The Effect of Identity Dissonance and Consonance on Professional Identity Formation in Medical Students

Presented as a poster at 2020 IUSM Education Day.Professional identity formation (PIF) in medical students is often considered a straightforward process of professional socialization where students adopt the norms, values, knowledge, and skills required of physicians. However, no studies have examined the processes through which medical students’ identities are transformed during the professionalization process and how their developing professional identities blend with their existing identities. Nine medical students from Indiana University School of Medicine completed this study spanning the second (MS2) and third (MS3) years of medical school. Participants completed three semi-structured interviews at the start of MS2, end of MS2, and end of MS3, and submitted 10 audio diaries at two-month intervals between interviews. In audio diary recordings, participants discussed who they wanted to be as physicians and how their experiences transformed their developing professional identities. A thematic analysis of interviews and audio diaries were used to create a framework of PIF.This study found several processes of PIF that related to how consonant one considered his/her personal identity to be to the identity of a ‘typical’ medical student and physician, and the degree to which one’s experiences fulfilled his/her expectations and conceptions of medicine, medical students, and physicians. Medical students experiencing identity consonance utilized processes to adapt their personalities and found their experiences to confirm their commitment to medicine. Those experiencing positive identity dissonance used processes to accommodate their personality and had experiences that challenged their connection to medicine. While they found medical professionalization to be arduous, their negative experiences were often seen as necessary processes. Finally, several participants experienced negative identity dissonance, in which they refused to modify their personality to match that of the "typical" medical student and doubted their ability to make it through medical education. This study identified identity dissonance in medical students and the processes they used to cope with it. Doubt has only recently been described in medical students but this study established the impact doubt has on PIF in that it prevents medical students from seeing themselves as future physicians. Dissonance was also experienced by participants who felt they did not have the identity of a typical medical student or physician (e.g., they are female, non-white, lower socioeconomic status, or introverted) and they had experiences with patients and faculty that confirmed they did not meet this stereotyped identity. Students experiencing identity dissonance, particularly those with negative experiences, are at greatest risk of internalizing a professional identity that is inconsistent with members of the profession and may even leave professional education. Medical educators need to recognize and address identity dissonance and the sources that are creating it to assist the medical students in becoming the physicians they aspire to be

The professionalization of medical students : a longitudinal analysis of professional identity formation and professionalism perceptions in second and third year medical students

Indiana University-Purdue University Indianapolis (IUPUI)Background: Recent literature on professional identity formation (PIF) conceptualizes the developmental process into stage theories that remove critical context. This study employed a longitudinal approach to PIF that explored the processes through which professional identity is formed in second (MS2) and third (MS3) year medical students and how their perceptions of professionalism transformed and influenced their PIF. Methods: Nine medical students (n=9) from Indiana University School of Medicine completed this study spanning MS2 and MS3. Participants completed three semi-structured interviews and submitted 10 audio diaries at two-month intervals between interviews. Participants also completed the Professionalism Assessment Tool (PAT) at the beginning of MS2 (PAT1) and end of MS3 (PAT2). Interviews and audio diaries were analyzed using the constant comparative approach and a Wilcoxon signed-rank test was used to determine significant differences between mean domain scores of PAT1 and PAT2. Results: This study found several processes of PIF within five themes: Exploring Self in Medicine, Connecting to Image of Medicine, Embodying Role, Internalizing Values, and Exploring Specialty Choice. Processes of participating in patient care and selecting a specialty have the most profound impact on PIF and resulted in medical students feeling like members of the medical community. Analyses revealed participants’ perceptions of professionalism became more complex with clinical experiences and their perceptions of their ability to enact those behaviors transformed across the study period. Furthermore, the participants’ perceptions of professionalism set the foundation for the values they desired to demonstrate as part of their professional identities. Conclusions: This study presents a cohesive picture of how PIF occurs across MS2 and MS3 and how professionalism influences this important developmental process. These results indicate PIF is best cultivated within a medical curriculum where students are able to utilize processes to foster its development. Since professionalism serves as an important foundation to professional identity and a comprehensive understanding is needed for medical students to appreciate a physician’s role in society, the curriculum must be structured in a way to promote a complex, reflective understanding of professionalism that is based on values, actions, and who one wants to be as a physician

"A Whole New Perspective on How the Body Fits Together" - An Evaluation of a Cadaver Lab Experience for High School and Undergraduate Students

