ networks. Ego-level social network data were collected via semi-structured interviews on professional interactions about evidence-based practice with 15 clinician-scientists in the area of general practice and elderly care. Quantitative analysis revealed that professional networks of clinician-scientists varied in size, composition, and frequency of interactions depending on appointed research time and experience. Less experienced clinician-scientists interacted most frequently with other clinician-scientists while experienced clinician-scientist experienced more sporadically with clinicians. Clinician-scientists with more research time interacted more frequently with scientists and had a slightly larger professional network than those with less research time. The thematic qualitative analysis revealed different decision-making processes of clinician-scientists on mobilising their social capital and connecting to others in the network: (1) deliberate decision about initiating connections; (2) reactive behaviour without a decision; (3) ad-hoc decision. Clinician-scientists exchange knowledge to enhance their own continuing professional development mainly but also contribute to the professional development of clinicians, scientists, and other clinician-scientists.
Background
Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring’s personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS).
Methods
A systematic scoping review using Krishna’s Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion.
Results
Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring’s CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes.
Conclusion
Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.
Core roles of medical school faculty are increasingly diverse, substantial, and evolving. In alignment with this dynamic nature of medical education, faculty effort should be accurately appraised, constantly evaluated, and rewarded to ensure faculty satisfaction and promote a culture of belonging. The study goal was to examine the imbalance in official assignments and perceptions of medical school faculty effort in various educator domains.
An 80-item survey was designed to collect quantitative and qualitative measures of faculty perceptions of effort. Survey questions collected data on faculty demographics, intent to stay, and perceptions of effort in the following educator domains: teaching, educational leadership and administration, research and scholarship, and service. A mixed methods approach was utilized in data analysis.
Eighty-eight complete survey responses were collected between February and May of 2022 from respondents from 27 states. There was a significant disparity between assigned and perceived effort in the educator domains of teaching, research, and service (P < 0.01). Faculty satisfaction with percent effort dedicated to teaching significantly correlated with intent to stay (P < 0.05). Satisfaction with workload assignments was higher with advanced academic rank and male gender. Qualitative analysis identified many key themes in the categories of promotion, workload, resources, and retention.
Our study revealed that satisfaction with workload directly correlates with intent to stay, and principles of equitable workload distribution are violated from the perspective of the medical educator. This data provides critical information that can be used to assist medical schools in developing metrics to evaluate faculty performance in medical education and improve retention in academic medicine.
Introduction
Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to ‘think, act, and feel like a physician’. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short‐sighted or reactionary responses to systemic issues.
Methods
A Systematic Evidence‐Based Approach‐guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases.
Results
A total of 2441 abstracts were reviewed, 607 full‐text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it.
Conclusions
Based on regnant theories and frameworks related to self‐concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory‐backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.
The National Academies of Sciences, Engineering, and Medicine (2019) recently released a consensus report on integrating healthcare and social care services. The authoring committee’s recommendations for better integration of social care into the delivery of healthcare services include growing the workforce for competent practice at the intersection of health and social care and conducting research and evaluation on integrated health and social care programming design, implementation, and effectiveness. The report describes the importance of interprofessional healthcare teams for the design, implementation, and provision of health system-based social care, and specifically acknowledges the historic expertise of professional social workers at the intersection of health and social care. In the rapidly growing field of health and social care integration, the discipline of social work should consider developing a cadre of clinician scientists (CSs) to bridge the gap between the historic practice expertise of health social work and the nascent, yet burgeoning, science of health and social care integration. Other health professions have a long history of a CS role but have faced increasing difficulties in defining and maintaining it over time. Social work CSs may be one mechanism by which health and social care integration can be better designed, implemented, and evaluated, but lessons from CSs in other health disciplines should be heeded.
Purpose:
Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators.
Method:
A qualitative descriptive study was conducted with a purposive sample of 58 BSME from seven allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted.
Results:
Factors shaping PIF were grouped into three broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued.
Conclusions:
This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.
Objective:
Provision of supervision is an integral component of training in psychology, a view that was solidified in 2014 with the development of the American Psychological Association created Guidelines for Clinical Supervision in Health Service Psychology ( APA, 2014). Current supervisory standards require several components before a relationship is considered supervisory. Among these are assumptions that the supervisory relationship is respectful and collaborative, that feedback is bidirectional, and that it focuses on the development of competency and professional identity by the supervisee. Although clinical and counseling psychology has created supervision models with a variety of different theoretical orientations focused on multiculturalism, neuropsychology as a specialty lacks cohesive, culture-centric, bidirectional supervisory models.
Method:
A systematic review of two electronic databases (PubMed and PsycInfo) was conducted to search for supervision models designed specifically for training in neuropsychology.
Results:
A new model for supervision in neuropsychology was developed, coined the Culturally Expressive and Responsive (CER) Model for Supervision in Neuropsychology. The model is dynamic, multifaceted, and bidirectional, integrating sociocultural and linguistic considerations throughout the supervisory relationship.
Conclusions:
The different facets of the CER Model are discussed, including its place embedded within a larger equitable healthcare model designed to increase healthcare equity. The CER Model highlights the bidirectional supervisory relationship and is designed to be tailored to the developmental level of the learner, encouraging high quality training and evidenced-based practice. Furthermore, the model encourages a process of identity development that is ongoing and emphasizes self-evaluation and cultural humility rather than a static sense of "competence."
