Professional Identity Formation Has Nothing To Do with a Clean White Coat

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by Bethany Von Hoff, Pharm.D.

Schools and Colleges of Pharmacy often formally welcome students into the profession when they enter pharmacy school or shortly after. Student pharmacists are encouraged to think, act, and feel like they will when they are pharmacists.1 After three to six years of this, surely students will view themselves as pharmacists at graduation — right? Yet I repeatedly talk to students and recent graduates who tell me they don’t “feel ready” and they don’t “feel like a real pharmacist.” What’s missing? I argue that pharmacy education is lacking a focus on professional identity formation,  too often confusing professionalism with professional identity.

In 2014, the Council of Deans defined professional identity formation as “the transformative process of identifying and internalizing the ways of being and relating within a professional role.”2 The council further identified ten factors and traits that play a role in the student’s’ transformation, as well as best practices and tools for pharmacy educators. Yet, several of these best practices are really targeting professionalism, not professional identity formation. Attending an etiquette dinner may help a student appear outwardly more professional, but it will do little to help them internalize the pharmacist’s way of being. We stress to students to show up on time, dress nicely, and be engaged — because that’s what a pharmacist would do. We encourage a sense of mimicry and obligation in our students to act like a pharmacist would, but we don’t do enough to encourage and ensure that students create an internal identity for themselves.

It has been argued that there are three frameworks of professionalism3:

  • Virtue-based: focused on moral character and moral reasoning
  • Behavior-based: focused on behaviors, milestones, and competencies
  • Professional identity formation: focused on evolving and changing identities

If these differences aren’t fully understood and appreciated, it’s easy to confuse professional identity formation with the professionalism associated with character and behaviors. Medical education researchers have commented that professional identity should be the foundation of their curriculum and a primary objective of medical education.4  This same sense of commitment to professional identity formation needs some work in pharmacy education.

Why is encouraging professional identity formation such a challenge in pharmacy education?

  1. As a profession, we often struggle with knowing our own identity. Previous research has shown that pharmacists can have role ambiguity and conflict about their professional identity.5 The identity many pharmacists have of themselves can often be at odds with how they feel they are viewed by others inside and outside of healthcare.  Further, as the pharmacy profession continues to grow, the identity of pharmacists is changing and evolving. It can be difficult to teach students about professional identity formation when as a profession, we struggle with this idea as well. This may require faculty development to first strengthen our own identities before helping students.
  2. Professional identity formation must occur alongside the students own identity formation. Most students are in their early to mid-twenties when they enter and graduate pharmacy school. This age is a time of personal exploration and growth as they navigate a  more independent life and are undergoing their own personal identity formation. Students must balance this personal identity formation with their newly forming professional identity. Further, according to developmental theory, students are still in a formative state and we wouldn’t fully expect students to reach a level of identity formation until their early to mid-thirties, several years after graduation.4

  3. Assessment of professional identity is hard. It’s much easier to assess attendance, participation, and a clean white coat than it is to assess an individual’s identity formation. Students will progress at their own rates and in their own ways, not in ways that fit neatly on a rubric. We must feel comfortable with guiding students, providing them with tools, and encouraging professional identity formation with the recognition that we won’t fully be able to assess the fruits of our labor by the time they walk across the stage.

Are our “white coat ceremonies” creating a false sense of professionalism similar to the “white coat phenomenon” and creating a falsely elevated blood pressure? Are we guiding students toward professional identity formation or merely teaching them to act like a professional?

The next article in this series will explore possible ways to overcome some of the challenges associated with professional identity formation.

REFERENCES

  1. Merton, Robert King. The Student-physician; Introductory Studies in the Sociology of Medical Education, Edited by Robert K. Merton, George G. Reader Patricia L. Kendall. Cambridge, Published for the Commonwealth Fund by Harvard University Press: n.p., 1957. Print.
  2. Scott J, Bell H, Welch B, et al. American Association of Colleges of Pharmacy Council of Deans Taskforce on Professional Identity Formation – Final Report. http://www.aacp.org/governance/councildeans/Documents/COD%20Taskforce%20on%20Professional%20Identity%20Formation%20Final%20Report%20July%202014.pdf.
  3. Irby, D. M., & Hamstra, S. J. (2016). Parting the clouds: three professionalism frameworks in medical education. Academic Medicine, 91(12), 1606-1611.
  4. Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing medical education to support professional identity formation. Academic Medicine, 89(11), 1446-1451.
  5. Elvey, R., Hassell, K., & Hall, J. (2013). Who do you think you are? Pharmacists’ perceptions of their professional identity. International Journal of Pharmacy Practice, 21(5), 322-332.
Bethany Von Hoff

Bethany Von Hoff, Pharm.D. is a third year PhD student in the Social and Administrative Pharmacy program at the University of Minnesota. Bethany’s education-related scholarship interest includes: the scholarship of teaching and learning and student development. In her free time, she enjoys traveling and listening to podcasts.

Pulses is a scholarly blog supported by a team of pharmacy education scholars.