Skip to main content Accessibility help
×
Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-20T22:29:59.803Z Has data issue: false hasContentIssue false

13 - Professional identity formation, the practicing physician, and continuing professional development

from Part III - Principles

Published online by Cambridge University Press:  05 April 2016

Jocelyn Lockyer
Affiliation:
University of Calgary, Calgary, Alberta, Canada
Janet de Groot
Affiliation:
University of Calgary, Calgary, Alberta, Canada
Ivan Silver
Affiliation:
University of Toronto, Toronto, Ontario, Canada
Richard L. Cruess
Affiliation:
McGill University, Montréal
Sylvia R. Cruess
Affiliation:
McGill University, Montréal
Yvonne Steinert
Affiliation:
McGill University, Montréal
Get access

Summary

Mary is a fifty-year-old family physician who has worked for nearly two decades in a large suburban multidisciplinary family medicine clinic with eight other family physicians as well as nurses, pharmacists, and a dietician. Many of her patients and their families have been with her for several years. To better enjoy and support her children and aging parents, she has recently left the clinic to join a group of medical and radiation oncologists in a breast cancer clinic where she will be the only family physician providing primary care and counseling to their patients who don't have a family physician. She wonders how she will adapt to this work environment in which other family physicians are not available on location to discuss cases with and calibrate her work. She is feeling anxious about working exclusively with cancer physicians, given how specialized their work is, and she does not know any other family physicians who have assumed this type of a role in a specialty clinic.

John is a forty-six-year-old MD-PhD working in a medical school. He has just been promoted to professor in his medical school based on the quality of his work as judged by peers within the medical school and internationally. However, he struggles to combine clinical work, teaching, research, and committee work. He frequently works twelve to fourteen-hour days to fulfill the responsibilities of his various roles and succeeds partly by compartmentalizing his work. When he is on clinical service, he tries to focus on being a physician and clinician educator to the medical students and residents on his service. When he is in the lab, he tries to focus on his research, getting grants, running the lab and ensuring graduate students are making progress. As a professor, he is now expected to bring in larger, more complex grants from international agencies and to support postdoctoral fellows as well as graduate students. Many days are difficult as he finds himself pulled with questions from his lab or from the clinic when he is not there. Hospital meetings occur regularly and he is expected to actively participate in quality assurance committee work. Dealing with the new expectations associated with the promotion has been difficult; he feels pulled in too many directions and is not staying on top of his work.

Type
Chapter
Information
Teaching Medical Professionalism
Supporting the Development of a Professional Identity
, pp. 186 - 200
Publisher: Cambridge University Press
Print publication year: 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cruess, RL, Cruess, SR, Boudreau, JD, Snell, L, Steinert, Y. Reframing medical education to support professional identity formation. Acad Med. 2014; 89(11):1446–51.Google Scholar
2. Jarvis-Selinger, S, Pratt, DD, Regehr, G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012; 87(9):1185–90.CrossRefGoogle Scholar
3. Sabel, E, Archer, J; Early Careers Working Group at the Academy of Medical Educators. “Medical education is the ugly duckling of the medical world” and other challenges to medical educators’ identity construction: a qualitative study. Acad Med. 2014; 89(11):1471–80.Google Scholar
4. Frost, HD, Regehr, G. “I am a doctor”: negotiating the discourses of standardization and diversity in professional identity construction. Acad Med. 2013; 88(10):1570–77.CrossRefGoogle Scholar
5. Erikson, EH. The Life Cycle Completed. New York, NY: WW Norton; 1997.
6. Vaillant, GE. Triumphs of Experience: The Men of the Harvard Grant Study. Cambridge, MA: Harvard University Press; 2012.