Education is widely recognized as a key ingredient in furthering society-wide sustainability transformation. Although there has been extensive research on higher education for sustainability, the qualitative outcomes of sustainability-focused education are less robustly interrogated. As more students graduate from sustainability-specific programmes, it should be asked: what kind of professionals are they and how do they operationalise sustainability at their work? This paper studied career paths and professionalism in the emerging professional field of sustainability, using semi-structured, in-depth interviews of 19 alumni of a master’s level sustainability-specific programme. The interview results reveal that professionalism in sustainability is based on ideals that appear to oppose or conflict the norms and values of several fields in which sustainability is applied. The results also show that the professionals often face challenges in practising sustainability in the workplace but have found strategies to manage these challenges. Finally, the alumni suggested that the sustainability profession is poised between being a specialisation orientation in other recognised fields and a generalist approach that takes sustainability itself as the specialisation practicable in several different fields.
Purpose:
To describe the literature on clinician-scientist training programs to inform the development of contemporary and inclusive training models.
Method:
The authors conducted a scoping review, searching the PubMed/MEDLINE, CINAHL, and Embase databases from database inception until May 25, 2020. Studies presenting primary research that described and evaluated clinician-scientist training programs were identified for data abstraction. On the basis of deductive and inductive methods, information about program characteristics, curricula, teaching strategies, and success metrics was extracted. The extracted variables were analyzed using descriptive statistics.
Results:
From the initial 7,544 citations retrieved and 4,974 unique abstracts screened, 81 studies were included. Of the 81 included studies, 65 (80.2%) were published between 2011 and 2020, 54 (66.7%) were conducted in the United States, and 64 (79.0%) described programs that provided broad clinician-scientist training. Few programs provided funding or protected research time or specifically addressed needs of trainees from underrepresented minority groups. Curricula emphasized research methods and knowledge dissemination, whereas patient-oriented research competencies were not described. Most programs incorporated aspects of mentorship and used multiple teaching strategies, such as direct and interactive instruction. Extrinsic metrics of success (e.g., research output) were dominant in reported program outcomes compared with markers of intrinsic success (e.g., career fulfillment).
Conclusions:
Although programs are providing clinician-scientists with practical skills training, opportunities exist for curricular and pedagogic optimization that may better support this complex career path. Training programs for clinician-scientists can address contemporary issues of wellness and equity by reconsidering metrics of program success and evolving the core tenets of their education models to include equity, diversity, and inclusion principles and patient-oriented research competencies.
Purpose:
Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM®) program.
Materials and methods:
We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes.
Results:
Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution.
Conclusions:
We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.
Rationale, aims, and objectives:
While paediatric clinician-scientists are ideally positioned to generate clinically relevant research and translate research evidence into practice, they face challenges in this dual role. The authors sought to explore the unique contributions, opportunities, and challenges of paediatric clinician-scientists, including issues related to training and ongoing support needs to ensure their success.
Method:
The authors used a qualitative descriptive approach with thematic analysis to explore the experiences of clinician-scientist stakeholders in child health (n = 39). Semi-structured interviews (60 min) were conducted virtually and recorded. Thematic analysis was conducted according to the phases outlined by Braun and Clarke (2006).
Results:
The analysis resulted in the creation of three themes: (1) "Walking on both sides of the fence": unique positioning of clinician-scientists for advancing clinical practice and research; (2) the clinician-scientist: a specialized role with significant challenges; and (3) beyond the basics of clinical and research training programmes: essential skill sets and knowledge for future clinician-scientists.
Conclusions:
While clinician-scientists can make unique contributions to the advancement of evidence-based practice, they face significant barriers straddling their dual roles including divergent institutional cultures in healthcare and academia and a lack of infrastructure to effectively support clinician-scientist positions. Training programmes can play an important role in mentoring and supporting early-career clinician-scientists.
Professional identity formation (PIF) is a dynamic developmental process by which individuals merge the knowledge and skills of clinical practice with the values and behaviors of their personal identity. For an individual physician, this process is a continuum which begins with their nascent interest in the field of medicine and extends through the end stages of a medical career. The impact of PIF has become a growing focus of medical education research in the last decade, and in that time, little attention has been paid to the influence underrepresented in medicine (UIM) identities may have on this fundamental process. Importantly, in discussions of how medical educators can support and encourage successful PIF, there is little discussion on the distinct challenges and different needs UIM learners may have. The purpose of this paper is to address the current literature around PIF for UIM trainees. This review explores various threats to identity formation, including identity fusion, stereotype threat, minority tax, implicit bias, and lack of mentorship. Evidence-based strategies to mitigate these challenges is also presented, including furthering institutional support for PIF, building the community of practice, supporting an inclusive environment, and developing PIF assessment tools. Through exploring these challenges and solutions, we are better able to address the needs of UIM trainees and physicians as they proceed in their PIF during their lifelong journey in medicine.
An area of interest for projectProject participants is career managementManagement. Some active network to find their next consulting engagement, upskill or prepare for major life changesChange (e.g. marriage or promotion). We find in the literature improved results for those who pursue a sustainable careerSustainable careers path. We examine sustainable project-oriented careersSustainable project-oriented career and offer error messagesError messages that indicate career turbulence such as infrequent upskilling. The sustainable project-oriented careerSustainable project-oriented career model is reviewed within the contextContext of the Gig EconomyGig Economy where significant turbulence exists (e.g. COVID-19 pandemic) with the mediating role of trainingTraining and continuing education. We conclude with an overview of innovations in post secondary education that facilitate a sustainable project-oriented careerSustainable project-oriented career. We bring together evolving career sustainabilitySustainability concepts within the projectProject environment and provide guidance for developing a sustainable project-oriented careerSustainable project-oriented career, especially important in our current tempestuous times.