Presented as a poster at 2020 IUSM Education Day.IUPUI Anatomy Lab Tour Project Abstract “A Whole New Perspective on How the Body Fits Together” – An Evaluation of a Cadaver Lab Experience for High School and Undergraduate Students Andrew Cale MS1, Jessica Byram PhD1, Naomi Schmalz MS1,2 1Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA 2Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA Background: Since 2014, the Center for Anatomy and Physiology Education at Indiana University School of Medicine – Indianapolis has hosted interactive human cadaver lab tours for local high school and undergraduate students. During these graduate student-led tours, touring students observe human anatomy on prosections and with isolated organs. Similar educational outreach initiatives have been shown to benefit adolescents by improving health literacy and encouraging interests in healthcare careers. Aim: To evaluate students’ perceptions of the anatomy lab tours and their impact on students’ interests in healthcare careers. Methods: Between April and December 2018, touring students (n=261) were invited to complete pre- and post-tour surveys evaluating their past experiences with cadaver labs, tour expectations, career interests, and additional thoughts and feelings regarding the tour. Pre-surveys were paper-based and completed in-person, while post-surveys were administered online via REDCap and completed within one week of the tour. Responses were aggregated into pre- and post-tour groups and analyzed using thematic analysis. This study was granted exempt status from the IRB at Indiana University (#1802755251). Results: Of the 261 students who completed pre-tour surveys, 204 (78%) completed the post-tour survey. Before the tour, students anticipated learning about human anatomy (52%) and expected to only be able to see (and not feel) a cadaver (66%). Most students expressed excitement (80%) or nervousness (45%). A few students viewed the lab tour as an opportunity to test if they could see themselves in a healthcare career (4%). After the tour, most students indicated that the tour either met (77%) or exceeded (22%) their expectations. Students found the lab tour to be educational and interesting. They were surprised by the opportunity to interact with the cadaver (23%) and by the pre-dissected appearance of the cadaver (26%). Numerous students (41%) also expressed an increased interest in healthcare careers after the lab tour. Conclusion: Overall, students perceived the lab tours as engaging, educational experiences that not only improved their anatomical knowledge, but also reinforced or increased their interest in healthcare careers. Academic institutions interested in positively impacting their local students can implement a cadaver lab tour program by sharing access to their in-house human cadaver lab and recruiting instructors to share their time and anatomy expertise

Shifting language for shifting anatomy: Using inclusive anatomical language to support transgender and nonbinary identities

While navigating a medical or surgical gender transition, transgender, and nonbinary people encounter anatomical language and concepts through their own informal research on the topics and directly through healthcare providers. Use of appropriate and inclusive language is important for affirming identities and can be fostered at any point during professional training through modeling of inclusive language and in the formal curriculum, including during anatomical education. In this article we discuss anatomical language and how it intersects with gender identity, first from the perspective of a transgender patient, then from the perspective of an anatomy educator. The patient shared how she benefited from informative resources, nongendered language, language tailored to her level of understanding, and providers not making generalizations about her based on her anatomy or sex assigned at birth. The educator shared her experience developing a primer on sex and gender that moved beyond a prescriptive binary and exposed students to language and concepts inclusive of diverse sexual and gender identities. Recommendations were made related to how to implement these lessons and better explore how transgender and nonbinary individuals experience anatomical language and the potential impact of language that is inclusive of gender-diverse persons in anatomical education as part of health professions programs. While sound medicine, procedure, science, and experienced professional skill were necessary, an essential positive aspect of the medical and gender transitions discussed was an intentionality around language by providers—including anatomical language

Viewing pre‐lab gross anatomy demonstration videos correlates positively with student performance when total dissection time is limited by Covid‐19 restrictions

This article is made available for unrestricted research re-use and secondary analysis in any form or be any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic

Investigating Student Perceptions of a Dissection‐Based Undergraduate Gross Anatomy Course Using Q Methodology

The demand for upper‐level undergraduate dissection‐based anatomy courses is growing, as professional programs require more advanced anatomy training prior to matriculation. To address this need, Indiana University School of Medicine (IUSM) partnered with Indiana University‐Purdue University Indianapolis—a large, urban, life science‐focused campus nearby to IUSM—to offer an undergraduate, dissection‐based course in regional gross anatomy. Because this is a new course, a deeper post‐course evaluation of student perceptions was conducted using Q methodology. In this study, Q methodology was used to evaluate student views of the overall course structure, pre‐laboratory materials and activities, assessments, and quality of instruction. Of the 15 students in the spring semester 2018 cohort, 80% (n = 12) participated in the evaluation, and 10 of those students followed up with written explanations for their rationale in selecting the four statements with which they most strongly agreed and disagreed. The Q methodology sorted the students into one of three statistically significant groups: Motivated Dissectors (n = 6), Traditional Students (n = 3), and Inspired Learners (n = 3). Motivated Dissectors and Inspired Learners felt strongly that the course did not encourage self‐directed learning and that the pre‐laboratory materials were not adequate to prepare them for quizzes. Traditional Students, however, disagreed, having a favorable opinion of the pre‐laboratory materials, even though this group felt most strongly that the amount of material covered in the course was overwhelming. This study demonstrates the utility of Q methodology to evaluate courses to elucidate student perspectives and inform future course modifications

