Habits of Good Medical Students - A Qualitative Analysis of What Students Attribute to their Success Professionally and Academically

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Hughes, Megan Fix, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6371871/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Medical student attrition rate is suggested to largely be driven by student perception of their academic and professional success. Despite this connection, little research has been conducted to evaluate what makes medical students successful in these domains. Study hypothesis or Objective Our study aims to evaluate medical student perception of drivers of success both academically and in professional identity formation. Methods Through the use of an open-ended qualitative digital survey we evaluated 655 habits of success from 123 first year medical students at our institution. These habits were then analyzed using a constructivist-interpretive thematic analysis, to identify patterns and themes within the responses. Findings From the responses, five main patterns that relate to academic success and professional identity formation emerged. We have designated them: (1) community development; (2) having a study strategy that works for you; (3) personal skill development; (4) professional career development; and (5) wellness. These patterns were represented by students as driving success in academic and professional identity formation with significant overlap. Study Implications The findings of this work suggest that medical students believe that the habits that drive success academically, and professionally are integrated. These findings also call for a holistic approach to academic success and professional identity formation emphasizing community, personal skill development, career development, and wellness as all increasing student perception of success across both domains. While the implications of this study are limited by a single-institution, single cohort design, future research can expand upon these findings by increasing generalizability through the use of multi-institutional and multi-cohort populations. Professional Identity Formation Undergraduate Medical Education Academic Success Habit Formation Introduction According to the International Federation of Medical Students Association, there are over 1.5 million students enrolled in medical school globally. 1 Of those 1.5 million students between 2.7% − 20.1% of medical students (average 9.1%) will not complete their medical education. 2 This attrition rate is largely theorized to be attributed to students' perception of their success with integration into medical education both academically, and professionally. 2 , 3 , 4 , 5 Despite this linkage between student perception of academic and professional success and attrition, there is limited research focused on student perception of their success in these domains. Of the research that does exist, the studies largely focus on either achieving academic success, 6 , 7 , 8 , 9 , 10 , 11 or professional success, mainly evaluated in the context of professional identity formation, 12 , 13 without consideration for strategies that improve both academic, and professional successes. Additionally, these studies almost exclusively focus on strategies that result in improved observable metrics of academic success; grades, exam scores, or improved observable metrics of professional identity formation; certainty in specialty choice, physical activity, nutrition, and stress, without consideration for what strategies improve student perception of their academic and professional wellbeing. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 The aim of this study is twofold. First, we aim to identify habits that medical students attribute to academic success. Second, we aim to identify habits that medical students signal as helping to foster professional identity formation. By understanding student perception of what contributes to their academic and cultural success, we can target strategies that foster these habits, and thereby identify strategies that may decrease attrition rates in medical education. Methods Qualitative Approach and Research Paradigm Due to the breadth and individuality of potential responses, this study employed a constructivist-interpretive qualitative approach using thematic analysis. Through the use of open-ended survey responses, we encouraged participants to express their perspectives in their own words. The subsequent thematic analysis was inductive, allowing our themes to emerge from the data. This approach allowed for us to explore experiences, perceptions, and attitudes towards medical education. This study emphasized subjectivity and multiple realities, holding true that each participant’s experience was shaped by their unique context. In addition, we aimed to explore how participants perceive and interpret their experience, acknowledging the influence of medical education structures, environments, and cultures on participant responses. Researcher Characteristics and Reflexivity Given that researchers involved in data analysis included both a medical student within the cohort being evaluated, and members of the Office of Education Quality Improvement at our institution, this study was conducted with an insider perspective on the study population, and on general medical education. The researchers involved in the study have significant experience in medical education research, as well as in data analysis . While the researchers background provided meaningful context for interpreting responses, it also increased potential for biases. Largely our familiarity with the research population, and the context in which these concepts were studied allowed us to frame participant perspectives, however, the lens in which we framed these perspectives may have been influenced by our own experiences in this population. Throughout this process, we remained aware of the potential of this bias. To enhance reflexivity, researchers took independent notes, and discussed biases openly as a team. Additionally, multiple researchers analyzed each data point to ensure diverse interpretation. An additional author not involved in the data analysis was available and utilized in the event that any discrepancies arose in the data interpretation. Context This study was conducted among a cohort of first year undergraduate medical students as they completed their preclinical education. All participants in this study were the first cohort of a new curriculum that emphasized both professional identity formation, and an innovative approach to academics. Students in this cohort completed a six-week transition to medical school course which largely emphasized developing tools and techniques to increase academic success, professional identity formation, and clinical skills. Following this six-week transition period, all medical students involved in this cohort were asked to rotate through student-led clinics, participate in team-based, problem-based, lecture-based, and experiential/lab-based learning, as well as continued optional and mandatory participation in professional identity formation workshops and lectures. Students were surveyed upon completion of this year, prior to their entrance into their formal clinical rotations during the MS2 year. Sampling Strategy As research has shown that the highest level of attrition rates occur within the preclinical years, 14 this study population was purposely selected to best capture students as they were determining and evaluating different strategies for academic and professional success in the peak of risk for cessation of education. 