Just Read: Professional Identity (Trans)Formation in Medical Education: Reflection, Relationship, Resilience

Just catching on overdue summer reading, this is a piece written by Hedy Wald, PhD (@Hedy_Wald) clinical associate professor of family medicine, Warren Alpert Medical School of Brown University (#FMRevolution 🙂 ).

I was first introduced to Hedy’s work, not through Hedy, but through writing of Danielle Ofri, MD (@danielleofri) (see: Just Read: What Doctors Feel, How Emotions Affect the Practice of Medicine, who was introduced to me by another physician, Dawn Clark, MD (@scpmgmdwellness) (see: Walking and Talking about Physician Wellness with Dawn Clark, MD, Physician Chief Wellness Facilitator.

That’s how this works – as Hedy herself states in the paper:

Relationships influence adoption of professional values within PIF (Professional Identity Formation). Students actively construct PIs through interactions with patients, mentors, and colleagues within complex learning environments…

Professional Identity Formation

[PIF] is the transformative journey through which one integrates the knowledge, skills, values, and behaviors of a competent, humanistic physician with one’s own unique identity and core values …. The education of all medical students is founded on PIF.

and

identities stabilize in early adulthood, yet transformation continues throughout life

This paper is an introduction to an entire issue in Academic Medicine and interestingly to me, the concepts here are extremely relevant to much of the work I write about (and do) in Washington, DC that I call “helping the world learning to love better” (aka, the reason why we are all here).

Reading the title is reminder of my work with the LGBTQ community and the unstoppable human drive to live in one’s identity – there is transformation to a well adult in this population that occurs (verified by extensive science) which is very similar to transformation to a physician. The journeys are parallel in my mind.

Reflection

There are many jokes that come to mind when we talk about becoming physicians, which I won’t repeat here. The expression that I like that’s not a joke is “once you get the two letters after your name, they can never be taken away.” I say it not with entitlement, but with responsibility.

The reality is that every physician, regardless of where they work or were trained, always have a commonality of experiences that are unmatched by most humans in any discipline (and the same is true for every profession). To an extent I feel a cohesion/congruity in every conversation, from the simplest to the most intense, with other physicians. After that, it’s what you do with it that matters, and I believe by definition every physician (and really everyone in health care) is exceptional; you have to be to do a job this challenging.

As I review the components discussed with Wald and relate them to my experience, I can recall great moments of supportive identity formation, alongside poor moments – usually as a result of neglect.

I recounted some of these in my post about Jess Jacobs’ death, nearing the one year mark. (see: Remembering Jess Jacobs – by the way the most read post on this blog, ever). However/and I do relate to these components in my own identity formation – here I am writing a blog, after all 🙂 .

Resilience

I would like to touch on resilience a bit because it is without a doubt the (a) word of the decade. Wald quotes it as “responding to stress in a healthy way with “bouncing back” after challenges and growing stronger.”

I think for me, it’s also the unstoppable drive as a physician to build resilience in others. Again, I feel this is a common experience that physicians have. Regardless of how we get here, we can’t or won’t walk away, even when we walk away, if that makes sense. See the few examples below from just the past month (and note, more reflection).

Yes, we go to dance parties in front of legislators’ homes, candle light vigils, marches, and parades, to help others live their healthy identities, too.

I was taught "you don't have to be perfect as a physician. You just have to be there for your patients." We're here for your long, healthy life. #FMRevolution #WerkForHealth #EqualityEqualsHealth #mostinclusivecity #asdcgoessogoesthenation #LGBTQ artist c
I was taught “you don’t have to be perfect as a physician. You just have to be there for your patients.” We’re here for your long, healthy life. #FMRevolution #WerkForHealth #EqualityEqualsHealth #mostinclusivecity #asdcgoessogoesthenation #LGBTQ artist credit WerkForPeace (View on Flickr.com)
We are your nurses, doctors, therapists, and allied health professionals and we care. Always and in all ways. It's what we came here to do. ✌️💪 #ACA #instaDC #DC Washington, DC USA
We are your nurses, doctors, therapists, and allied health professionals and we care. Always and in all ways. It’s what we came here to do. ✌️💪 #ACA #instaDC #DC Washington, DC USA (View on Flickr.com)

I sometimes experience people who are not physicians ascribe some of what we do to preservation of self, rather than preservation and support of the people we serve, which is a mistake.

Like the other definition of resilience that I have mentioned on this blog, we’ll never completely understand it.

I also strongly identify with what Wald says about studying history

…there is a growing recognition that essential lessons for students and doctors derive from studying history even as medicine remains committed to pushing the frontier of knowledge.

"Don't be trapped by dogma - which is living with the results of other people's thinking". It's what we do with it ....
“Don’t be trapped by dogma – which is living with the results of other people’s thinking”. It’s what we do with it …. (View on Flickr.com)

In some of the work that I do, there’s tension between “heritage” and “the future”. Partially because I am a history geek, I study the people and places who were from the future in their time, and so there’s no tension for me. To know where you came from helps the knowing of where you’re going to, especially if you live in the future. And if you live in the future, that means not living someone else’s life, with the other misfits….

Relationship

Speaking of living in the future, I finally got to meet Hedy earlier this month. I can’t believe of all the times I didn’t have my camera handy this was the time. In any event, it happened, and I’m delighted to learn that there is a community of experts interested in helping generations of physicians from today and tomorrow establish healthy professional identities. My generation of physicians trained during one of the most profound ethical crises in modern medicine (HIV/AIDS), and as a result we emerged with the goal to change everything. We need all the support we can get, allies need allies.

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