Sawatsky, Adam P.

Abstract Medical education transmits more than formal knowledge; it signals what matters through formal, informal, and hidden curricula. Drawing on Schein’s theory of organizational culture, this commentary synthesizes insights from three 2026 Research in Medical Education (RIME) studies to examine how artifacts, values, and underlying assumptions shape learning environments. The reviewed studies—on multimorbidity in undergraduate medical education, ritualized group handoff in residency, and learner recovery from failure—illustrate how educational practices encode organizational priorities in distinct ways. In curricular structures, multimorbidity is often marginalized or abstracted, signaling the privileging of specialized over integrative, generalist care. In clinical routines, ritualized handoffs align shared values with practices while simultaneously reinforcing hierarchical assumptions. In learner–teacher interactions, responses to failure communicate whether growth and psychological safety are genuinely supported. Together, these studies highlight three mechanisms through which the hidden curriculum operates: invisibly through structural design, explicitly through tightly aligned rituals, and relationally through interpersonal enactment. Highlighting these mechanisms, this research underscores the need for deliberate alignment between educational artifacts and espoused values. Ongoing attention to these signals is essential to cultivating organizational cultures that prepare physicians to navigate complexity, engage meaningfully in practice, and develop resilient professional identities.

Abstract Introduction Professional identity formation in healthcare professions education (HPE) is a complex and often fraught process. Physicians and trainees experience identity struggles as they navigate their personal and professional development, along with the conflicting expectations, cultural norms and systemic pressures within the healthcare environment. Despite growing attention to these challenges, conceptual clarity around identity struggle remains limited. Method To advance theoretical understanding of identity struggle, we conducted a critical narrative review of identity theories from developmental psychology, social psychology and sociology. We selected three major theoretical traditions—Neo‐Eriksonian, symbolic interactionist and social identity theories—and analysed their conceptualizations of identity, identity development and identity struggle. We examined these diverse perspectives to inform research and educational practice on professional identity formation in HPE. Results Each theoretical tradition offers distinct insights into identity struggle. Neo‐Eriksonian theories emphasize exploration and commitment as central processes, framing struggle as developmental and potentially productive. Symbolic Interactionist theories highlight the role of socialization and identity dissonance, viewing struggle as emerging from tensions between personal agency and societal norms. Social Identity theories focus on group belonging and intergroup dynamics, conceptualizing struggle at both individual and socio‐contextual levels. We provide common critiques and limitations of each theoretical tradition. These perspectives illuminate varied mechanisms through which identity struggle manifests and evolves. Discussion This review underscores the multifaceted nature of identity struggle and the value of theoretical pluralism in understanding professional identity formation. Struggle is not inherently negative; rather, it can be a catalyst for growth when appropriately framed and supported. We propose how educators and researchers might use these theoretical lenses to design interventions that foster productive identity development and address systemic contributors to identity struggles. We invite scholars drawing on critical perspectives of power and structure to challenge and deepen the conversation on identity struggle in HPE.

Abstract Purpose Professional identities impact professional boundaries and hierarchies, influencing how physicians approach collaboration. Despite the growing emphasis on developing students to become effective collaborators, little is known about how other health professionals (OHPs) shape students' professional identity formation (PIF). This study explored how interacting with OHPs during clinical care contributed to medical students' construction of what it means to be a physician. Methods For this constructivist grounded theory study, researchers conducted 20 semi‐structured interviews with medical students during clinical clerkships. Students drew rich pictures representing their interactions with OHPs and described these pictures during their interviews. Interviews were iteratively conducted and analysed, enabling the research team to theorize how interacting with OHPs contributed to medical students' PIF. Results Participants expressed a strong desire to contribute to patient care and described how interprofessional interactions provided opportunities to do so in ways aligned with their current capabilities. These opportunities were often more accessible than the roles and responsibilities of physicians, and participating alongside OHPs fostered participants' sense of their own developing capabilities and belonging on healthcare teams. Interactions with OHPs helped participants to see the expertise of OHPs and the value of collaborating with them in ways that shifted their focus away from becoming independent. Conceptually, participants' interactions with OHPs became both a mirror reflecting their present readiness to meaningfully contribute and a prism through which they could envision their future identities as physicians in new ways. Conclusions Interprofessional interactions influenced medical students' current and future professional identities, enabling students to see themselves as contributors on health care teams and highlighting collaboration and interdependence as core attributes of the physician profession. These findings highlight opportunities to amplify the impact of interprofessional interactions on the PIF of medical students and the need for research into how OHPs view their roles in these processes.