14 Additionally, by using a cohort of students who were experiencing a new curriculum, students were largely forced to develop strategies that were individualized, as opposed to ingrained in the institution. Finally, this study was conducted following the completion of the pre-clinical year as this cohort was alloted approximately equal amounts of time for both professional identity formation and academics, a dynamic which changes throughout their remaining undergraduate medical education. This population was relatively compact in terms of size and accessibility, and as such the entire population was given equal opportunity to participate. Ethical Issues Pertaining to Human Subjects The University of Utah Institutional Review Board deemed this study non-human subjects research since the data was collected anonymously. Data Collection Methods It was decided that the digital survey would be emailed to our entire study population by the Department of Education Quality Improvement as part of a series of surveys that participants were asked to complete to evaluate the overall medical education curriculum. This method of data collection allowed for participants to independently synthesize and articulate their responses without bias from other participants, or the research facilitators. It also permitted flexibility in both the timing of response, and the direction of participant responses. Data Collection Instruments and Technologies To date, there are no surveys designed to measure the intersection of academic success and professional identity formation. Additionally, there is not a list of academic success and professional identity formation habits in the literature. Thus, in keeping with best practices in survey design, 16 we decided to use an open-ended question format instead of a rating scale question format so as to not limit all potential habits that students might generate. The survey (Appendix A) we designed for this study consisted of two open-ended free-response questions; “What top one to three habits would be helpful to promote in year one for your academic success?” and “what top one to three habits would be helpful to promote in year one for your professional identity formation?” These questions were designed to explore student perspectives of success in both the academic and professional identity formation spaces. This study utilized the online data collection platform Qualtrics, which allowed participants to respond anonymously. Participants accessed the survey via email link and responses were collected over a period of one week with one reminder email. The use of mobile-friendly design and mandatory response settings helped ensure accessibility and data completeness. Units of Study We coded each habit so there were 655 habits total in the data set from 125 of the 127 (97%) first year medical students. Data Processing Survey responses were automatically transcribed into a digital spreadsheet using Microsoft Excel. Data Analysis All survey responses were coded thematically by two of the authors, who met regularly to identify areas of convergence until full agreement was reached. A third author was available to mediate in the event that full agreement could not be reached by the original coding authors. Techniques to Enhance Trustworthiness Investigator triangulation was employed. This study utilized two researchers of different backgrounds which added diverse perspectives on the findings of the study. Additionally, to ensure rigor and increase authenticity in our methodology we used an audit trail throughout our coding and analysis process. Results/Findings Of the 127 students who were eligible to complete the survey, 125 (97%) completed the two open-ended questions. Each student was asked to list six total habits, three habits that helped promote academic success and three habits for professional identity formation, for a total of 737 habits of success in medication education. 82 of those responses were excluded due to lack of clarity or completeness leading to a total of 655 habits. These habits were then evaluated for overall patterns and emerging themes leading to the following results. We outlined five main patterns that relate to academic success and professional identity formation and dubbed them: (1) community development; (2) having a study strategy that works for you; (3) personal skill development; (4) professional career development; and (5) wellness. Each pattern is made of a collection of themes or methods in which to promote this overall pattern of success (Table 1 ) . We were able to code nearly every response obtained into one of these five patterns, and subsequent themes. Several of these patterns, and collection themes served both as habits to promote academic success, as well as professional identity formation (Table 2 ). Discussion Interpretation The results of this study suggest that many of the habits that medical students found helpful to promote their academic success are also helpful for promoting professional identity formation. These results suggest that habits that promote professional skill development, professional career development, community development, and wellness, all can be integrated into a medical students’ routine to foster increased academic performance, and increased professional identity formation. Previous Studies Our study further echoes and expands upon the work of previous studies. In a systematic review of studies evaluating drivers of academic success in United States medical students, it was found that despite the impact of sociocultural factors on medical students, the largest driver of medical student study decisions are their independent behavior and attitudes. 6 This finding is reflected in our study in which the largest student recommended habit for success across any pattern was; having a study strategy that works for you. Additionally, our study provides interesting insight to the pedagogical approach suggested by the International Association for Medical Education (AMEE). 