Purpose:
Professional identity formation is the process of internalizing the ideals, values, and beliefs of a profession. In recent years, research on clinician educator (CE) identity formation has expanded, yet gaps exist in understanding initial influences on an educator identity, sustainment throughout a career, and development of successful pathways for early CEs. This study explored the initial influences on and characteristics of the professional identity formation of CEs in an age-diverse, multispecialty population in the United States.
Method:
This was a cross-sectional qualitative study of a purposive sample of medical educators at 6 institutions across the United States between 2018-2019. Focus groups were conducted to obtain participants' perspectives on their career choice and subsequent formation of their professional identity as CEs. The authors used a thematic analysis of focus group data to identify themes and domains through an iterative process.
Results:
Twelve focus groups were conducted with a total of 93 participants. Responses were categorized into 5 domains: community supportive of medical education, culture of institution and training, personal characteristics, facilitators, and professionalization of medical education. Themes highlighted the importance of role models and mentors, an affinity and aptitude for teaching and education, specific facilitators for entry into a career in medical education, the evolution from a layperson, importance of formalized training programs, and a supportive academic community.
Conclusions:
Clinicians experienced a variety of factors that influenced their initial career choice in medical education and subsequent professional identity formation as a clinician educator. This study confirms and expands the current understanding of this process in an age-diverse, multispecialty population of CEs. Educators and administrators designing career development programs across the continuum of medical education should consider these aspects as they mentor and support their learners and faculty.
Background:
Evidence-based patient care requires clinicians to make decisions based on the best available evidence and researchers to provide new scientific knowledge. Clinician-scientists (i.e., registered nurses [RNs] and physicians with a PhD) make important contributions to health care; yet, their roles are not fully understood, supported, or recognized by healthcare leaders. Only a few studies have addressed the factors that enable RNs and physicians to simultaneously pursue both clinical work and research after earning a PhD.
Aim:
To explore what factors have a bearing on the ability of RNs and physicians to pursue research and clinical work simultaneously after earning a PhD.
Methods:
The study used a qualitative design based on open-ended, in-depth interviews. Data were analyzed using conventional content analysis.
Results:
Analysis of the data yielded a broad range of factors that RNs and physicians perceived to either facilitate or hinder continued research while simultaneously undertaking clinical work. Most of the perceived barriers were due to factors external to the individual. Several factors applied to both professions yet differed in impact. Factors mentioned as fundamental to continued research were financial support and allocated time for research. Maintenance of a good relationship with academia and support from management were also considered to be important. In addition, personal factors, such as motivation to pursue a research career after obtaining a PhD, were influential.
Linking evidence to action:
A supportive infrastructure is important for enabling clinician-scientists to pursue research after earning a PhD. Creating favorable conditions for RNs and physicians to combine research with clinical work can facilitate evidence-based practice. This information can be used for interventions aimed at improving the conditions for clinician-scientists.
Background: To reverse the dramatic decline in the U.S. physician-scientist workforce, interventions are necessary to retain physicians in research careers.
Objective: To evaluate the impact of an annual 3-day symposium, the Respiratory Disease Young Investigators' Forum (RDYIF), designed to guide fellows and junior faculty into successful physician-scientist careers.
Methods: In this retrospective, observational study, a questionnaire was e-mailed to 308 physicians who participated in the RDYIF between 2005 and 2018. The questionnaire was administered by National Jewish Health study personnel in the spring of 2019. Responses were primarily analyzed using descriptive and qualitative approaches.
Results: The response rate was 39.3% (n = 121), with 107 of responders (88.4%) completing the full survey. The majority of survey completers currently worked as physician-scientists (76.6%; n = 82), held faculty positions (88.8%; n = 95) in an academic center (90.6%; n = 97), and were currently involved in research (93.4%; n = 100). The majority had been an author on ≥10 peer-reviewed publications (61.3%, n = 65) and had been awarded research grants (71.7%; n = 76). Thirty completers (28.3%) had served as a principal investigator on one or more clinical trials. Completers indicated that participation in the RDYIF had a "strong impact" or "very strong impact" on their career development as physician-scientists.
Conclusion: Participation in the RDYIF strengthened participants' interest in physician-scientist careers and appeared to track with successful career development. Young Investigator Forums such as the RDYIF may be an effective intervention to support the declining supply of physician-scientists in North America.
Through a six-year qualitative study of medical residents, we build theory about professional identity construction. We found that identity construction was triggered by work-identity integrity violations: an experienced mismatch between what physicians did and who they were. These violations were resolved through identity customization processes (enriching, patching, or splinting), which were part of interrelated identity and work learning cycles. Implications of our findings (e.g., for member identification) for both theory and practice are discussed.
The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.
Purpose:
A number of indicators suggest that the physician scientist career track is threatened. As such, it is an opportune time to evaluate current training models. Perspectives on physician scientist education and career path were surveyed in trainees at the University of Toronto, home to Canada's longest standing physician scientist training programs.
Methods:
Trainees from the Clinician Investigator Program (CIP) and MD/PhD Program at the University of Toronto were surveyed. Liekert-style closed-ended questions were used to assess future career goals, present and future perspectives and concerns about and beliefs on training. Demographic information was collected regarding year of study, graduate degree program and focus of clinical and health research. Statistical analysis included non-parametric tests for sub-group comparisons.
Results:
Both groups of trainees were motivated to pursue a career as a physician scientist. While confident in their decision to begin and complete physician scientist training, they expressed concerns about the level of integration between clinical and research training in the current programs. They also expressed concerns about career outlook, including the ability to find stable and sustainable careers in academic medicine. Trainees highlighted a number of factors, including career mentorship, as essential for career success.