Learning environments are critical to individual growth and expression. While high stakes environments can drive self‐doubt and imposterism, the authors warn that overly comfortable environments may encourage ‘strategic imposterism.’

Transformation = change. Learning = change. So what do @VipsMDMEd & @APSawatskyMD mean when they say #TransformativeLearning?

Abstract Introduction To enter a profession is to take on a new identity. Professional identity formation can be difficult, with medical learners struggling to adopt professional norms. The role of ideology in medical socialisation may offer insight into these tensions experienced by medical learners. Ideology is the system of ideas and representations that dominates the minds of individuals or social groups and calls individuals into certain ways of being and acting in the world. In this study, we use the concept of ideology to explore residents' experiences with identity struggle during residency. Methods We conducted a qualitative exploration of residents in three specialties at three academic institutions in the United States. Participants engaged in a 1.5‐hour session involving a rich picture drawing and one‐on‐one interview. Interview transcripts were coded and analysed iteratively, with developing themes compared concurrently to newly collected data. We met regularly to develop a theoretical framework to explain findings. Results We identified three ways that ideology contributed to residents' identity struggle. First was the intensity of work and perceived expectations of perfectionism. Second were tensions between the developing professional identity and pre‐existing personal identities. Many residents perceived messages regarding the subjugation of personal identities, including the feeling that being more than physicians was impossible. Third were instances where the imagined professional identity clashed with the reality of medical practice. Many residents described how their ideals misaligned with normative professional ideals, constraining their ability to align their practice and ideals. Conclusion This study uncovers an ideology that shapes residents' developing professional identity—an ideology that creates struggle as it calls them in impossible, competing or even contradictory ways. As we uncover the hidden ideology of medicine, learners, educators and institutions can play a meaningful role in supporting identity development in medical learners through dismantling and rebuilding its damaging elements.

Abstract Background The medical intensive care unit (MICU) offers rich resident learning opportunities, but traditional teaching strategies can be difficult to employ in this fast-paced, high-acuity environment. Resident perspectives of learning within this environment may improve our understanding of the common challenges residents face and inform novel approaches to transform the MICU educational experience. Objective We conducted a qualitative study of internal medicine residents to better understand their approach to learning the critical care activities that they are entrusted to perform in the MICU. Methods Using a thematic analysis approach, we conducted six focus group interviews with 15 internal medicine residents, separated by postgraduate year. A trained investigator led each interview, which was audio-recorded and transcribed verbatim for analysis. Our diverse research team, representing different career stages across the continuum of learning to minimize interpretive bias, identified codes and subsequent themes inductively. We refined these themes through group discussion and sensitizing social learning theory concepts using Wenger’s community of practice and organized them to create learner archetypes and a conceptual framework of resident learning in the MICU. Results We identified three thematic resident learning categories: learning goals and motivation, clinical engagement, and interprofessional collaboration. We distinguished three learner archetypes, the novice, experiential learner, and practicing member, to describe progressive resident development within the interprofessional MICU team, the challenges they frequently encounter, and potential teaching strategies to facilitate learning. Conclusion We developed a conceptual framework that describes the resident’s journey to becoming a trusted, collaborating member of the interprofessional MICU team. We identified common developmental challenges residents face and offer educational strategies that may support their progress. These findings should inform future efforts to develop novel teaching strategies to promote resident learning in the MICU.

By appraising the definition of 'identity', Sawatsky and Monrouxe encourage researchers and educators who do professional identity formation work to engage with its rich theoretical tradition.