15 In their evidence-informed guide on supporting professional identity formation, AMEE suggests first and foremost, medical students require autonomy and independence to develop a professional identity. AMEE then goes on to outline six recommendations that should be employed by medical education institutes to encourage professional identity formation. These six recommendations are: (1) students need an environment to slow down and reflect; (2) professional identity formation should emphasize a longitudinal approach; (3) professional identity formation should be part of the formal curriculum; (4) professional identity formation should refrain from being graded; (5) professional identity formation should employ an interdisciplinary expert team; and (6) Institutions should provide teacher training on professional identity formation. Many of these recommendations are mirrored by thematic responses from the students in our study as demonstrated in Table 3 . Strengths and Limitations Our study has many strengths that add to the validity of our data. The high response rate ensures the findings represent the entire cohort. Additionally, our study represents a novel focus in which we studied both professional identity formation and academic success in the context of overall medical education evaluation. This provided a more holistic perspective on medical student success. Finally, our qualitative approach allowed for nuanced data that offered insights into the medical student experience. The implications of our data are limited, as this is a single-institution self-reported study that lacks longitudinal follow up. This study design prevents our data from being generalizable to a broader or global population, and we were not able to assess trends in perspectives over time since the data was collected anonymously. Additionally, our study did not clearly define academic success or professional identity formation to participants in the study, leaving room for student interpretation and variability in defining these key concepts. Clinical Implications The findings of this study suggest several important implications for medical education. First, the results of this study suggest that there is significant overlap between what students believe make them successful academically, and what fosters professional identity formation. This suggests that academic success and professional development are integrated from a student perspective and can be blended within medical school curricula rather than be treated as separate domains. Additionally, this study echoes the importance of self-directed and individualized study plans for students, with room for flexible discovery and personal time, rather than a one-sized approach. Finally, this study highlights the importance of a holistic student support system including wellness, personal skill development, community development, and career development to improve student perception of success. Research Implications Further studies could expand on the results of our work by evaluating the longitudinal perspectives of students over time, as well as future surveys of faculty members and clinicians. Additionally, evaluating student perspectives from multiple institutions will help consider cultural contexts and social structures to increase the generalizability of these findings. Finally, future research can investigate how implementation and fostering of the suggested habits impact the overall student performance and perception of success within these domains. Do you have observational data on their academic success? How do you measure their professional identity formation? It would be good you have outcome variables, and see how those habits relate to outcomes. Conclusion The findings of this study suggest that first year medical students believe there is significant overlap between what improves academic success, and what fosters professional identity formation. These student perspectives highlight the importance of a holistic and individualized approach to medical education that focuses on personal skill and career development, community, wellness, and personalized learning plans. Declarations Ethics approval no consent to participate The University of Utah Institutional Review Board deemed this study non-human subjects research since the data was collected anonymously. The need for consent to participate was waived by the University of Utah Institutional Review Board. Consent for Publication Not Applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Disclaimers Findings represent the work of the authors and not their institution. Funding No grant funding was utilized to conduct the research outlined in this document. Disclosures and Competing interests The authors report no relevant financial or non-financial interests related to this work. Clinical Trial Number Not applicable. Author contributions SP analyzed, and interpreted the data and was a major contributor in the writing of the manuscript. SG analyzed and interpreted the data. JCG analyzed and interpreted the data. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank Katheryn Moore, Tom Hurtado, Andrew Smith, Katherine Anderson, and Paige Patterson for their invaluable guidance, and inspiration of this work. We also appreciate the RealMD and SCoPE Development team at the Spencer Fox Eccles School of Medicine, their work on professional identity formation and development of academic success skills including personal skill development and community development have been incredibly influential in the development of this research. References International Federation of Medical Students' Associations. Available at: https://ifmsa.org/. Accessed March 20, 2025. Hefny AF, Fathi MA, Mansour NA, Al-Ali MA. Early student attrition from medical schools: a scoping review. Health Prof Educ. 2024;10(3):7. doi:10.55890/2452-3011.1288. Available at: https://hpe.researchcommons.org/journal/vol10/iss3/7. Accessed March 20, 2025. O’Neill LD, Wallstedt B, Eika B, Hartvigsen J. Factors associated with dropout in medical education: a literature review. Med Educ. 2011;45(5):440-454. doi:10.1111/j.1365-2923.2010.03898.x Tinto V. Student attrition and retention. In: Clarke BR, Neave G, eds. Encyclopedia of Higher Education. 3rd ed. Oxford: Pergamon Press; 1992:1697-1709. Tinto V. Dropout from higher education: a theoretical synthesis of recent research. Rev Educ Res. 1975;45(1):89-125. Hamzah S, Rafiq E, Blair E. Medical students’ study habits through a sociocultural lens: a systematic literature review. Int J Med Students. 2024. doi:10.5195/ijms.2024.2200 Khalid A, Abdulrahman B, Ahmad M, Khalaf F, Abbas B, Thabet O, Alanazi. Study habits of highly effective medical students. Adv Med Educ Pract. 2021. doi:10.2147/AMEP.S309535 Liles J, Vuk J, G S, Tariq. Study habits of medical students: an analysis of which study habits most contribute to success in the preclinical years. MedEdPublish. 2018. doi:10.15694/MEP.2018.0000061.1 Sheena. A study to determine students' study habits, clinical experiences, and attitudes related to their knowledge and behaviour intentions in the healthcare profession. Int J Health Care Nutr. 2022. doi:10.55938/ijhcn.v1i1.26 Kind T, Olvet DM, Farina S, et al. Reading and study habits of medical students on clerkships and performance outcomes: a multi-institutional study. Med Sci Educ. 2021. doi:10.1007/S40670-021-01409-5 Bickerdike A, O'Deasmhunaigh C, O’Flynn S, O’Tuathaigh CMP. Learning strategies, study habits, and social networking activity of undergraduate medical students. Int J Med Educ. 2016. doi:10.5116/IJME.576F.D074 Puente-Hidalgo S, Prada-García C, Benítez-Andrades JA, Fernández-Martínez E. Promotion of healthy habits in university students: literature review. Healthcare. 2024;12(10):993. doi:10.3390/healthcare12100993 Schrepel C, Amick AE, Bann M, et al. Self, physician, and specialty: a qualitative exploration of medical students’ specialty identity formation during undergraduate medical training. Acad Med. 2024. doi:10.1097/acm.0000000000005818 Maher BM, Hynes H, Sweeney C, et al. Medical school attrition—beyond the statistics: a ten-year retrospective study. BMC Med Educ. 2013;13:13. doi:10.1186/1472-6920-13-13. Fleer J, Smit MJ, Boer HJ, Knevel M, Velthuis F, Trippenzee M, Scholtens S. An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171. Med Teach. 