Conclusion:
These findings indicate that while trainees at different stages consistently express career motivation, they identified concerns that are program- and training stage-specific. These concerns mirror those highlighted in the medical education literature regarding threats to the physician scientist career path. Understanding these different and changing perspectives and exploring those differences could form an important basis for trainee program improvements both nationally and internationally.
The declining number of physician scientists is an alarming issue. A systematic review of all existing programs described in the literature was performed, so as to highlight which programs may serve as the best models for the training of successful physician scientists. Multiple databases were searched, and 1,294 articles related to physician scientist training were identified. Preference was given to studies that looked at number of confirmed publications and/or research grants as primary outcomes. Thirteen programs were identified in nine studies. Eighty-three percent of Medical Scientist Training Program (MSTP) graduates, 77% of Clinician Investigator Training Program (CI) graduates, and only 16% of Medical Fellows Program graduates entered a career in academics. Seventy-eight percent of MSTP graduates succeeded in obtaining National Institute of Health (NIH) grants, while only 15% of Mayo Clinic National Research Service Award-T32 graduates obtained NIH grants. MSTP physician scientists who graduated in 1990 had 13.5 ± 12.5 publications, while MSTP physician scientists who graduated in 1975 had 51.2 ± 38.3 publications. Additionally, graduates from the Mayo Clinic's MD-PhD Program, the CI Program, and the NSRA Program had 18.2 ± 20.1, 26.5 ± 24.5, and 17.9 ± 26.3 publications, respectively. MSTP is a successful model for the training of physician scientists in the United States, but training at the postgraduate level also shows promising outcomes. An increase in the number of positions available for training at the postgraduate level should be considered.
Introduction:
MD-PhD students experience a prolonged hiatus away from clinical medicine during their laboratory research phase and some have experienced difficulty transitioning back to clinical medicine during clerkship years. We developed a clinical refresher program that serves to rebuild clinical skills prior to re-entering the clinical clerkship years.
Methods:
A nine-week program includes a combination of didactic and practical review in history, physical exam, presentation and clinical reasoning skills. The program uses multiple modalities from classroom-based activities to patient care encounters and includes a final assessment using standardized patients.
Results:
After seven years of experience, we have made modifications that result in our students scoring comparably well on a standardized patient exam to their second-year medical student colleagues. By the end of the course, all students reported feeling more comfortable completing a history and physical examination and some improvement in preclinical knowledge base. Review of clerkship scores showed a higher percentage of MD-PhD students scoring Honors in a clerkship in years after course implementation as compared to years prior to course implementation.
Conclusion:
We describe a clinical refresher course for successfully retraining MD-PhD students to re-enter clinical medical training. It is effective at restoring clinical skills to a level comparable to their medical student contemporaries and prepares them to rejoin the medical student class at the conclusion of their research phase.
Physician scientists (researchers with either M.D. or M.D.-Ph.D. degrees) have the unique potential to combine clinical perspectives with scientific insight, and their participation in biomedical research has long been an important topic for policymakers and educators. Given the recent changes in the research environment, an update and extension of earlier studies of this population was needed. Our findings show that physician scientists are less likely to take a major role in biomedical research than they were in the past. The number of physician scientists receiving postdoctoral research training and career development awards is at an all-time low. Physician scientists today, on average, receive their first major research award (R01 equivalent) at a later age than in the 1980s. The number of first-time R01-equivalent awards to physicians is at the same level as it was 30 yr ago, but physicians now represent a smaller percentage of the grant recipients. The long-term decline in the number of physicians entering research careers was temporarily halted during the period of substantial U.S. National Institutes of Health (NIH) budget growth (1998-2003). These gains are lost, however, in the subsequent years when NIH budgets failed to keep pace with rising costs.- Garrison, H. H., Deschamps, A. M. NIH research funding and early career physician scientists: continuing challenges in the 21st century.
To describe educational outcomes for a national cohort of students who enrolled in MD-PhD programs at medical school matriculation (MD-PhD matriculants).
The authors used multivariate logistic regression to identify factors independently associated with overall MD-PhD program attrition (MD-only graduation or medical school withdrawal/dismissal) compared with MD-PhD program graduation among the 1995-2000 national cohort of MD-PhD matriculants at medical schools with and without Medical Scientist Training Program (MSTP) support.
Of 2,582 MD-PhD matriculants, 1,885 (73.0%) were MD-PhD graduates, 597 (23.1%) were MD-only graduates, and 100 (3.9%) withdrew/were dismissed from medical school by July 2011. MD-PhD matriculants at non-MSTP-funded schools (adjusted odds ratio [AOR], 1.96; 95% confidence interval [CI], 1.60-2.41) and who had lower Medical College Admission Test scores (< 31 versus ≥ 36: AOR, 1.60; 95% CI, 1.20-2.14; 31-33 versus ≥ 36: AOR, 1.31; 95% CI, 1.01-1.70) were more likely to leave the MD-PhD program; matriculants who reported greater planned career involvement in research (AOR, 0.65; 95% CI, 0.51-0.84) and matriculated more recently (AOR, 0.90; 95% CI, 0.85-0.96) were less likely to leave the MD-PhD program. Gender, race/ethnicity, and premedical debt were not independently associated with overall MD-PhD program attrition.
Most MD-PhD matriculants completed the MD-PhD program; most of those who left were MD-only graduates. Findings regarding variables associated with attrition can inform efforts to recruit and support students through successful completion of MD-PhD program requirements.