7. Vaillant, GE. Mental health. Am J Psychiatry. 2003; 160(8):1373–84.CrossRefGoogle Scholar
8. Levinson, DJ, Darrow, CN, Klein, EV, Levinson, MH, McKee, B. The Seasons of a Man's Life. New York, NY: Knopf; 1978.
9. Levinson, DJ, Levinson, JD. The Seasons of a Woman's Life. New York, NY: Knopf; 1996.
10. Kittrell, D. A comparison of the evolution of men's and women's dreams in Daniel Levinson's theory of adult development. J Adult Dev. 1998; 5(2):105–15.Google Scholar
11. Kohlberg, L. The Psychology of Moral Development: The Nature and Validity of Moral Stages (Essays on Moral Development, Volume 2). San Francisco, CA: Harper and Row; 1984.
12. Gilligan, C. In a Different Voice: Psychological Theory and Women's Development. Cambridge, MA: Harvard University Press; 1982.
13. Held, V. The Ethics of Care: Personal, Political, and Global. Oxford, UK: Oxford University Press; 2006.
14. Eagly, AH, Wood, W. The nature-nurture debates: 25 years of challenges in understanding the psychology of gender. Perspect Psychol Sci. 2013; 8(3):340–57.Google Scholar
15. Zell, E, Krizan, Z, Teeter, SR. Evaluating gender similarities and differences using metasynthesis. Am Psychol. 2015; 70(1):10–20.Google Scholar
16. Shrier, DK, Zucker, AN, Mercurio, AE, Landry, LJ, Rich, M, Shrier, LA. Generation to generation: discrimination and harassment experiences of physician mothers and their physician daughters. J Womens Health (Larchmt). 2007; 16(6):883–94.CrossRefGoogle Scholar
17. Eagly, AH, Carli, LL. Through the Labyrinth: The Truth About How Women Become Leaders. Boston, MA: Harvard Business Review Press; 2007.
18. Eagly, AH, Carli, LL. Women and the labyrinth of leadership. Harv Bus Rev. 2007; 85(9):62–71.Google Scholar
19. Hays, S. The Cultural Contradictions of Motherhood. New Haven, CT: Yale University Press; 1996.
20. Dillaway, H, Paré, E. Locating mothers: how cultural debates about stay-at-home versus working mothers define women and home. J Fam Issues. 2008; 29(4):437–64.Google Scholar
21. Teunissen, PW, Westerman, M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. Med Educ. 2011; 45(1):51–59.Google Scholar
22. Kilminster, S, Zukas, M, Quinton, N, Roberts, T. Learning practice? Exploring the links between transitions and medical practice. J Health Organ Manag. 2010; 24(6):556–70.Google Scholar
23. Wilkie, G, Raffaelli, D. In at the deep end: making the transition from SpR to consultant. Adv Psychiatr Treat. 2005; 11:107–14.Google Scholar
24. Lave, J, Wenger, E. Situated Learning: Legitimate Peripheral Participation. Cambridge, UK: Cambridge University Press; 1991.
25. Bennett, NL, Hotvedt, MO. Stage of career. In Fox, RD, Mazmanian, PE, Putnam, RW, eds. Changing and Learning in the Lives of Physicians. New York, NY: Praeger; 1989:65–77.
26. Westerman, M, Teunissen, PW, van der Vleuten, CP, Scherpbier, AJ, Siegert, CE, van der Lee, N, Scheele, F. Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study. Acad Med. 2010; 85(12):1914–19.Google Scholar
27. McKinstry, B, Macnicol, M, Elliot, K, Macpherson, S. The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants. BMC Med Educ. 2005; 5(1):17.Google Scholar
28. Brown, JM, Ryland, I, Shaw, NJ, Graham, DR. Working as a newly appointed consultant: a study into the transition from specialist registrar. Br J Hosp Med (Lond). 2009; 70(7):410–14.CrossRefGoogle Scholar
29. Beckett, M, Hulbert, D, Brown, R. The new consultant survey 2005. Emerg Med J. 2006; 23(6):461–63.Google Scholar
30. Higgins, R, Gallen, D, Whiteman, S. Meeting the non-clinical education and training needs of new consultants. Postgrad Med J. 2005; 81:519–23.Google Scholar
31. Lockyer, J, Silver, I, Oswald, A, Bullock, G, Campbell, C, Frank, JR, Taber, S, Wilson, J, Harris, KA. The continuum of medical education. In Harris, KA, Frank, JR, eds. Competence by Design: Reshaping Canadian Medical Education. Ottawa, ON: Royal College of Physicians and Surgeons of Canada; 2014:135–37. [Accessed March 5, 2015.] Available from www.royalcollege.ca/portal/page/portal/rc/advocacy/educational_initiatives/competence_by_design.
