Professional identity development of pre-clerkship medical students: a critical analysis

Ramlackhansingh, Jinelle N. (2022) Professional identity development of pre-clerkship medical students: a critical analysis. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

This dissertation examines how the undergraduate medical education learning environment shapes the development of “the good doctor” professional identity amongst pre-clerkship medical students. The research addresses the gap in scholarship on how the hidden curriculum shapes medical professional identity. The research highlights how the beliefs and practices of students are shaped not by a value-neutral curriculum, but out of and in response to official ideologies perpetuated in the broader learning environment (the “culture” of medical school) in ways that are often hidden. This research was based on a two-year longitudinal critical ethnographic case study of one Canadian medical school. Data collection included focus groups with a core group of students during their first two years of medical school. This was supplemented by interviews with administrative staff and faculty, and observation of the medical school governance meetings. Undergraduate medical education training was examined from students’ perspectives, focusing on how the formal, informal, and hidden curricula shape professional identity. The critical theoretical frameworks of Pierre Bourdieu and Michel Foucault were used to analyze the complex relations of power and influence in pre-clerkship education. Particular attention was paid to how power intersects with the culture of medicine as the identity of a medical professional is constructed. The results show how official ideologies of what it means to be “the good doctor” as prescribed in the national CanMEDS roles and mandated locally through medical school governance structures, are in conflict with and resisted through the counter-ideologies promoted through the hidden curriculum. This research has important implications for curriculum planning in medical education. The findings provide compelling evidence that the formal curriculum must be designed to account for the effects of a hidden curriculum. Specific recommendations are: (1) Medical students would benefit from having a pedagogical space in the formal curriculum to critically reflect on their experiences and the various ideologies and counter-ideologies of “the good doctor” that are shaping their identity; and (2) Establishing communities of practice as a pedagogical space model, would be a useful framework for facilitating this approach, supporting students to navigate the hidden curriculum and negotiate their own professional identity.

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