The transition from trainee to career clinician-scientist can be a stressful and challenging time, particularly for those entering the less established role of nonphysician clinician-scientist. These individuals are typically PhD-prepared clinicians in the allied health professions, who have either a formal or informal joint appointment between a clinical institution and an academic or research institution. The often poorly defined boundaries and expectations of these developing roles can pose additional challenges for the trainee-to-career transition. It is important for these trainees to consider what they want and need in a position in order to be successful, productive, and fulfilled in both their professional and personal lives. It is also critical for potential employers, whether academic or clinical (or a combination of both), to be fully aware of the supports and tools necessary to recruit and retain new nonphysician clinician-scientists. Issues of relevance to the trainee and the employer include finding and negotiating a position; the importance of mentorship; the value of effective time management, particularly managing clinical and academic time commitments; and achieving work-life balance. Attention to these issues, by both the trainee and those in a position to hire them, will facilitate a smooth transition to the nonphysician clinician-scientist role and ultimately contribute to individual and organizational success.
ABSTRACT The story a person tells about his or her life is viewed as a polyphonic novel. This metaphor implies that the self is multivoiced; that is, there is no single “I” as an agent of self-organization but several, relatively independent “I” positions that complement and contradict each other in dialogical relationships. From this perspective the role ofimaginal figures in the organization of the self is analyzed. A theory and method are presented allowing us to study both the content and the organization of multivoiced self-narratives. The method is illustrated with two idiographic studies, where people tell their life story not only from the perspective of the familiar “I” but also from the perspective of an imaginal figure with whom they have had a long-lasting relationship. Finally, it is argued that the metaphor of a polyphonic novel is particularly useful because it allows us to decentralize the Western concept of the self.
This conceptual paper introduces the Theory of Dialogical Self to the career development literature. The life themes component of the Theory of Career Construction is the focus of application for dialogical self. It is proposed that the notion of dialogical self may contribute to understanding how individuals construct the career-related life themes. Dialogical self is thus presented as a promising theoretical construct to augment the explanatory capacity of the Theory of Career Construction and the constructivist, narrative approach to career theory in general. Implications for career counselling are presented.
To explore how the Canadian Child Health Clinician Scientist Program (CCHCSP) works to achieve prearticulated and emergent outcomes.
In 2009, after gaining ethical approval from the Hospital for Sick Children, the authors examined quantitative data (e.g., participation in curriculum elements) to ensure sufficient exposure by trainees to the program and quantitative outputs (e.g., publications) to measure achievement of CCHCSP goals. They identified emergent outcomes through grouping and analyzing qualitative data generated through interviews with program graduates. Then, to explore possible theoretical explanations for the emergent findings, the authors conducted a literature review.
Graduates participated in high rates in each component of the CCHCSP and produced publications, presented research, and received funding. Interview data revealed an unexpected outcome: that the CCHCSP helped graduates to form new professional identities. These data, along with theoretical assumptions from Ibarra's theory on professional identity change, informed a new theory or model for the CCHCSP.
Early investment in building a program's logic model is invaluable for understanding program goals and for guiding program planning and development. Both employing a strategy that captures emergent program outcomes and investigating (e.g., through a literature search) why and how the program actually works to arrive at these outcomes informs the development and evaluation of future program offerings and may, as in the case of the CCHCSP, offer a new program model or theory.
This is a constructivist grounded theory study of the impact of the clinical
psychology flexible training scheme on the development of professional identity.
Professional identity development involves the acquisition of new role behaviours
and new views of the self. Research into professional identity development amongst
clinical psychology trainees is scarce. Studies involving clinical psychology trainees
have mainly focused on their psychological adaptation to the challenges of training.
A longitudinal study of the 2003 cohort of the University of Edinburgh Clinical
Psychology Training Programme was conducted to identify factors that facilitate and
impede professional identity development. A combination of focus groups and
individual interviews were used to explore flexible trainees’ experiences during their
4th and 5th years of training and the experiences of 4-year flexible and 3-year trainees
in their first-year post-qualification. All interviews were transcribed and coded
line-by-line in order to facilitate the development of analytic categories. Six main
categories were identified: Perceived Competence, Formal Status, Comparisons of
Self with Others, Expectations of Others, Role Conflict and Role Ambiguity.
The results suggest that professional identity development involves attaining
equilibrium between the formal status of the role and the individual’s perceived
competence in that role. Role conflict, role ambiguity, comparisons of self with
others and the expectations of others can all create a sense of disequilibrium and
impede the individual’s ability to identify with the professional role.
It would appear that flexible trainees are better able to identify with the professional
role on qualification as they have greater opportunities to develop a sense of
competence during their training in comparison with their 3-year peers. However,
they also appear to experience greater conflict and ambiguity in their roles as flexible
trainees, which has implications for their identity development during training.
Multiinstitutional research collaborations now form the most rapid and productive project execution structures in the health sciences. Effective adoption of a multidisciplinary team research approach is widely accepted as one mechanism enabling rapid translation of new discoveries into interventions in human health. Although the impact of successful team-based approaches facilitating innovation has been well-documented, its utility for training a new generation of scientists has not been thoroughly investigated. We describe the characteristics of how multidisciplinary translational teams (MTTs) promote career development of translational research scholars through competency building, interprofessional integration, and team-based mentoring approaches. Exploratory longitudinal and outcome assessments from our experience show that MTT membership had a positive effect on the development of translational research competencies, as determined by a self-report survey of 32 scholars. We also observed that all trainees produced a large number of collaborative publications that appeared to be associated with their CTSA association and participation with MTTs. We conclude that the MTT model provides a unique training environment for translational and team-based learning activities, for investigators at early stages of career development. Clin Trans Sci 2015; Volume #: 1-9.