2024;47(4):580-588. doi:10.1080/0142159X.2024.2387809. DeVellis, R.F. and Thorpe, C.T., 2021. Scale development: Theory and applications. Sage publications. Tables Table 1: Patterns of Habits that Promote Academic Success and Professional Identity Formation According to Student Perspectives and their Incorporated Themes Community Development Having a study strategy that works for you Personal Skill Development Professional Career Development Wellness Mentorship Learning Strategies Communication Reading Exercise Networking Reviewing Strategies Meaning & Purpose Real MD 1 Nutrition Volunteering School Provided resources Open-mindedness Research Recreation/Activities outside of medicine Third party resources Personal Reflection/Journaling Shadowing Relationships Routine & Schedule Student led Clinic Self Care Willingness to ask for help/questions Sleep Table 2: Patterns of student perspectives that increase academic success, professional identity formation, and both. Most common categories Academic Success Professional Identity Formation Both Most common response Having a study strategy that works for you (199) Professional career development (106) Having a study strategy that works for you (202) 2nd most common response Personal skill development (72) Personal skill development (100) Personal skill development (172) 3rd most common response Wellness (48) Community development (17) Professional career development (106) 4th most common response Community Development (17) Wellness (22) Community Development (105) 5th most common response Professional skill/career development (0) Having a study strategy that works for you (3) Wellness (70) Table 3: The relationship between AMEE recommendations for professional identity formation and their associated student perspectives from our study AMEE Recommendations for Medical Education to support Professional Identity Formation 15 Medical Student Perspectives Relating to AMEE’s Recommendations Create a setting that enables students to slow down Students emphasized the importance of reflection/journaling as well as overall wellness. Take a longitudinal approach Students highlighted the importance of relationships and community to improve both professional identity formation and academic success, with many students. Highlighted their specific longitudinal learning communities. Have professional identity formation as part of the formal curriculum Many students identified RealMD 1 and its programming as a crucial part of professional identity formation. Refrain from grading in professional identity formation This concept was not well represented by the respondents in our study. Use an interdisciplinary expert team Students from our study highlighted many different types of mentors and specific faculty who assisted in both professional identity formation and academic success. While no students from our cohort specifically recommended an interdisciplinary expert team to encourage development in either discipline, the variety of faculty highlighted suggest that different students benefit from mentorship and guidance from multiple domains. Provide teacher training for professional identity formation Students recommend mentorship, networking, and asking for help/asking questions. Some respondents went on to highlight specific faculty members at our institution who were trained in professional identity formation, including the faculty on the RealMD team. 1 RealMD referenced the RealMD program at our institution. This is a unique program that aims to promote connection to mission and purpose and foster professional identity formation. This program is part of the formal curriculum at our institution and includes both optional and mandatory workshops and lectures. Additional Declarations No competing interests reported. Supplementary Files AppendixAHabits.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Nov, 2025 Reviewers agreed at journal 11 Jul, 2025 Reviews received at journal 20 Jun, 2025 Reviewers agreed at journal 19 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 21 Apr, 2025 Submission checks completed at journal 15 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6371871","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471094490,"identity":"791eaabf-009d-4d7c-809b-2371539e8200","order_by":0,"name":"Sarah Petelinsek","email":"data:image/png;base64,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","orcid":"","institution":"University of Utah","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Petelinsek","suffix":""},{"id":471094491,"identity":"5551dff3-d399-4b85-bb5f-0ecc204bd451","order_by":1,"name":"Sarah Groves","email":"","orcid":"","institution":"University of Utah","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Groves","suffix":""},{"id":471094492,"identity":"30f38081-cff0-4bc4-996f-6a0b51d91d95","order_by":2,"name":"Patrick G. 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Of the research that does exist, the studies largely focus on either achieving academic success, \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e or professional success, mainly evaluated in the context of professional identity formation, \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e without consideration for strategies that improve both academic, and professional successes. Additionally, these studies almost exclusively focus on strategies that result in improved observable metrics of academic success; grades, exam scores, or improved observable metrics of professional identity formation; certainty in specialty choice, physical activity, nutrition, and stress, without consideration for what strategies improve student perception of their academic and professional wellbeing. \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study is twofold. First, we aim to identify habits that medical students attribute to academic success. Second, we aim to identify habits that medical students signal as helping to foster professional identity formation. By understanding student perception of what contributes to their academic and cultural success, we can target strategies that foster these habits, and thereby identify strategies that may decrease attrition rates in medical education.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003eQualitative Approach and Research Paradigm\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eDue to the breadth and individuality of potential responses, this study employed a constructivist-interpretive qualitative approach using thematic analysis. Through the use of open-ended survey responses, we encouraged participants to express their perspectives in their own words. The subsequent thematic analysis was inductive, allowing our themes to emerge from the data. This approach allowed for us to explore experiences, perceptions, and attitudes towards medical education. This study emphasized subjectivity and multiple realities, holding true that each participant\u0026rsquo;s experience was shaped by their unique context. In addition, we aimed to explore how participants perceive and interpret their experience, acknowledging the influence of medical education structures, environments, and cultures on participant responses.