The Ebb and Flow of Identity Formation and Competence Development in Sub-specialty Residents: Study of a Continuity Training Setting

Abstract Background Professional identity and competence development are evolving processes, shaped by clinical experiences and socialization in the workplace. The purpose of this study was to investigate the simultaneous development of professional identify formation and competence in a sub-specialty training program. Methods The study was conducted in a General Internal Medicine sub-specialty (PGY-4 and PGY-5) continuity training setting, at an academic health sciences center, in Canada. Participants included: current residents, recent graduates, attending physicians and administrative assistants. Data was collected from 2017–2018. A constructivist grounded theory approach was used to analyze anonymized focus group and individual interviews. Results The study identified the following: 1) learning activities that support professional identity formation in advanced residents; 2) the relationship between professional identity formation and competencies; 3) the role of administrative assistants and continuity training supervisors in supporting professional identity formation; and 4) a set of invisible learning experiences that occurred as a result of assumptions made by residents about expectations of training and expectations of patient care. Although, there was limited data available on the latter, findings suggested that invisible learning experiences may adversely impact residents’ functioning as independent physicians. Conclusions Residents’ professional identities continue to evolve with increasing competency requirements during training. Training programs, for sub-specialty residents, must balance granting of independence with supporting ongoing professional identity formation. They must also be explicit about what constitutes healthy patient care expectations and how practicing physicians manage these expectations.