© 2015 Wiley Periodicals, Inc.
A fundamental goal of medical education is the active, constructive, transformative process of professional identity formation (PIF). Medical educators are thus charged with designing standardized and personalized curricula for guiding, supporting, and challenging learners on the developmental professional identity pathway, including the process of socialization. The author of this Commentary provides an overview of foundational principles and key drivers of PIF supporting the being, relating, and doing the work of a compassionate and competent physician. Key elements of PIF including guided reflection, use of personal narratives, integral role of relationships and role modeling, and community of practice are viewed through various lenses of PIF theory and pedagogy. Questions informing the PIF discourse are raised, including interprofessional identity considerations. Central emergent themes of reflective practice, relationships, and resilience are described as supporting and reciprocally enhancing PIF. Overarching lessons include attending to learners' and faculty's PIF within a developmental trajectory of the professional life cycle; process and content within PIF curricula as well as learners' individual and collective voices; curricular/extracurricular factors contributing to socialization, self-awareness, development of core values, and moral leadership; integrating PIF domains within pedagogy; faculty development for skilled mentoring and reflective coaching; and implementing resilience-promoting skill sets as "protective" within PIF. Outcomes assessment including the impact of curricula on learners and on patient-centered care can be challenging, and potential next steps toward this goal are discussed.
Recent calls to focus on identity formation in medicine propose that educators establish as a goal of medical education the support and guidance of students and residents as they develop their professional identity. Those entering medical school arrive with a personal identity formed since birth. As they proceed through the educational continuum, they successively develop the identity of a medical student, a resident, and a physician. Each individual's journey from layperson to skilled professional is unique and is affected by "who they are" at the beginning and "who they wish to become."Identity formation is a dynamic process achieved through socialization; it results in individuals joining the medical community of practice. Multiple factors within and outside of the educational system affect the formation of an individual's professional identity. Each learner reacts to different factors in her or his own fashion, with the anticipated outcome being the emergence of a professional identity. However, the inherent logic in the related processes of professional identity formation and socialization may be obscured by their complexity and the large number of factors involved.Drawing on the identity formation and socialization literature, as well as experience gained in teaching professionalism, the authors developed schematic representations of these processes. They adapted them to the medical context to guide educators as they initiate educational interventions, which aim to explicitly support professional identity formation and the ultimate goal of medical education-to ensure that medical students and residents come to "think, act, and feel like a physician."
Emerging from an extensive study of physician education by The Carnegie Foundation for the Advancement of Teaching, Educating Physicians calls for a major overhaul of the present approach to preparing doctors for their careers. The text addresses major issues for the future of the field and takes a comprehensive look at the most pressing concerns in physician education today. The key findings of the study recommend four goals for medical education: standardization of learning outcomes and individualization of the learning process; integration of formal knowledge and clinical experience; development of habits of inquiry and innovation; and focus on professional identity formation. Like The Carnegie Foundation's revolutionizing Flexner Report of 1910, Educating Physicians is destined to change the way administrators and faculty in medical schools and residency programs prepare physicians for the future.
Physician scientists bridge the gap between biomedical research and clinical practice. However, the continuing decrease in number of people who choose this career path poses a threat to the advancement of biomedical science and the translation of research findings to clinical practice.
Teaching medical professionalism is a fundamental component of medical education. The objective is to ensure that students understand the nature of professionalism and its obligations and internalize the value system of the medical profession. The recent emergence of interest in the medical literature on professional identity formation gives reason to reexamine this objective. The unstated aim of teaching professionalism has been to ensure the development of practitioners who possess a professional identity. The teaching of medical professionalism therefore represents a means to an end.The principles of identity formation that have been articulated in educational psychology and other fields have recently been used to examine the process through which physicians acquire their professional identities. Socialization-with its complex networks of social interaction, role models and mentors, experiential learning, and explicit and tacit knowledge acquisition-influences each learner, causing them to gradually "think, act, and feel like a physician."The authors propose that a principal goal of medical education be the development of a professional identity and that educational strategies be developed to support this new objective. The explicit teaching of professionalism and emphasis on professional behaviors will remain important. However, expanding knowledge of identity formation in medicine and of socialization in the medical environment should lend greater logic and clarity to the educational activities devoted to ensuring that the medical practitioners of the future will possess and demonstrate the qualities of the "good physician."
On the 100th anniversary of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching published a new study of medical education. This study, titled Educating Physicians: A Call for Reform of Medical Schools and Residency Programs, contained four primary recommendations intended to stimulate innovation and improvement in medical education. In this article, the authors examined the ways others have applied the four recommendations from Educating Physicians within and beyond medical education. In their review of 246 publications citing the Carnegie work, they found that the recommendation for integration was addressed most frequently, often through descriptions of integration of curricular content in undergraduate medical education. The recommendation to focus on professional identity formation was the second most frequently addressed, followed by standardization and individualization, then inquiry, innovation, and improvement. The publications related to these latter three recommendations tended to be conceptual rather than descriptive or empirical. Publications spanned the continuum of medical education (from medical school to residency to physicians in practice) and even into other fields, but undergraduate medical education received the most attention. The authors discuss common themes among the citing publications and highlight opportunities for further discussion and innovation. Many exciting developments have occurred in medical education and beyond since the publication of Educating Physicians in 2010. Thus far, most of the publications citing the Carnegie recommendations describe incremental changes in medical education, particularly in the area of integration. Some of the conceptual work around these recommendations, coupled with a variety of external factors such as changes in health care and accreditation systems, suggests the potential for changes that are more transformative in nature.
