A Pathway to Professional Identity Formation: Report of the 2020-2021 AACP Student Affairs Standing Committee

Chair G.K., Bacci J.L., Chui M.A., Farley J., Gannett P.M., Holstad S.G., Livet M., Farrell D.

Welch B.E., Arif S.A., Bloom T.J., Isaacs A.N., Janke K.K., Johnson J.L., Moseley L.E., Ross L.J.

Kellar J., Paradis E., van der Vleuten C.P., oude Egbrink M.G., Austin Z.

Sorensen T.D., Hager K.D., Schlichte A., Janke K.

Mylrea M.F., Gupta T.S., Glass B.D.

Urick B.Y., Meggs E.V.

The history of community pharmacy in America since the 1920s is one of slow progress towards greater professional standing through changes in pharmacy education and practice. The history of American community pharmacy in the modern era can be divided into four periods: 1920–1949 (Soda Fountain Era), 1950–1979 (Lick, Stick, Pour and More Era), 1980–2009 (Pharmaceutical Care Era), and 2010–present (Post-Pharmaceutical Care Era). As traditional compounding has waned, leaders within community pharmacy have sought to shift focus from product to patient. Increasing degree requirements and postgraduate training have enhanced pharmacists’ ability to provide patient care services not directly associated with medication dispensing. However, the realities of practice have often fallen short of ideal visions of patient-focused community pharmacy practice. Positive trends in the recognition of the impact of community pharmacists on healthcare value and the need for more optimal medication management suggest that opportunities for community pharmacists to provide patient care may expand through the 21st century.

Noble C., McKauge L., Clavarino A.

Transitioning from being pharmacy students to pharmacists is challenging. Students need to reconcile their professional aspirations and what they have learnt with the realities of practice. A smooth transition can be hampered when they are unable to enact the role they have envisaged or if their expectations are not met. These challenges relate to professional identity. A key challenge for pharmacy educators is how best to support the professional identity formation (PIF) of pharmacy students. To assist with this challenge, we conducted a scoping review to identify factors influencing pharmacy students' PIF and pedagogical strategies to support PIF.In September 2018, we undertook a scoping review of all contemporary research investigating pharmacy student PIF including all relevant qualitative, quantitative, theoretical, and gray literature. We searched eight databases for the review: MEDLINE, CINAHL, PsycINFO, Embase, Australian Education Index, PubMed, Scopus, and Web of Science. Literature published between January 2008 and September 2018 was reviewed and screened using inclusion/exclusion criteria. The selected articles were charted and thematically analyzed.We included 22 articles in the review. Studies generally concurred about the importance of attending to PIF throughout the whole pharmacy curriculum. Yet, those studies reporting on pharmacy students' professional identities found that students experienced challenges forming their identities. While several curriculum interventions supporting PIF have been implemented, these tended to be one-offs and there was an absence of interventions engaging key stakeholders including placement preceptors, other health professionals, and patients/consumers.Supporting the formation of pharmacy students' professional identity, while recognized as an important goal for pharmacy education, requires further empirical inquiry. Pedagogical practices focused on identity formation including adopting an integrative curricular approach are required.

Cruess S.R., Cruess R.L., Steinert Y.

Cruess S.R., Cruess R.L.

This chapter is based upon the premise that professional identity formation should be 'the central focus in educating tomorrow's physicians'. It addresses the issue of the formation of a professional identity in physicians. In doing so, it stresses that the current emphasis on identity formation has grown out of what has been termed the 'professionalism movement' in medical education. Explicitly addressing the issues of professionalism and professional identity formation in the medical curriculum is a recent phenomenon. Professional identity or identities are acquired through the process of socialisation within medicine's community of practice at the undergraduate and postgraduate levels and throughout practice. The chapter points the way for the development of curricula whose primary objective is the support of individuals as they develop their identities or, to activities within a traditional curriculum that will recognise the importance of professional identity formation and address it specifically in programmes of instruction.

Cantillon P., Dornan T., De Grave W.

Most clinical teachers have not been trained to teach, and faculty development for clinical teachers is undermined by poor attendance, inadequate knowledge transfer, and unsustainability. A crucial question for faculty developers to consider is how clinicians become teachers "on the job." Such knowledge is important in the design of future workplace-based faculty development initiatives. The authors conducted a scoping review of research on the relationship between becoming a clinical teacher and the clinical environments in which those teachers work.In June 2017, using the scoping review design described by Levac et al (2010), the authors searched 12 databases. They subjected the articles discovered to four phases of screening, using iteratively developed inclusion/exclusion criteria. They charted data from the final selection of articles and used thematic analysis to synthesize findings.Thirty-four research reports met the inclusion criteria. Most (n = 24) took an individualist stance toward identity, focusing on how teachers individually construct their teacher identity in tension with their clinician identities. Only 10 studies conceptualized clinical teacher identity formation as a social relational phenomenon, negotiated within hierarchical social structures. Twenty-nine of the included studies made little or no use of explicit theoretical frameworks, which limited their rigor and transferability.Clinicians reconciled their identities as teachers with their identities as clinicians by juggling the two, finding mutuality between them, or forging merged identities that minimized tensions between educational and clinical roles. They did so in hierarchical social settings where patient care and research were prioritized above teaching.

