Introduction: Understanding how physicians interpret their societal and institutional contexts remains crucial for addressing the complexities of professional identity. This study explores professional identity formation (PIF) in clinical medical education through learners’ narratives and the perspectives of their role models. Methods: Using a multi-center qualitative narrative design, data were collected from clinical-year medical students across accredited state and private medical faculties representing diverse geographical regions. Reflective narrative writing and in-depth interviews were analyzed through a staged contextual qualitative approach. Results: Findings indicate that PIF is shaped through the dynamic interplay between clinical environments, societal and systemic structures, role modelling, and learners’ reflective engagement. Narratives framed professional identity not only in terms of technical competence but also through relational, ethical, and humanistic dimensions. Contextual analysis revealed that tensions between service demands and educational engagement, hierarchy and learner agency, and technical efficiency and humanistic care significantly influenced identity development. Reflection and narrative meaning-making emerged as mediating processes through which learners interpreted and internalized these experiences. Discussion: Drawing on a socio-cultural paradigm informed by activity theory, the study proposes a conceptual framework positioning PIF as a relational and contextually mediated construction shaped by both planned and implicit learning processes. The findings underscore the need for medical education programs to intentionally integrate reflective, narrative, and context-sensitive approaches to support sustainable professional identity development.
Introduction: Entrustable Professional Activities (EPAs) represent an integral component of Competency-Based Medical Education (CBME). They provide a practical framework to assess a trainee’s readiness to perform clinical tasks with increasing independence. This study investigates trainees’ perceptions of EPAs, including benefits, obstacles, shifts in feedback culture, and changes in assumed responsibility using the Consolidated Framework for Implementation Research (CFIR) as a theoretical framework. Methods: We conducted a theory-informed qualitative study using semi-structured interviews with cardiology trainees in Switzerland to examine early implementation of Entrustable Professional Activities (EPAs). The study was informed by the Consolidated Framework for Implementation Research (CFIR). Data were analysed using the Framework Method, drawing on CFIR to inform the deductive analysis while identifying context-specific aspects of participants’ experiences inductively. Results: We identified ten themes, of which the most prominent were ‘Impact of time constraints for EPA assessment’, ‘Incorporating EPAs into workflows’, ‘Satisfaction with EPA App’, and ‘Enhancement of Feedback through EPAs’. Trainees perceived the use of EPAs as increasing feedback opportunities but reported that their educational value depended largely on time availability, workflow integration, and supervisor engagement. Discussion: Our findings suggest that the implementation and educational value of EPAs depend not only on the introduction of EPA-based assessments themselves but also on the interaction between structural conditions and social factors. Based on these findings, we formulated seven recommendations for training sites implementing EPAs. These are: Carry out assessments carefully, assess EPAs at handover, allocate time for assessments, begin assessments early in postgraduate medical education, provide all affected parties with thorough training, improve didactic competencies and share responsibility of assessments.
Introduction: Professional identity formation (PIF) is a cornerstone of medical education. Residency programs often apply group-based learning approaches to foster PIF. However, little is known about how learning experiences in these settings continue to shape PIF after graduation. This study explores 1) how graduated physicians retrospectively make sense of their experiences with supervised collaborative reflection (SCR), a group-based reflective learning approach used during residency, and 2) how these experiences inform their current professional practice. Methods: We conducted a qualitative study using an interpretative phenomenological analysis approach. We performed semi-structured interviews with 15 general practitioners and elderly care physicians, recruited from four Dutch training institutes. Results: Three aspects of SCR were salient in participants’ sense-making of their experiences: SCR as a structured educational approach, the small-group setting in SCR, and the role of the supervisor. Participants described SCR experiences as informing their current practice in five aspects: internalising and integrating reflective practice into professional work, developing awareness of personal and others’ perspectives, developing relational and reflective communication, navigating emotional development, and maintaining personal wellbeing. Discussion: This study explored how physicians make sense of SCR learning experiences and how these continue to inform their current practice. Participants described reflective practice as becoming internalised and integrated in their way of working and as meaningful in shaping awareness, relational communication, emotional development, and personal wellbeing. Taken together, these experiences portray the internalisation and integration of reflective practice in professional practice and illustrate how early-career physicians incorporate this reflective practice into their evolving professional identity.