In this article, we introduce the concept of social identity complexity—a new theoretical construct that refers to an individual's subjective representation of the interrelationships among his or her multiple group identities. Social identity complexity reflects the degree of overlap perceived to exist between groups of which a person is simultaneously a member When the overlap of multiple ingroups is perceived to be high, the individual maintains a relatively simplified identity structure whereby memberships in different groups converge to form a single ingroup identification. When a person acknowledges, and accepts, that memberships in multiple ingroups are not fully convergent or overlapping, the associated identity structure is both more inclusive and more complex. In this article, we define the concept of social identity complexity and discuss its possible antecedents and consequences. Results from initial studies support the prediction that social identity complexity is affected by stress and is related to personal value priorities and to tolerance of outgroup members.
This article describes how people adapt to new roles by experimenting with provisional selves that serve as trials for possible but not yet fully elaborated professional identities. Qualitative data collected from professionals in transition to more senior roles reveal that adaptation involves three basic tasks: (1) observing role models to identify potential identities, (2) experimenting with provisional selves, and (3) evaluating experiments against internal standards and external feedback. Choices within tasks are guided by an evolving repertory that includes images about the kind of professional one might become and the styles, skills, attitudes, and routines available to the person for constructing those identities. A conceptual framework is proposed in which individual and situational factors influence adaptation behaviors indirectly by shaping the repertory of possibilities that guides self-construction.
Many aspects of MD-PhD training are not optimally designed to prepare students for their future roles as translational clinician-scientists. The transition between PhD research efforts and clinical rotations is one hurdle that must be overcome. MD-PhD students have deficits in clinical skills compared with those of their MD-only colleagues at the time of this transition. Reimmersion programs (RPs) targeted to MD-PhD students have the potential to help them navigate this transition.The authors draw on their experience creating and implementing an RP that incorporates multiple types of activities (clinical exam review, objective structured clinical examination, and supervised practice in patient care settings) designed to enhance the participants' skills and readiness for clinical efforts. On the basis of this experience, they note that MD-PhD students' time away from the clinical environment negatively affects their clinical skills, causing them to feel underprepared for clinical rotations. The authors argue that participation in an RP can help students feel more comfortable speaking with and examining patients and decrease their anxiety regarding clinical encounters. The authors propose that RPs can have positive outcomes for improving the transition from PhD to clinical MD training in dual-degree programs. Identifying and addressing this and other transitions need to be considered to improve the educational experience of MD-PhD students.
Academic pediatrics is motivated by a vision wherein the children of tomorrow are healthier than those of today. The physician-scientist is uniquely well positioned to create and translate discoveries into care. Over the last 30 years, proportionately fewer physician-scientists capable of sustaining a research program have committed to a hypothesis-driven research career focused on child-health issues. Since the 1980s, the percentage of physicians dedicating significant components of a professional life to research has declined from approximately 5% to 1.5%.1 Pediatrics may be more affected than other medical specialties. Despite more trainees, the population of physician-scientists is aging and the absolute number is declining.2 In 1980, 25% of research program grants were awarded to physicians older than 50 years, compared with 50% at present.1 The implications of these trends are substantial.
Objectives:
The aim of this study was to examine pharmacists' perceptions of their professional identity, both in terms of how they see themselves and how they think others view their profession.
Methods:
A qualitative study was undertaken, using group and individual interviews with pharmacists employed in the community, hospital and primary care sectors of the profession in England. The data were recorded, transcribed verbatim and analysed using the framework method.
Key findings:
Forty-three pharmacists took part in interviews. A number of elements help determine the professional identities of pharmacists, including attributes (knowledge and skills), personal traits (aptitudes, demeanour) and orientations (preferences) relating to pharmacists' work. The study identified the presence of nine identities for pharmacists: the scientist, the medicines adviser, the clinical practitioner, the social carer, the medicines maker, the medicines supplier, the manager, the business person and the unremarkable character. While the scientist was the strongest professional identity to emerge it nevertheless seemed to overlap and compete with other professional identities, such as that of the medicines maker.
Conclusions:
The relatively high number of identities may reflect some degree of role ambiguity and lack of clear direction and ownership of what makes pharmacists unique, but also suggests a flexible view of their role.
JOHNSON M., COWIN L.S., WILSON I. & YOUNG H. (2012) Professional identity and nursing: contemporary theoretical developments and future research challenges. International Nursing Review
Aim: We propose that the conceptual orientation of professional identity is a logical consequence of self-concept development by focusing on career and its meaning and presents a measurable set of concepts that can be manipulated to improve retention of student and registered nurses within health service.
Background: Although professional identity is a term that is commonly written of in nursing literature, its theoretical origins remain unclear, and available empirical evidence of its presence or ability to change is omitted from nursing research.
Sources of evidence: We present a professional identity pathway and explore the factors that influence professional identity throughout a career in nursing.
Discussion: Nurses' professional identities develop throughout their lifetimes, from before entering nursing education, throughout their years of study and clinical experience, and continue to evolve during their careers. Education is, however, a key period as it is during this time students gain the knowledge and skills that separate nurses as professional healthcare workers from lay people.
Conclusion: Finally, a call for longitudinal studies of students to graduates, using conceptually derived and psychometrically proven instruments capable of detecting the subtle changes in the construct over time, is recommended. Further empirical research into the theoretical concepts that underline professional identity, and the factors that influence changes in this important construct in nursing, is required. Ultimately, the practical relevance of such research will lie in the potential it provides for enhanced nursing career support and improved workforce policies.