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eResearcher Characteristics and Reflexivity\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eGiven that researchers involved in data analysis included both a medical student within the cohort being evaluated, and members of the Office of Education Quality Improvement at our institution, this study was conducted with an insider perspective on the study population, and on general medical education. The researchers involved in the study have significant experience in medical education research, as well as in data analysis . While the researchers background provided meaningful context for interpreting responses, it also increased potential for biases. Largely our familiarity with the research population, and the context in which these concepts were studied allowed us to frame participant perspectives, however, the lens in which we framed these perspectives may have been influenced by our own experiences in this population. Throughout this process, we remained aware of the potential of this bias. To enhance reflexivity, researchers took independent notes, and discussed biases openly as a team. Additionally, multiple researchers analyzed each data point to ensure diverse interpretation. An additional author not involved in the data analysis was available and utilized in the event that any discrepancies arose in the data interpretation.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eContext\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThis study was conducted among a cohort of first year undergraduate medical students as they completed their preclinical education. All participants in this study were the first cohort of a new curriculum that emphasized both professional identity formation, and an innovative approach to academics. Students in this cohort completed a six-week transition to medical school course which largely emphasized developing tools and techniques to increase academic success, professional identity formation, and clinical skills. Following this six-week transition period, all medical students involved in this cohort were asked to rotate through student-led clinics, participate in team-based, problem-based, lecture-based, and experiential/lab-based learning, as well as continued optional and mandatory participation in professional identity formation workshops and lectures. \u0026nbsp;Students were surveyed upon completion of this year, prior to their entrance into their formal clinical rotations during the MS2 year.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eSampling Strategy\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAs research has shown that the highest level of attrition rates occur within the preclinical years, \u003csup\u003e14\u003c/sup\u003e this study population was purposely selected to best capture students as they were determining and evaluating different strategies for academic and professional success in the peak of risk for cessation of education.\u003csup\u003e14\u003c/sup\u003e Additionally, by using a cohort of students who were experiencing a new curriculum, students were largely forced to develop strategies that were individualized, as opposed to ingrained in the institution. Finally, this study was conducted following the completion of the pre-clinical year as this cohort was alloted approximately equal amounts of time for both professional identity formation and academics, a dynamic which changes throughout their remaining undergraduate medical education. This population was relatively compact in terms of size and accessibility, and as such the entire population was given equal opportunity to participate.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eEthical Issues Pertaining to Human Subjects\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe University of Utah \u0026nbsp;Institutional Review Board deemed this study non-human subjects research since the data was collected anonymously. \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData Collection Methods\u003c/h3\u003e\n\u003cp\u003eIt was decided that the digital survey would be emailed to our entire study population by the Department of Education Quality Improvement as part of a series of surveys that participants were asked to complete to evaluate the overall medical education curriculum. This method of data collection allowed for participants to independently synthesize and articulate their responses without bias from other participants, or the research facilitators. It also permitted flexibility in both the timing of response, and the direction of participant responses.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eData Collection Instruments and Technologies\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eTo date, there are no surveys designed to measure the intersection of academic success and professional identity formation. \u0026nbsp; Additionally, there is not a list of academic success and professional identity formation habits in the literature. \u0026nbsp; Thus, in keeping with best practices in survey design,\u003csup\u003e16\u003c/sup\u003e we decided to use an open-ended question format instead of a rating scale question format so as to not limit all potential habits that students might generate. The survey (Appendix A) we designed for this study consisted of two open-ended free-response questions; \u0026ldquo;What top one to three habits would be helpful to promote in year one for your academic success?\u0026rdquo; and \u0026ldquo;what top one to three habits would be helpful to promote in year one for your professional identity formation?\u0026rdquo; \u0026nbsp;These questions were designed to explore student perspectives of success in both the academic and professional identity formation spaces. \u0026nbsp;This study utilized the online data collection platform Qualtrics, which allowed participants to respond anonymously. Participants accessed the survey via email link and responses were collected over a period of one week with one reminder email. The use of mobile-friendly design and mandatory response settings helped ensure accessibility and data completeness.\u003c/p\u003e\n\u003ch3\u003eUnits of Study\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eWe coded each habit so there were 655 habits total in the data set from 125 of the 127 (97%) first year medical students.\u003c/p\u003e\n\u003ch3\u003eData Processing\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eSurvey responses were automatically transcribed into a digital spreadsheet using Microsoft Excel.\u003c/p\u003e\n\u003ch3\u003eData Analysis\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAll survey responses were coded thematically by two of the authors, who met regularly to identify areas of convergence until full agreement was reached. A third author was available to mediate in the event that full agreement could not be reached by the original coding authors.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eTechniques to Enhance Trustworthiness\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eInvestigator triangulation was employed. This study utilized two researchers of different backgrounds which added diverse perspectives on the findings of the study. Additionally, to ensure rigor and increase authenticity in our methodology we used an audit trail throughout our coding and analysis process.