32. Loh, E. How and why doctors transition from clinical practice to senior hospital management: a case research study from Victoria, Australia. The International Journal of Clinical Leadership. 2013; 17(4):235–44.Google Scholar
33. Lockyer, J, Hofmeister, M, Crutcher, R, Klein, D, Fidler, H. International medical graduates: learning for practice in Alberta, Canada. J Contin Educ Health Prof. 2007; 27(3):157–63.Google Scholar
34. McLean, M, McKimm, J, Major, S. Medical educators working abroad: a pilot study of educators’ experiences in the Middle East. Med Teach. 2014; 36(9):757–64.CrossRefGoogle Scholar
35. Lockyer, J, Wycliffe-Jones, K, Raman, M, Sandhu, A, Fidler, H. Moving into medical practice in a new community: the transition experience. J Contin Educ Health Prof. 2011; 31(3):151–56.Google Scholar
36. O'Sullivan, PS, Irby, DM. Identity formation of occasional faculty developers in medical education: a qualitative study. Acad Med. 2014; 89(11):1467–73.Google Scholar
37. Frugé, E, Margolin, J, Horton, T, Venkateswaran, L, Lee, D, Yee, DL, Mahoney, D. Defining and managing career challenges for mid-career and senior stage pediatric hematologist/oncologists. Pediatr Blood Cancer. 2010; 55(6):1180–84.CrossRefGoogle Scholar
38. Choudhry, NK, Fletcher, RH, Soumerai, SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005; 142(4):260–73.Google Scholar
39. Durning, SJ, Artino, AR, Holmboe, E, Beckman, TJ, van der Vleuten, C, Schuwirth, L. Aging and cognitive performance: challenges and implications for physicians practicing in the 21st century. J Contin Educ Health Prof. 2010; 30(3):153–60.Google Scholar
40. Goldberg, R, Thomas, H, Penner, L. Issues of concern to emergency physicians in pre-retirement years: a survey. J Emerg Med. 2011; 40(6):706–13.Google Scholar
41. Hickey, GL, Grant, SW, Freemantle, N, Cunningham, D, Munsch, CM, Livesey, SA, Roxburgh, J, Buchan, I, Bridgewater, B. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register. J R Soc Med. 2014; 107(9):355–64.CrossRefGoogle Scholar
42. Tessler, MJ, Shrier, I, Steele, RJ. Association between anesthesiologist age and litigation. Anesthesiology. 2012; 116(3):574–79.Google Scholar
43. Moss, AJ, Greenberg, H, Dwyer, EM, Klein, H, Ryan, D, Francis, C, Marcus, F, Eberly, S, Benhorin, J, Bodenheimer, M, Brown, M, Case, R, Gillespie, J, Goldstein, R, Haigney, M, Krone, R, Lichstein, E, Locati, E, Oakes, D, Thomsen, PE, Zareba, W. Senior academic physicians and retirement considerations. Prog Cardiovasc Dis. 2013; 55(6):611–15.Google Scholar
44. Byles, J, Tavener, M, Robinson, I, Parkinson, L, Smith, PW, Stevenson, D, Leigh, L, Curryer, C. Transforming retirement: new definitions of life after work. J Women Aging. 2013; 25(1):24–44.Google Scholar
45. Barnett, RC, Hyde, JS. Women, men, work, and family. An expansionist theory. Am Psychol. 2001; 56(10):781–96.Google Scholar
46. Buddeberg-Fischer, B, Stamm, M, Buddeberg, C, Bauer, G, Hämmig, O, Knecht, M, Klaghofer, R. The impact of gender and parenthood on physicians’ careers – professional and personal situation seven years after graduation. BMC Health Serv Res. 2010; 10:40.Google Scholar