MD-PhD training programs provide an integrated approach for training physician-scientists. The goal of this study was to characterize the career path taken by MD-PhD program alumni during the past 40 years and identify trends that affect their success.
In 2007-early 2008, 24 programs enrolling 43% of current trainees and representing half of the National Institutes of Health-funded MD-PhD training programs submitted anonymous data on 5,969 current and former trainees.
The average program enrolled 90 trainees, required 8.0 years to complete, and had an attrition rate of 10%. Nearly all (95%) of those who graduated entered residencies. Most (81%) were employed in academia, research institutes, or industry; 16% were in private practice. Of those in academia, 82% were doing research and at least 61% had identifiable research funding. Whereas two-thirds devoted more than 50% effort to research, only 39% devoted more than 75% effort. Many with laboratory-based PhDs reported doing clinical, as well as basic and translational, research. Emerging trends include decreasing numbers of graduates who forego residencies or hold primary appointments in nonclinical departments, increasing time to graduation, and expanding residency choices that include disciplines historically associated with clinical practice rather than research.
Most MD-PhD program graduates follow career paths generally consistent with their training as physician-scientists. However, the range of their professional options is broad. Further thought should be given to designing their training to anticipate their career choices and maximize their likelihood of success as investigators.
Medical education is as much about the development of a professional identity as it is about knowledge learning. Professional identities are contested and accepted through the synergistic internal-external process of identification that is constituted in and through language and artefacts within specific institutional sites. The ways in which medical students develop their professional identity and subsequently conceptualise their multiple identities has important implications for their own well-being, as well as for the relationships they form with fellow workers and patients.
This paper aims to provide an overview of some current thinking about identity and identification with the aim of highlighting some of the core underlying processes that have relevance for medical educationists and researchers. These processes include aspects that occur within embodied individuals (e.g. the development of multiple identities and how these are conceptualised), processes specifically to do with interactional aspects of identity (e.g. how identities are constructed and co-constructed through talk) and institutional processes of identity (e.g. the influence of patterns of behaviour within specific hierarchical settings).
Developing a systematic understanding into the processes through which medical students develop their identities will facilitate the development of educational strategies, placing medical students' identification at the core of medical education.
Understanding the process through which we develop our identities has profound implications for medical education and entails that we adopt and develop new methods of collecting and analysing data. Embracing this challenge will provide better insights into how we might develop students' learning experiences, facilitating their development of a doctor identity that is more in line with desired policy requirements.
In 2000, faced with a national concern over the decreasing number of physician-scientists, Vanderbilt School of Medicine established the institutionally funded Vanderbilt Physician-Scientist Development (VPSD) program to provide centralized oversight and financial support for physician-scientist career development. In 2002, Vanderbilt developed the National Institutes of Health (NIH)-funded Vanderbilt Clinical Research Scholars (VCRS) program using a similar model of centralized oversight. The authors evaluate the impact of the VPSD and VCRS programs on early career outcomes of physician-scientists.
Physician-scientists who entered the VPSD or VCRS programs from 2000 through 2006 were compared with Vanderbilt physician-scientists who received NIH career development funding during the same period without participating in the VPSD or VCRS programs.
Seventy-five percent of VPSD and 60% of VCRS participants achieved individual career award funding at a younger age than the comparison cohort. This shift to career development award funding at a younger age among VPSD and VCRS scholars was accompanied by a 2.6-fold increase in the number of new K awards funded and a rate of growth in K-award dollars at Vanderbilt that outpaced the national rate of growth in K-award funding.
Analysis of the early outcomes of the VPSD and VCRS programs suggests that centralized oversight can catalyze growth in the number of funded physician-scientists at an institution. Investment in this model of career development for physician-scientists may have had an additive effect on the recruitment and retention of talented trainees and junior faculty.
A transformational model of professional identity formation, anchored and globalized in workplace conversations, is advanced. Whilst the need to theorize the aims and methods of clinical education has been served by the techno-rational platform of 'reflective practice', this platform does not provide an adequate psychological tool to explore the dynamics of social episodes in professional learning and this led us to positioning theory. Positioning theory is one such appropriate tool in which individuals metaphorically locate themselves within discursive action in everyday conversations to do with personal positioning, institutional practices and societal rhetoric. This paper develops the case for researching social episodes in clinical education through professional conversations where midwifery students, in practice settings, are encouraged to account for their moment-by-moment interactions with their preceptors/midwives and university mentors. It is our belief that the reflection elaborated by positioning theory should be considered as the new epistemology for professional education where professional conversations are key to transformative learning processes for persons and institutions.
Market expectations of physiotherapists reflect changing demands of health care for client centred, community based management of chronic disease in an ageing population. This study forms a component part of a longitudinal study of students' socialization throughout their education programme examining the outcome of professional identity throughout professional socialization processes. The aim of this study was to explore characteristics of graduating physiotherapy students' professional identity before leaving the University. An interview guide, agreed between the Swedish and UK researchers, was used to focus the semi-structured interviews. The phenomenon of professional identity of 18 students was studied through their perceptions of their role, practice, vision, beliefs and scope of practice as physiotherapists. A phenomenographic approach was taken to analysis and identified three qualitatively different categories of professional identity as a physiotherapist which are described as the Empowerer, the Educator and the Treater. A variation of concepts in professional identity at graduation questions the extent to which educators consider how they guide the development of professional identities which fit the expectations of stakeholders and which are able to respond to promotion and development of the profession of physiotherapy in the changing fields of health care over future years.
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