\u0026nbsp;\u003c/p\u003e"},{"header":"Results/Findings","content":"\u003cp\u003eOf the 127 students who were eligible to complete the survey, 125 (97%) completed the two open-ended questions. Each student was asked to list six total habits, three habits that helped promote academic success and three habits for professional identity formation, for a total of 737 habits of success in medication education. 82 of those responses were excluded due to lack of clarity or completeness leading to a total of 655 habits. These habits were then evaluated for overall patterns and emerging themes leading to the following results.\u003c/p\u003e\n\u003cp\u003eWe outlined five main patterns that relate to academic success and professional identity formation and dubbed them: (1) community development; (2) having a study strategy that works for you; (3) personal skill development; (4) professional career development; and (5) wellness. Each pattern is made of a collection of themes or methods in which to promote this overall pattern of success (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e. We were able to code nearly every response obtained into one of these five patterns, and subsequent themes. Several of these patterns, and collection themes served both as habits to promote academic success, as well as professional identity formation (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003ch3\u003eInterpretation\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThe results of this study suggest that many of the habits that medical students found helpful to promote their academic success\u0026nbsp; are also helpful for promoting professional identity formation. These results suggest that habits that promote professional skill development, professional career development, community development, and wellness, all can be integrated into a medical students\u0026rsquo; routine to foster increased academic performance, and increased professional identity formation.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003ePrevious Studies\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eOur study further echoes and expands upon the work of previous studies. In a systematic review of studies evaluating drivers of academic success in United States medical students, it was found that despite the impact of sociocultural factors on medical students, the largest driver of medical student study decisions are their independent behavior and attitudes.\u003csup\u003e6\u003c/sup\u003e This finding is reflected in our study in which the largest student recommended habit for success across any pattern was; having a study strategy that works for you.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, our study provides interesting insight to the pedagogical approach suggested by the International Association for Medical Education (AMEE).\u003csup\u003e15\u003c/sup\u003e In their evidence-informed guide on supporting professional identity formation, AMEE suggests first and foremost, medical students require autonomy and independence to develop a professional identity. \u0026nbsp;AMEE then goes on to outline six recommendations that should be employed by medical education institutes to encourage professional identity formation. These six recommendations are: (1) students need an environment to slow down and reflect; (2) professional identity formation should emphasize a longitudinal approach; (3) professional identity formation should be part of the formal curriculum; (4) professional identity formation should refrain from being graded; (5) professional identity formation should employ an interdisciplinary expert team; and (6) Institutions should provide teacher training on professional identity formation. Many of these recommendations are mirrored by thematic responses from the students in our study as demonstrated in \u003cem\u003eTable 3\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eOur study has many strengths that add to the validity of our data. The high response rate ensures the findings represent the entire cohort. Additionally, our study represents a novel focus in which we studied both professional identity formation and academic success in the context of overall medical education evaluation. This provided a more holistic perspective on medical student success. Finally, our qualitative approach allowed for nuanced data that offered insights into the medical student experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe implications of our data are limited, as this is a single-institution self-reported study that lacks longitudinal follow up. This study design prevents our data from being generalizable to a broader or global population, and we were not able to assess trends in perspectives over time since the data was collected anonymously. Additionally, our study did not clearly define academic success or professional identity formation to participants in the study, leaving room for student interpretation and variability in defining these key concepts.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eClinical Implications\u003c/h3\u003e\n\u003cp\u003eThe findings of this study suggest several important implications for medical education. First, the results of this study suggest that there is significant overlap between what students believe make them successful academically, and what fosters professional identity formation. This suggests that academic success and professional development are integrated from a student perspective and can be blended within medical school curricula rather than be treated as separate domains. Additionally, this study echoes the importance of self-directed and individualized study plans for students, with room for flexible discovery and personal time, rather than a one-sized approach. Finally, this study highlights the importance of a holistic student support system including wellness, personal skill development, community development, and career development to improve student perception of success.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eResearch Implications\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eFurther studies could expand on the results of our work by evaluating the longitudinal perspectives of students over time, as well as future surveys of faculty members and clinicians. Additionally, evaluating student perspectives from multiple institutions will help consider cultural contexts and social structures to increase the generalizability of these findings. Finally, future research can investigate how implementation and fostering of the suggested habits impact the overall student performance and perception of success within these domains.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDo you have observational data on their academic success? How do you measure their professional identity formation? It would be good you have outcome variables, and see how those habits relate to outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study suggest that first year medical students believe there is significant overlap between what improves academic success, and what fosters professional identity formation. These student perspectives highlight the importance of a holistic and individualized approach to medical education that focuses on personal skill and career development, community, wellness, and personalized learning plans.