47. Cassel, CK, Neugarten, BL. A forecast of women's health and longevity. Implications for an aging America. West J Med. 1988; 149(6):712–17.Google Scholar
48. Cook, DJ, Griffith, LE, Cohen, M, Guyatt, GH, O'Brien, B. Discrimination and abuse experienced by general internists in Canada. J Gen Intern Med. 1995; 10(10):565–72.Google Scholar
49. Hicks, MH. “What are you?” A recurring question in a cross-cultural psychiatrist's life and career. Transcult Psychiatry. 2011; 48(1–2):37–52.Google Scholar
50. Symonds, A. Emotional conflicts of the career woman: women in medicine. Am J Psychoanal. 1983; 43(1):21–37.Google Scholar
51. Mansh, M, Garcia, G, Lunn, MR. From patients to providers: changing the culture in medicine toward sexual and gender minorities. Acad Med. 2015; 90(5):574–80.CrossRefGoogle Scholar
52. Risdon, C, Cook, D, Willms, D. Gay and lesbian physicians in training: a qualitative study. CMAJ. 2000; 162(3):331–34.Google Scholar
53. Molleman, E, Broekhuis, M, Stoffels, R, Jaspers, F. Consequences of participating in multidisciplinary medical team meetings for surgical, nonsurgical, and supporting specialties. Med Care Res Rev. 2010; 67(2):173–93.CrossRefGoogle Scholar
54. Molleman, E, Rink, F. Professional identity formation amongst medical specialists. Med Teach. 2013; 35(10):875–76.Google Scholar
55. Wright, B, Lockyer, J, Fidler, H, Hofmeister, M. Roles and responsibilities of family physicians on geriatric health care teams: health care team members’ perspectives. Can Fam Physician. 2007; 53(11):1954–55.Google Scholar
56. Magrane, D, Khan, O, Pigeon, Y, Leadley, J, Grigsby, RK. Learning about teams by participating in teams. Acad Med. 2010; 85(8):1303–11.Google Scholar
57. Bogetz, AL, Bogetz, JF. An evolving identity: how chronic care is transforming what it means to be a physician. Acad Psychiatry. May 9, 2014. [‘Online First’: DOI 10.1007/s40596–014–0141–8]
58. Keshet, Y. Dual embedded agency: physicians implement integrative medicine in health-care organizations. Health (London). 2013; 17(6):605–21.CrossRefGoogle Scholar
59. Aase, M, Nordrehaug, JE, Malterud, K. “If you cannot tolerate that risk, you should never become a physician”: a qualitative study about existential experiences among physicians. J Med Ethics. 2008; 34(11):767–71.CrossRefGoogle Scholar
60. Khan, L, Wong, R, Li, M, Zimmermann, C, Lo, C, Gagliese, L, Rodin, G. Maintaining the will to live of patients with advanced cancer. Cancer J. 2010; 16(5):524–31.CrossRefGoogle Scholar
61. Lingard, L, Reznick, R, DeVito, I, Espin, S. Forming professional identities on the health care team: discursive constructions of the “other” in the operating room. Med Educ. 2002; 36(8):728–34.CrossRefGoogle Scholar
62. Boss, RD, Geller, G, Donohue, PK. Conflicts in learning to care for critically ill newborns: “it makes me question my own morals.” J Bioeth Inq. 2015; 12(3):437–48.Google Scholar
63. Jin, CJ, Martimianakis, MA, Kitto, S, Moulton, CA. Pressures to “measure up” in surgery: managing your image and managing your patient. Ann Surg. 2012; 256(6):989–93.Google Scholar