An Investigation of the Metacognitive Awareness of Postbaccalaureate Premedical Students at Indiana University School of Medicine

Presented at 2021 IUSM Education Day. View the presentation recording here: [LINK]https://purl.dlib.indiana.edu/iudl/media/h83k91mw2m[/LINK]BACKGROUND AND AIMS: Medical school curriculum is tasked with producing lifelong self-directed learners, a set of characteristics requiring strong metacognitive skills. Metacognitive skills directly impact students’ metacognition, which is their ability to understand and regulate their own thinking and learning. It may then be postulated that metacognition may be key in distinguishing students that require a postbaccalaureate program from those that do not. Metacognition has two critical domains: metacognitive knowledge and metacognitive regulation, each of which contain multiple subprocesses. Metacognitive knowledge includes knowing strategies for learning, when to use those strategies, and knowing oneself as a learner. Metacognitive regulation includes strategies for planning, monitoring, evaluating, and debugging learning strategies. Therefore, the purpose of this study is to investigate: 1) the impact of a graduate TBL course on students’ metacognitive awareness, and 2) the relationship between metacognition and course performance. Methods Students enrolled in a TBL graduate histology course at Indiana University took part in this study. Students completed a 19-item Metacognitive Awareness Inventory (MAI) at the beginning (MAI1) and end of the semester (MAI2). The MAI has two domains, Knowledge (8 items) and Regulation (11 items), where items are rated on a 5-point scale from “not at all typical of me” to “very typical of me.” Free response questions asked about knowledge and study abilities, plans for studying in histology and how study skills and abilities have improved across the semester. Finally, students completed a voluntary reflection about their examination performance after the first unit exam. Differences between MAIs were investigated using a Wilcoxon signed-rank test. Spearman's correlations explored the relationship between MAI and final course grades. MAI free responses and exam reflection were analyzed using thematic analysis. Responses were coded using a conceptual framework of metacognition based on processes of knowledge and regulation. Results Thirty-one (94%) students completed both MAIs. There were no differences between MAI1 and MAI2 scores and there was no relationship between MAI1 or MAI2 and final course grades. The Wilcoxon test demonstrated a significant difference between the Knowledge and Regulation domains for MAI1 (p=0.002) and MAI2 (p=0.001) where students reported the items in the Knowledge domain were more typical of them than items in the Regulation domain. There were no differences across the domains between the two timepoints. Students reported initial hesitation and difficulty with learning histology content in a lecture-free, flipped classroom approach. Students discussed plans for approaching studying, but many reported modifying study strategies throughout the semester. However, few students discussed active learning strategies that would allow them to evaluate and assess their knowledge prior to assessments. Conclusion While the MAI failed to demonstrate any improvement in metacognition, students reported an increase in their ability to adapt their study strategies to the content and learning materials. Differences in knowledge of cognition and regulation suggests educators in TBL classrooms may need to provide students with additional resources and strategies to regulate their learning. Future studies aim to investigate the validity of the MAI for measuring metacognition in anatomy courses

How the distinctive cultures of osteopathic and allopathic medical schools affect the careers, perceptions, and institutional efforts of their anatomy faculties: A qualitative case study of two schools

Anatomy faculties are integral to basic science instruction in medical schools, particularly given the preponderance of anatomic instruction in the preclinical curriculum. Recent years have witnessed major curricular restructuring and other emerging national trends that pose significant challenges to anatomists. An examination of anatomy faculty perceptions at two philosophically distinct medical schools within this shifting climate provides an indicator of how different institutional characteristics may impact anatomy instruction and other faculty responsibilities. Semistructured interviews of anatomy faculty from a large, well-established allopathic medical school (Indiana University School of Medicine) and a small, new osteopathic medical school (Marian University College of Osteopathic Medicine) were explored using qualitative thematic analysis. Four overarching themes were identified: (1) Institutional philosophies, such as affiliation with osteopathic versus allopathic medicine, have minimal impact on how the anatomical sciences are taught. (2) Differences in anatomy faculty experiences at these two institutions are largely driven by the institution's size and history. There is a disparity between institutions in the relative importance of teaching and research, but an ability to do research is important for both faculties. (3) Anatomy instruction and research agendas are driven by personal philosophies and interests rather than institutional philosophy. (4) Autonomy is highly valued by anatomists at both institutions. All the participants share a devotion to educating future physicians. In fact, this study identified more similarities than differences in these two faculties. Finally, we argue that shared educational resources and research collaborations can improve anatomy education and faculty development at both institutions. Anat Sci Educ. © 2015 American Association of Anatomists

The Effect of Identity Dissonance and Consonance on Professional Identity Formation in Medical Students