Livet M., Haines S.T., Curran G.M., Seaton T.L., Ward C.S., Sorensen T.D., Roth McClurg M.

Health care is experiencing increasing pressure to implement evidence-based interventions that improve quality, control costs, and maximize value. Unfortunately, many clinical services and interventions to optimize medication use do not consistently produce the intended humanistic, clinical, and economic outcomes. The lack of conclusive results is believed to stem from the widely recognized research-to-practice gap. The field of implementation science seeks to discover and apply strategies designed to accelerate successful integration of interventions into routine practice. This primer provides an overview of implementation science principles for pharmacists and other health care providers interested in accelerating practice transformation to improve health care delivery and, ultimately, patient care.

Bloom T.J., Smith J.D., Rich W.

Johnson J.L., Chauvin S.

Atkinson J., de Paepe K., Sánchez Pozo A., Rekkas D., Volmer D., Hirvonen J., Bozic B., Skowron A., Mircioiu C., Marcincal A., Koster A., Wilson K., van Schravendijk C., Wilkinson J.

Cruess R.L., Cruess S.R., Steinert Y.

In 1990, George Miller published an article entitled "The Assessment of Clinical Skills/Competence/Performance" that had an immediate and lasting impact on medical education. In his classic article, he stated that no single method of assessment could encompass the intricacies and complexities of medical practice. To provide a structured approach to the assessment of medical competence, he proposed a pyramidal structure with four levels, each of which required specific methods of assessment. As is well known, the layers are "Knows," "Knows How," "Shows How," and "Does." Miller's pyramid has guided assessment since its introduction; it has also been used to assist in the assessment of professionalism.The recent emphasis on professional identity formation has raised questions about the appropriateness of "Does" as the highest level of aspiration. It is believed that a more reliable indicator of professional behavior is the incorporation of the values and attitudes of the professional into the identity of the aspiring physician. It is therefore proposed that a fifth level be added at the apex of the pyramid. This level, reflecting the presence of a professional identity, should be "Is," and methods of assessing progress toward a professional identity and the nature of the identity in formation should be guided by currently available methods.

Peddi A.N., Astle K.N., Hong L., Riley B.L., Ruble M., Vandervoort L., Knockel L.

Odem S., Kellett K., Maxwell W., Whalen K.

Burke M., Randles E.

This qualitative phenomenological study explored factors influencing veterinary students with disabilities, neurodiversity, or chronic conditions (VSDNCC) in pursuing equine practice in the UK and Ireland. Equine practice is often seen as exclusive and unsupportive, 1 , 2 contributing to recruitment challenges. 3 , 4 This study examined career influences and the impact of equine placements on their decisions. Semi-structured interviews via Microsoft Teams explored the experiences and perceptions of VSDNCC in equine practice. Participants aged 18–29 years were recruited from UK and Irish veterinary schools through social media and referrals. The sample included six individuals with diverse diagnoses, often multiple. Thematic analysis identified four overarching themes and seven subthemes. Participants’ career decisions were influenced by factors such as work nature, environment, team dynamics, and preparedness, with perceptions varying by diagnosis. For instance, those with mobility issues considered accessibility, while neurodiverse participants focused on environmental control. Many reported ableism during equine extramural studies, negatively impacting their experience and career outlook. None encountered equine vets with similar conditions, highlighting the need for relatable role models to inspire their career aspirations. The equine veterinary industry is often seen as unwelcoming by VSDNCC, with ableism during extramural studies and a lack of relatable role models reinforcing exclusion. Greater openness from equine vets about their diagnoses and adjustments, along with supportive learning environments that encourage skill-building and accommodations, could improve perceptions and inspire VSDNCC to consider careers in equine practice.

Gortney J.S., Lacroix M., Dunn B.L.

Howle A., Carter G., Reising D.

