Evaluating professional identity transformation in medical education: how complicated can it get?

If you are a clinician, you can probably remember how you thought about medicine as a student – perhaps seeing your future role as a healer? For most clinicians working in today’s NHS, however, there comes a point when you realise that patients tend to accumulate diagnoses rather than walk away from them. The clinician’s role shifts from healer to more of a ‘shoulder-to-shoulder’ stance with patients, families and carers: trying to see the road ahead through their eyes, working with them, often in multidisciplinary teams or with external agencies, negotiating their next steps in chronic condition management. The clinician’s most valuable tool becomes supporting their patients’ and carers’ self-efficacy in managing their health, and the smoothness of their journey or the bumpiness of the terrain, becomes a concern.

At Imperial College School of Medicine (@Imperial_SoM), we are aiming to support our students in adopting this stance through an architectural co-design project: seeing service-users as ‘experts through experience’ and learning to work with non-healthcare experts in improving their experience of healthcare. Our aim is for students to see NHS services through the eyes of patients and carers, and for them to work in collaboration with service-users and designers to propose changes. The service-users we are recruiting have a range of life-impacting health issues including chronic pain, disability and mental health problems. The services they will work with include local primary care, secondary care and community services. The designers are students from the University of Westminster School of Architecture & Cities.

The module, designed by Wing May Kong (diabetologist and ethics lead) and Jennifer Wallis (historian and medical humanities lead), consists of an introductory presentation, two workshops using established co-design methods, and protected time for project work. Students will be assessed through a team-based design proposal, and a personal reflection on learning. Their assessments will contribute towards their end-of-phase progression through a programmatic assessment portfolio within their ‘professional values and behaviours’ strand, led by Elizabeth Muir (general practitioner and lead for professional identity formation).

So, how will we know whether we have achieved our aims? This becomes complex, especially when you are aiming high: at no less than a transformational reframing of students’ professional stance with patients.

The project is ongoing, so watch this space, but our evaluation will draw on the Wenger Trayner value creation framework for communities of practice. Echoing the Kirkpatrick model this framework considers immediate, intentional, applied and realised value. The Wenger Trayner framework, however, adds on a fifth higher level: “reframing value” which they define as “when learning causes a reconsideration of how success is defined. It includes reframing strategies, goals and values”. 

Our analysis will be conducted semi-independently by Kay Leedham-Green from Imperial’s Medical Education Research Unit (@ImperialMERU@ImperialMERU), and will include observations, coursework analysis, module feedback, and focus groups across stakeholder groups including service-users, facilitators and students. Evidence will be coded according to this value creation framework, and then re-explored through focus groups, trying to analyse not only the effectiveness of this type of educational activity but also the mechanisms of how transformational shifts in perspective and professional identity occur. Kay Leedham-Green has recently co-authored a chapter on professional identity formation for a major Springer series on clinical education.