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval no consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Utah Institutional Review Board deemed this study non-human subjects research since the data was collected anonymously. \u0026nbsp; The need for consent to participate was waived by the University of Utah Institutional Review Board.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings represent the work of the authors and not their institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo grant funding was utilized to conduct the research outlined in this document.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures and Competing interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no relevant financial or non-financial interests related to this work. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSP analyzed, and interpreted the data and was a major contributor in the writing of the manuscript. SG analyzed and interpreted the data. JCG analyzed and interpreted the data. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Katheryn Moore, Tom Hurtado, Andrew Smith, Katherine Anderson, and Paige Patterson for their invaluable guidance, and inspiration of this work. We also appreciate the RealMD and SCoPE Development team at the Spencer Fox Eccles School of Medicine, their work on professional identity formation and development of academic success skills including personal skill development and community development have been incredibly influential in the development of this research.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eInternational Federation of Medical Students\u0026apos; Associations. Available at: https://ifmsa.org/. Accessed March 20, 2025.\u003c/li\u003e\n \u003cli\u003eHefny AF, Fathi MA, Mansour NA, Al-Ali MA. Early student attrition from medical schools: a scoping review. Health Prof Educ. 2024;10(3):7. doi:10.55890/2452-3011.1288. Available at: https://hpe.researchcommons.org/journal/vol10/iss3/7. Accessed March 20, 2025.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Neill LD, Wallstedt B, Eika B, Hartvigsen J. Factors associated with dropout in medical education: a literature review. Med Educ. 2011;45(5):440-454. doi:10.1111/j.1365-2923.2010.03898.x\u003c/li\u003e\n \u003cli\u003eTinto V. Student attrition and retention. In: Clarke BR, Neave G, eds. Encyclopedia of Higher Education. 3rd ed. Oxford: Pergamon Press; 1992:1697-1709.\u003c/li\u003e\n \u003cli\u003eTinto V. Dropout from higher education: a theoretical synthesis of recent research. Rev Educ Res. 1975;45(1):89-125.\u003c/li\u003e\n \u003cli\u003eHamzah S, Rafiq E, Blair E. Medical students\u0026rsquo; study habits through a sociocultural lens: a systematic literature review. Int J Med Students. 2024. doi:10.5195/ijms.2024.2200\u003c/li\u003e\n \u003cli\u003eKhalid A, Abdulrahman B, Ahmad M, Khalaf F, Abbas B, Thabet O, Alanazi. Study habits of highly effective medical students. Adv Med Educ Pract. 2021. doi:10.2147/AMEP.S309535\u003c/li\u003e\n \u003cli\u003eLiles J, Vuk J, G S, Tariq. Study habits of medical students: an analysis of which study habits most contribute to success in the preclinical years. MedEdPublish. 2018. doi:10.15694/MEP.2018.0000061.1\u003c/li\u003e\n \u003cli\u003eSheena. A study to determine students\u0026apos; study habits, clinical experiences, and attitudes related to their knowledge and behaviour intentions in the healthcare profession. Int J Health Care Nutr. 2022. doi:10.55938/ijhcn.v1i1.26\u003c/li\u003e\n \u003cli\u003eKind T, Olvet DM, Farina S, et al. Reading and study habits of medical students on clerkships and performance outcomes: a multi-institutional study. Med Sci Educ. 2021. doi:10.1007/S40670-021-01409-5\u003c/li\u003e\n \u003cli\u003eBickerdike A, O\u0026apos;Deasmhunaigh C, O\u0026rsquo;Flynn S, O\u0026rsquo;Tuathaigh CMP. Learning strategies, study habits, and social networking activity of undergraduate medical students. Int J Med Educ. 2016. doi:10.5116/IJME.576F.D074\u003c/li\u003e\n \u003cli\u003ePuente-Hidalgo S, Prada-Garc\u0026iacute;a C, Ben\u0026iacute;tez-Andrades JA, Fern\u0026aacute;ndez-Mart\u0026iacute;nez E. Promotion of healthy habits in university students: literature review. Healthcare. 2024;12(10):993. doi:10.3390/healthcare12100993\u003c/li\u003e\n \u003cli\u003eSchrepel C, Amick AE, Bann M, et al. Self, physician, and specialty: a qualitative exploration of medical students\u0026rsquo; specialty identity formation during undergraduate medical training. Acad Med. 2024. doi:10.1097/acm.0000000000005818\u003c/li\u003e\n \u003cli\u003eMaher BM, Hynes H, Sweeney C, et al. Medical school attrition\u0026mdash;beyond the statistics: a ten-year retrospective study. BMC Med Educ. 2013;13:13. doi:10.1186/1472-6920-13-13.\u003c/li\u003e\n \u003cli\u003eFleer J, Smit MJ, Boer HJ, Knevel M, Velthuis F, Trippenzee M, Scholtens S. An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171. Med Teach. 2024;47(4):580-588. doi:10.1080/0142159X.2024.2387809.\u003c/li\u003e\n \u003cli\u003eDeVellis, R.F. and Thorpe, C.T., 2021. Scale development: Theory and applications. Sage publications.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Patterns of Habits that Promote Academic Success and Professional Identity Formation According to Student Perspectives and their Incorporated Themes\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving a study strategy that works for you\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal Skill Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional Career Development\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWellness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eMentorship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eLearning Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eCommunication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eReading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eExercise\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eNetworking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eReviewing Strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eMeaning \u0026amp; Purpose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eReal MD\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eNutrition\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eVolunteering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eSchool Provided resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eOpen-mindedness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eResearch\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eRecreation/Activities outside of medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eThird party resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003ePersonal Reflection/Journaling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eShadowing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eRelationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eRoutine \u0026amp; Schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eStudent led Clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eSelf Care\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eWillingness to ask for help/questions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003eSleep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Patterns of student perspectives that increase academic success, professional identity formation, and both.