ABSTRACTAimTo explore the current state of the science on influencing factors of acute care nursing professional identity.DesignIntegrative review.MethodsData were collected and screened using Covidence systematic review software, adhering to pre‐defined inclusion criteria. The Critical Appraisal Skills Programme checklist was used for critical appraisal, and content analysis was applied to analyse the data.Data SourcesCINAHL, PsycINFO and PubMed were utilised to search literature published between 2018 and 2023.ResultsA total of 18 articles were included. Five themes were identified: (1) internal influences; (2) external influences; (3) externalisation of role; (4) early versus seasoned career experiences and (5) barriers to professional identity formation.ConclusionThis review found evidence of multiple influencing factors, predominantly external, shaping acute care nurse professional identity. Research on the long‐term impacts on practice, management, policy and education remains limited.ImplicationsEnablers to forming professional identity foster empowerment, confidence, belonging and job satisfaction. Barriers to formation lead to hesitation, performance impediments, stress and exhaustion. Development of nurse professional identity may be instrumental in tackling acute care workforce challenges.ImpactReview findings on professional identity formation can guide initiatives for enhancing healthy work environments and workforce retention. This exploration has international contemporary relevance for the nursing profession with suggestions for future research.Impact StatementExisting literature underscores the significance of professional identity in nursing, yet the mechanisms underlying its integration and maintenance in the contemporary acute care workforce remain unclear. In the context of overwhelming workloads that adversely affect nurse mental health and retention, coupled with the escalating nursing shortage as we emerge from the pandemic, this examination of professional identity formation holds contemporary relevance for the evolving acute care landscape, offering implications for future research. The insights gleaned from this review may guide organisational leaders in developing new strategies addressing acute care nurse management, policy, education and retention.Reporting MethodReporting adheres to the EQUATOR network, ENTREQ guidelines.Patient or Public ContributionNone.

Park S.K., Chen A.M., Lebovitz L., Ellington T.M., Lahiri M., Weldon D., Behnen E., Sease J., Vellurattil R.P., Donahoe H., Bechtol R.

Hall J.J., Tong H., Watson K.E., Tsuyuki R.T., Biggs C., Charrois T.L.

Purpose: As the scope of practice continues to evolve for pharmacists, professional abstinence is being observed by students in workplaces and practicums. Professional abstinence is defined as “consciously choosing not to provide the full scope of patient care activities”. Exposure of students to professional abstinence may cause cognitive dissonance, as they are challenged by practices that do not match what they are taught in school. This study explores pharmacy student perspectives on professional abstinence in community practice settings and their thoughts on how it could be addressed. Methods: Pharmacy students enrolled at an accredited Canadian pharmacy school with previous experience at a community practice site were invited to participate via email and social media. Data were collected between March and November 2021 through virtual individual interviews using a semistructured guide and the Zoom platform. Recordings were transcribed verbatim, and data were analyzed using cognitive dissonance theory to guide the inductive coding and interpretation of results. Results: Twenty students representing 6 pharmacy schools were recruited. Themes identified regarding students’ experiences with professional abstinence were “introspection and reflection” and “the system”, with the subthemes of emotion, excuses, professional identity and infrastructure, and inertia/disengagement, respectively. Regarding how to address professional abstinence, the themes “self as professional” and “empowering professionals” emerged. Self as professional included the subthemes of continuous learning, role modelling/mentorship, and internal drive/initiative, while empowering professionals included improved logistics, self-care, and advocacy. Conclusion: Students’ experiences with professional abstinence led to mixed feelings and influences on their professional identity. Pharmacy schools should be made aware of the phenomenon of professional abstinence and its effect on students, as they can potentially help manage learners’ cognitive dissonance and best prepare them for their future full-scope practices.

Dinamarca-Aravena K.A., Herrera-Lillo A., Sandoval-Ramírez M.

ABSTRACT Purpose: to analyze the professional identity of speech-language-hearing pathologists in Chile. Methods: an exploratory qualitative study using semi-structured interviews with 14 speech-language-hearing pathologists with at least one year of work experience. Participants were selected by convenience to ensure diversity in their professional practice. The interviews, approximately 40 minutes long, were conducted, remotely, in 2021, addressing ethical aspects, professional roles, and theoretical knowledge. The data were analyzed thematically with ATLAS.ti using a constructivist approach. Results: the results indicate a lack of consensus among interviewees regarding their professional identity. However, they all identify themselves as health professionals with a primarily rehabilitative role, although this is not entirely clear. The challenges are related to identifying opportunities in professional training to develop a professional identity that responds not only to their practice but also to the construction of an identity hallmark that connects them better with the work setting. Conclusion: the professional identity of the participating speech-language-hearing pathologists is mostly limited to health, although diffuse and fragmented. Their perception tends to be self-centered, focused mainly on their work, with limited knowledge of other areas.

Dinamarca-Aravena K.A., Herrera-Lillo A., Sandoval-Ramírez M.

