How do medical students learn professionalism and develop professional identities? An institutional ethnography of the curriculum at one medical school

Abstract

Professionalism and professional identity are becoming central topics in educating tomorrow’s physicians. This dissertation is an institutional ethnography of the curriculum on professionalism and professional identity at one medical school. By examining the three types of curricula – the formal curriculum, the informal curriculum, and the hidden curriculum – and highlighting the gaps between them, this study provides a detailed account and an explanation of medical students’ learning experiences with professionalism and professional identity.

Utilizing the methodology of IE, I conduct document analysis, participant observation, and in-depth interviews with medical students and faculty to reveal institutional practices, identify social relations, and describe students’ learning experiences. I apply a combination of Giddens’s structuration theory of understanding the complexity of social practice, and Lave and Wenger’s understanding of the context of social practice – community – to analyze the processes and consequences of students’ development of professionalism and professional identity formation in medical education.

In pre-clerkship, the medical school’s institutional practices of narrowly defining professionalism and equating the concept to student professionalism and professionalism in professionals is not effective in transformative learning to support students’ development of medical professionalism and professional identity formation. Clerkship is a more significant stage of learning of professionalism and professional identity formation as students’ immersion in the community of medical practice provides not only explicit but also tacit knowledge to master the practice of medicine. Through legitimate peripheral participation in a situated learning environment, students develop a more realistic understanding of medical professionalism and physician roles and develop a specialty-defined professional identity.

Many changes have been made to the formal curriculum and, to some extent, the informal curriculum in medical education to support students’ learning of professionalism and development of a professional identity that performs more roles than simply the medical expert. However, the gap between what students are taught in classroom and what they observe and are taught in practice is still significant. Medical students continue to develop and negotiate their professional identities in the context of competing discourses where the other physician roles often lose the battle to the role of medical expert.