64. Gendron, TL, Myers, BJ, Pelco, LE, Welleford, EA. Promoting the development of professional identity of gerontologists: an academic/experiential learning model. Gerontol Geriatr Educ. 2013; 34(2):176–96.Google Scholar
65. Krueger, G, Canellos, G. Where does hematology end and oncology begin? Questions of professional boundaries and medical authority. J Clin Oncol. 2006; 24(16):2583–88.CrossRefGoogle Scholar
66. Beaulieu, MD, Rioux, M, Rocher, G, Samson, L, Boucher, L. Family practice: professional identity in transition. A case study of family medicine in Canada. Soc Sci Med. 2008; 67(7):1153–63.CrossRefGoogle Scholar
67. McKinstry, B, Macnicol, M, Elliott, K, Macpherson, S. The transition from learner to provider/teacher: the learning needs of new orthopaedic consultants. BMC Med Educ. 2005; 5(1):17.Google Scholar
68. Curran, V, Hollett, A, Hann, S, Bradbury, C. A qualitative study of the international medical graduate and the orientation process. Can J Rural Med. 2008; 13(4):163–69.Google Scholar
69. American Medical Association. H-300.988 – Restoring Integrity to Continuing Medical Education. [Accessed March 2, 2015.] Available from www.ama-assn.org/ssl3/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=/resources/html/PolicyFinder/policyfiles/HnE/H-300.988.HTM.
70. Eva, KW, Regehr, G. “I'll never play professional football” and other fallacies of self-assessment. J Contin Educ Health Prof. 2008; 28(1):14–19.CrossRefGoogle Scholar
71. Eva, KW, Regehr, G. Effective feedback for maintenance of competence: from data delivery to trusting dialogues. CMAJ. 2013; 185(6):463–64.Google Scholar
72. Silver, I, Campbell, C, Marlow, B, Sargeant, J. Self-assessment and continuing professional development: the Canadian perspective. J Contin Educ Health Prof. 2008; 28(1):25–31.CrossRefGoogle Scholar
73. Campbell, CM, Parboosingh, J. The Royal College experience and plans for the maintenance of certification program. J Contin Educ Health Prof. 2013; 33 Suppl 1:S36–S47.Google Scholar
74. Holmboe, ES. Maintenance of certification, revalidation, and professional self-regulation. J Contin Educ Health Prof. 2013; 33 Suppl 1:S63–S66.Google Scholar
75. Shollen, SL, Bland, CJ, Center, BA, Finstad, DA, Taylor, AL. Relating mentor type and mentoring behaviors to academic medicine faculty satisfaction and productivity at one medical school. Acad Med. 2014; 89(9):1267–75.CrossRefGoogle Scholar
76. Harrison, R, Anderson, J, Laloë, PA, Santillo, M, Lawton, R, Wright, J. Mentorship for newly appointed consultants: what makes it work? Postgrad Med J. 2014; 90(1066):439–45.Google Scholar
77. Harrison, R, McClean, S, Lawton, R, Wright, J, Kay, C. Mentorship for newly appointed physicians: a strategy for enhancing patient safety? J Patient Saf. 2014; 10(3):159–67.CrossRefGoogle Scholar
78. Ontario College of Family Physicians. The Centre of Excellence and Innovations in Mentoring and Coaching: The OCFP's Collaborative Care CME/CPD Networks. Toronto, ON: OCFP. [Accessed Jan. 31, 2015.] Available from http://ocfp.on.ca/docs/publications/the-centre-of-excellence-and-innovation-in-mentoring-and-coaching–-the-ocfps-collaborative-care-cme-cpd-networks.pdf?sfvrsn=2.