Presented as a poster at 2020 IUSM Education Day.Professional identity formation (PIF) in medical students is often considered a straightforward process of professional socialization where students adopt the norms, values, knowledge, and skills required of physicians. However, no studies have examined the processes through which medical students’ identities are transformed during the professionalization process and how their developing professional identities blend with their existing identities. Nine medical students from Indiana University School of Medicine completed this study spanning the second (MS2) and third (MS3) years of medical school. Participants completed three semi-structured interviews at the start of MS2, end of MS2, and end of MS3, and submitted 10 audio diaries at two-month intervals between interviews. In audio diary recordings, participants discussed who they wanted to be as physicians and how their experiences transformed their developing professional identities. A thematic analysis of interviews and audio diaries were used to create a framework of PIF.This study found several processes of PIF that related to how consonant one considered his/her personal identity to be to the identity of a ‘typical’ medical student and physician, and the degree to which one’s experiences fulfilled his/her expectations and conceptions of medicine, medical students, and physicians. Medical students experiencing identity consonance utilized processes to adapt their personalities and found their experiences to confirm their commitment to medicine. Those experiencing positive identity dissonance used processes to accommodate their personality and had experiences that challenged their connection to medicine. While they found medical professionalization to be arduous, their negative experiences were often seen as necessary processes. Finally, several participants experienced negative identity dissonance, in which they refused to modify their personality to match that of the "typical" medical student and doubted their ability to make it through medical education. This study identified identity dissonance in medical students and the processes they used to cope with it. Doubt has only recently been described in medical students but this study established the impact doubt has on PIF in that it prevents medical students from seeing themselves as future physicians. Dissonance was also experienced by participants who felt they did not have the identity of a typical medical student or physician (e.g., they are female, non-white, lower socioeconomic status, or introverted) and they had experiences with patients and faculty that confirmed they did not meet this stereotyped identity. Students experiencing identity dissonance, particularly those with negative experiences, are at greatest risk of internalizing a professional identity that is inconsistent with members of the profession and may even leave professional education. Medical educators need to recognize and address identity dissonance and the sources that are creating it to assist the medical students in becoming the physicians they aspire to be

An Integrated Strategy: Preparing Future Biomedical Science Faculty for Teaching-Related Roles

In our biomedical science research PhD programs and postdoctoral training experiences, opportunities for these future faculty to learn about and gain experience related to teaching and learning in university settings is extremely limited. Our PhD students’ graduate appointments are limited to research assistantships, and our postdoctoral scholars are employed in research-focused roles. These factors limit their time and opportunities to participate in experiences related to how people learn and effective teaching strategies. The problem we attempted to solve was how to create and maximize teaching-related experiences in an environment where these opportunities are minimal. We created a multi-layered approach to providing graduate students and postdocs with opportunities to learn about and practice core skills related to teaching students through Division-developed programs, partnerships with existing programs and services, and fostering student/trainee-led programs. Division-developed programs and services that have been developed intentionally for the purpose of preparing trainees for teaching-related faculty roles include: - Designing and implementing an annual 1-2 week-long institute related to essentials of teaching and learning - A learning community with a journal club, networking opportunities, and workshops - Facilitating a process to find and screen potential volunteer teaching opportunities for students and postdocs - Providing specific, tailored, one-on-one and small group guidance and mentoring upon request These programs and services are co-curricular, non-academic experiences in which any PhD student or postdoctoral scholar at IU School of Medicine may participate and have been designed complement and not conflict with the primary biomedical science research training experiences of these trainees. We will also share how these Division-developed programs and services fit into existing School of Medicine and IUPUI programs, including the Academy of Teaching Scholars, CIRTL@IUPUI programming, IUPUI CTL programs and services, and IUPUI’s Preparing Future Faculty and Professionals program. The relationship between Division and school/campus/university-level program will also be discussed during our presentation in terms of the strategic importance of each to the other. Additionally, in partnership with the Department of Anatomy, Cell Biology and the IUPUI School of Education, the Division has developed a doctoral minor for graduate students in the life sciences that is an optional, curricular experience for graduate students who wish to include preparation and experience related to life science teaching and learning into their experience at IU School of Medicine. We will discuss how this doctoral minor complements the Division’s co-curricular programming and how the minor fits into a greater strategic framework for preparing future faculty in the biomedical sciences for teaching-related faculty roles. Finally, as part of a student-initiated and led initiative called Teaching, Learning, and Professor Support for Graduate Teaching Assistants (TLPS-GTA), we will discuss how a student-led, peer-to-peer program that overlaps in content with Division-level programming fits into our overall strategic framework. We will discuss how providing graduate student instructors with just-in-time knowledge and skills to current graduate teaching assistants complements the Division’s greater strategy for preparing future biomedical science faculty for teaching related roles while fulfilling a distinct part of our overall strategy for graduate student and postdoctoral scholar focused educational development