IAMSE Winter 2022 Session 4 Highlights

[The following notes were generated by Sandra Haudek, PhD.]

The Winter 2022 IAMSE Webinar Seminar Series, titled “How Science Educators Still Matter. Leveraging The Basic Sciences for Student Success” continued with its fourth seminar on Thursday January 27, 2022, titled “Identity Shape Shifting: How basic science teaching practices can foster identity transformation from medical student to medical professional”. This seminar was presented by Dr. Michelle Lazarus and Dr. Shemona Rozario, both from Monash University in Melbourne, Australia. Dr. Lazarus is the Director of the Centre of Human Anatomy Education and leader of the Centre for Scholarship in Health Education Curriculum Integration Network. Dr. Shemona Rozario is a physician and PhD student in Dr. Lazarus’ research group. They presented an overview of what professional identity (PI) is, mechanisms of professional identity development (PID), ways foundational medical sciences can impact PID, and applied teaching practices basic science educators can implement to help support medical student PID.

Dr. Lazarus and Dr. Rozario introduced themselves by telling us their journey of PI formation from basic scientist / physician to medical researcher. Dr. Lazarus started the presentation with discussing the historical apprentice model, in which trainees watched and learned in a didactic fashion. In the present, medical curricula integrate simulation opportunities. Future curricula will be full with technology including artificial intelligence (AI) and PID must shift alongside this development.

Dr. Rozario quoted Rees & Monrouxe “How we perceive ourselves as professionals is based on our attributes, beliefs, values, motives, and experiences in relation to our profession, providing us with ethical frameworks and values”. She provided an example from the Australian Medical Association: https://www.ama-assn.org/residents-students/specialty-profiles/what-it-s-specialize-emergency-medicine-shadowing-dr-clem, concluding that PI comes from “What we do influences how we view ourselves”. She explained that our identity development includes the formation of personal and professional identities that both develop through social interactions over our life span. Pre-determined factors (genetics) are unchangeable. During childhood, we are most malleable to social construction of identity formation and the results are most resistant to changes. The dynamic social construction of identity occurs in adult life when we interact more formally with our environment, individuals, and community (religion, culture, socioeconomics, status, personal relationships).

Dr. Rozario quoted work by Monrouxe & Poole who compared the structure of identify with the structure of an onion (core = internal identity, inner layer = internal identity, outer layer = constructed identity). As we grow and interact more widely with others, we add more layers (complexity) to our identity. Identity dissonance occurs when professional and personal identities clash while growing. Pratt and colleagues described identity dissonance in a study investigating identity construction of medical residents in different specialties over a 6-year period. They found that radiology residents spent more time on attending lectures and thus developed a parallel identity as medical educators since their work did no match their expectations of the roles and responsibilities of a physician (identity splinting). Similarity, surgery residents spent more time on paperwork and thus developed a parallel identity as general physicians (identity patching). By contrast, primary care residents experienced only minor violations and thus were reinforced of their current identity (identity enriching).

Dr. Lazarus continued with discussing how basic science educators can help students develop their PI by providing the right environment and right people. She reviewed work from Dr. Nicole Woods, a cognitive psychologist specializing on identity formation https://staff.ki.se/kiprime-podcast-episode-6-nicole-n-woods. She explained that expert physicians have encapsulated knowledge that leads to quick clinical reasoning, yet trainees work with isolated basic blocks. One goal of basic science educators is to help students encapsulate these blocks and thus nurture their PID. Teaching psychosocial skills without the sciences will lead to “empty capsules” and ineffectual integration of skills and knowledge.

Dr. Lazarus used the field of anatomy as an example to explain the impact of technology on anatomy curricula. Her group performed a metanalysis showing that anatomy content was taught at every medical school using different modalities, yet all students learned it equally well. She suggested to integrate AI into the anatomy curricula to deliver content more effectively and use the gained time to enhance critical thinking and thus increase PID. Her work demonstrated that AI technology increased student engagement and learner monitoring, but also developed a view that healthcare has singular logic, that individuals fit into categories, and that psychological skills have limitations. In another study, her group identified six themes that were linked to PID: Process, peer relationships, tutor relationships, ethics, tolerance of uncertainty, and exposure. Of those, the tolerance of uncertainly (= managing novelty effectively) was the only theme that negatively impacting PID in students. Using a clinical case, she illustrated the process of uncertainly tolerance: the physician’s response to a patient’s symptom (the uncertain stimulus) is moderated by cognitive (doubt/confidence), emotional (fear/curiosity), and behavioral (avoidance/decisions) influences. Her group stated that basic science education is a powerful moderator of uncertain times that can increase PID; it can increase job satisfaction, independence, creative solutions, and curiosity, and it can decrease burnout, requirement of supervision, difficulty in solving problems (insecurity), and disengagement.

Dr. Lazarus then listed how educators can stimulate students’ uncertainty in the classroom: (1) Transferring knowledge to a real-world example. (2) Gray cases in which parameters are changed. (3) Providing multifaceted perspectives from different specialists. (4) Questioning preconceptions, e.g., show same experiment with different outcomes. She suggested to bring different moderators into the classroom once students have been stimulated, including educator- and student-sourced moderators (e.g., self-reflection, discuss career value, give assessments with more than 1 correct answers, clinical cases without a diagnosis). She explained that it was important to know which moderator(s) to use at what time and what level.  She also listed three cultural literacy pedagogical components: critical incidents (case studies), destabilization (role-play, simulation), iso-immersion (work integrated learning, placements).

Dr. Lazarus concluded that appropriately build-in of PID in the basic science curriculum has advantages: (1) It prepares students better for the realities of their future careers. (2) By creating a classroom fostering uncertainty tolerance, it helps students manage future transitions to work. (3) Uncertainty tolerance will increase students’ ability to detect novelty and promote PID.

The presentation lasted about 40 minutes and a rich discussion followed. Among other topics, questions from the audience addressed: What is the level of PID? How can uncertainty tolerance be coordinated with the necessity of correct answers in USMLE step exams? How do we train faculty to teach uncertainty without undermining their expertise? How does this impact the ratio students to instructors?

  1. Rees, C.E. and Monrouxe, L.V., “Who are you and who do you want to be? Key considerations in developing professional identities in medicine.” Medical Journal of Australia, 2018. 209(5): p. 202-203.
  2. Monrouxe, L.V and Poole, G., “An onion? Conceptualizing and researching identity.” Medical Education 47.4 (2013): 425-429.
  3. Pratt, M.G., Rockmann K.W. and Kaufmann J.B., “Constructing Professional Identity: The Role of Work and Identity Learning Cycles in the Customization of Identity among Medical Residents.” Academy of Management Journal 49 (2006): 235-262.