79. Gazelle, G, Liebschutz, JM, Riess, H. Physician burnout: coaching a way out. J Gen Intern Med. 2015; 30(4):508–13.Google Scholar
80. Slegers, AS, Gültuna, I, Aukes, JA, van Gorp, EJ, Blommers, FM, Niehof, SP, Bosman, J. Coaching reduced the radiation dose of pain physicians by half during interventional procedures. Pain Pract. 2015; 15(5):400–06.CrossRefGoogle Scholar
81. Chase, SM, Crabtree, BF, Stewart, EE, Nutting, PA, Miller, WL, Stange, KC, Jaén, CR. Coaching strategies for enhancing practice transformation. Fam Pract. 2015; 32(1):75–81.Google Scholar
82. Kenny, NP, Mann, KV, MacLeod, H. Role modeling in physicians’ professional formation: reconsidering an essential but untapped educational strategy. Acad Med. 2003; 78(12):1203–10.Google Scholar
83. D'Eon, M, Overgaard, V, Harding, SR. Teaching as a social practice: implications for faculty development. Adv Health Sci Educ Theory Pract. 2000; 5(2):151–62.CrossRefGoogle Scholar
84. Wenger, E. Communities of Practice: Learning, Meaning, and Identity. Cambridge, UK: Cambridge University Press; 1998.
85. Roberts, M. Balint groups: a tool for personal and professional resilience. Can Fam Physician. 2012; 58(3):245.Google Scholar
86. Armson, H, Wakefield, J. Expanding the horizons of practice-based small-group learning: what are we learning? Educ Prim Care. 2013; 24(3):153–55.Google Scholar
87. Parboosingh, JT. Physician communities of practice: where learning and practice are inseparable. J Contin Educ Health Prof. 2002; 22(4):230–36.Google Scholar
88. Singh, G, McPherson, M, Sandars, J. Continuing professional development through reflexive networks: disrupting online communities of practice. Paper presented at ProPEL International Conference: University of Stirling, UK; 2012.
89. Marinopoulos, SS, Dorman, T, Ratanawongsa, N, Wilson, LM, Ashar, BH, Magaziner, JL, Miller, RG, Thomas, PA, Prokopowicz, GP, Qayyum, R, Bass, EB. Effectiveness of Continuing Medical Education. Evidence Report No. 149. Agency for Healthcare Research and Quality: Rockville, MD; 2007. [Accessed March 5, 2015.] Available from www.ahrq.gov/clinic/tp/cmetp.htm.
90. Forsetlund, L, Bjørndal, A, Rashidian, A, Jamtvedt, G, O'Brien, MA, Wolf, F, Davis, D, Odgaard-Jensen, J, Oxman, AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;(2):CD003030.Google Scholar
91. Steinman, MA, Landefeld, CS, Baron, RB. Industry support of CME–are we at the tipping point? N Engl J Med. 2012; 366(12):1069–71.Google Scholar
92. Lo, B, Field, MJ, eds; Institute of Medicine (US) Committee on Conflict of Interest in Medical Research, Education, and Practice. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
93. Davis, NL, Davis, DA, Johnson, NM, Grichnik, KL, Headrick, LA, Pingleton, SK, Bower, E, Gibbs, R. Aligning academic continuing medical education with quality improvement: a model for the 21st century. Acad Med. 2013; 88(10):1437–41.Google Scholar
94. Shojania, KG, Silver, I, Levinson, W. Continuing medical education and quality improvement: a match made in heaven? Ann Intern Med. 2012; 156(4):305–08.CrossRefGoogle Scholar
95. Rotter, T, Kinsman, L, James, E, Machotta, A, Gothe, H, Willis, J, Snow, P, Kugler, J. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;(3):CD006632.Google Scholar
96. Wolfson, D, Tucker, L. Foundations Supporting Stewardship of Health Care Resources Through Medical Education and Training. Bethesda, MD: Health Affairs Blog; 2014. [Accessed March 5, 2015.] Available from http://healthaffairs.org/blog/2014/01/22/foundations-supporting-stewardship-of-health-care-resources-through-medical-education-and-training/?cat=grantwatch.

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×