RESUMEN Objetivo: analizar la identidad profesional de fonoaudiólogos(as) en Chile. Métodos: este estudio cualitativo exploratorio utilizó entrevistas semiestructuradas a 14 fonoaudiólogos(as) con al menos un año de experiencia laboral. Los participantes fueron seleccionados por conveniencia para asegurar diversidad en su ejercicio profesional. Las entrevistas, de aproximadamente 40 minutos, se realizaron de forma remota en 2021, abordando aspectos éticos, rol profesional y conocimientos teóricos. Los datos fueron analizados temáticamente con Atlas Ti bajo un enfoque constructivista. Resultados: los resultados indican una falta de consenso entre los entrevistados respecto a su identidad profesional. Sin embargo, todos se identifican como profesionales de la salud con un rol principalmente rehabilitador, aunque no del todo claro. Los desafíos se relacionan con identificar oportunidades en el ámbito de la formación profesional para desarrollar una identidad profesional que responda no solo al quehacer sino que además a la construcción de un sello identitario que le permita una mejor vinculación con el entorno laboral. Conclusión: la identidad profesional de los(as) fonoaudiólogos(as) participantes se circunscribe mayormente al área de la salud, aunque de manera difusa y fragmentada. Su percepción tiende a ser egocéntrica, centrada principalmente en su propio quehacer, con un conocimiento limitado de otras áreas.

Sourial M., Begley K.J., Dougherty J.A., Woodruff A.E.

Wollen J., Davis S.R., Rosario N.

Kiles T.M., Weaver T., Stallings A.

Branzetti J., Gisondi M.A., Hopson L.R., Regan L., Botti S.

AbstractContextA career in medicine is a journey of countless opportunities, challenges and choices. Determining the “right” decision for any given career choice ultimately must come from within; thus, a clear understanding of a physician's core professional identity is critical. Existing conceptualizations of professional identity within medicine focus primarily on medical training; however, it is clear that professional identity evolves throughout one's career. We propose the use of brand management principles as a novel means of understanding and expressing a physician's evolving professional identity throughout their career.MethodsWe propose a conceptual framework for managing academic physician professional identity based upon brand management principles derived from marketing and consumer research literature. The four key framework elements include brand identity (“Who am I?”), brand delivery (“What actions do I choose to present myself to others”), brand experience (“How are my actions experienced by others?”) and brand image (“How do others see me?”). Successful management of one's brand starts with understanding the core professional brand identity, then determining the best way to deliver this identity through specific actions experienced by target audiences (e.g., patients, collaborators, colleagues, employers, learners, promotion committees, etc.), and ends with the target audience having a clear and compelling brand image that reflects the underlying professional identity. Alignment of these components results in an array of benefits; misalignment can result in feelings of burnout or career stalling.ConclusionsWe contend that physicians can and should see themselves as their own unique brand. Though often confused with naked self‐promotion, developing a professional brand is an identity exploration and reflection experience that allows individuals to better control the course of their careers. A strong personal brand has numerous practical applications; three key examples presented herein include navigating promotion through the professoriate, managing one's reputation and achieving professional fulfilment.

Elmes-Patel A.T., Allen S.M., Kachlic M.D., Schriever A.E., Driscoll T.P., Tekian A., Cheung J.J., Podsiadlik E., Haines S.T., Schwartz A., Jarrett J.B.

Logan L.D., Johnson B.R., Grout K., Gyamfi K., Fulford M.

Objective This study used a self-authorship framework to explore if diversity, equity, and inclusion (DEI) and social determinants of health (SDoH)-focused labs and learning activities increase student confidence in understanding aspects of implicit bias (IB) and SDoH and how these activities impact student comfort discussing and confidence initiating conversations on DEI/SDoH topics with colleagues, faculty, supervisors, and patients. Methods First year (P1) PharmD students engaged in three learning activities across two courses. Students were challenged to evaluate their biases and incorporate DEI/SDoH into their professional identity formation (PIF). This study utilized a mixed-method, embedded approach to analyze assessment data collected via a questionnaire and assignments administered at three points during the fall semester. Quantitative analysis used a quasi-experimental, between-subjects, pretest-posttest design. The qualitative component used open-ended questions to gain additional insight into participant experiences, gathered detail on perceptions, and provided context. Results A one-way ANOVA showed statistically significant increases between assessment points for all items related to confidence understanding IB and SDoH. Comfort discussing DEI/SDoH topics with supervisors/faculty and patients increased over time. Comfort discussing DEI/SDoH topics with colleagues did not increase. Three salient themes emerged from qualitative analyses (bias and privilege awareness, education, and professionalism). Conclusion This study found students started evaluating their own knowledge, beliefs, and claims in social and professional settings as defined by the self-authorship framework. Student comfort and confidence discussing DEI/SDoH topics increased over time. Findings support engaging students in multimodal programming may support incorporation of DEI/SDoH into PIF.