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost common categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic Success\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessional Identity Formation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBoth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eMost common response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eHaving a study strategy that works for you (199)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eProfessional career development (106)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eHaving a study strategy that works for you (202)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e2nd most common response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePersonal skill development (72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePersonal skill development (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003ePersonal skill development (172)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e3rd most common response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eWellness (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eCommunity development (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eProfessional career development (106)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e4th most common response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eCommunity Development (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eWellness (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eCommunity Development (105)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e5th most common response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eProfessional skill/career development (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eHaving a study strategy that works for you (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eWellness (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: The relationship between AMEE recommendations for professional identity formation and their associated student perspectives from our study\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMEE Recommendations for Medical Education to support Professional Identity Formation\u003csup\u003e15\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical Student Perspectives Relating to AMEE\u0026rsquo;s Recommendations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eCreate a setting that enables students to slow down\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eStudents emphasized the importance of reflection/journaling as well as overall wellness.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eTake a longitudinal approach\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eStudents highlighted the importance of relationships and community to improve both professional identity formation and academic success, with many students. Highlighted their specific longitudinal learning communities.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eHave professional identity formation as part of the formal curriculum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eMany students identified RealMD\u003csup\u003e1\u003c/sup\u003e\u003ca href=\"#_ftn1\" name=\"_ftnref1\" title=\"\"\u003e\u003csup\u003e\u003c/sup\u003e\u003c/a\u003e and its programming as a crucial part of professional identity formation.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eRefrain from grading in professional identity formation \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eThis concept was not well represented by the respondents in our study.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUse an interdisciplinary expert team\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eStudents from our study highlighted many different types of mentors and specific faculty who assisted in both professional identity formation and academic success. While no students from our cohort specifically recommended an interdisciplinary expert team to encourage development in either discipline, the variety of faculty highlighted suggest that different students benefit from mentorship and guidance from multiple domains.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eProvide teacher training for professional identity formation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eStudents recommend mentorship, networking, and asking for help/asking questions. Some respondents went on to highlight specific faculty members at our institution who were trained in professional identity formation, including the faculty on the RealMD team.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003e1\u003c/sup\u003e\u003ca href=\"#_ftnref1\" name=\"_ftn1\" title=\"\"\u003e\u003c/a\u003eRealMD referenced the RealMD program at our institution. This is a unique program that aims to promote connection to mission and purpose and foster professional identity formation. This program is part of the formal curriculum at our institution and includes both optional and mandatory workshops and lectures.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Professional Identity Formation, Undergraduate Medical Education, Academic Success, Habit Formation","lastPublishedDoi":"10.21203/rs.3.rs-6371871/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6371871/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical student attrition rate is suggested to largely be driven by student perception of their academic and professional success. Despite this connection, little research has been conducted to evaluate what makes medical students successful in these domains.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy hypothesis or Objective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study aims to evaluate medical student perception of drivers of success both academically and in professional identity formation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThrough the use of an open-ended qualitative digital survey we evaluated 655 habits of success from 123 first year medical students at our institution. These habits were then analyzed using a constructivist-interpretive thematic analysis, to identify patterns and themes within the responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the responses, five main patterns that relate to academic success and professional identity formation emerged. We have designated them: (1) community development; (2) having a study strategy that works for you; (3) personal skill development; (4) professional career development; and (5) wellness. These patterns were represented by students as driving success in academic and professional identity formation with significant overlap.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this work suggest that medical students believe that the habits that drive success academically, and professionally are integrated. These findings also call for a holistic approach to academic success and professional identity formation emphasizing community, personal skill development, career development, and wellness as all increasing student perception of success across both domains. While the implications of this study are limited by a single-institution, single cohort design, future research can expand upon these findings by increasing generalizability through the use of multi-institutional and multi-cohort populations.\u003c/p\u003e","manuscriptTitle":"Habits of Good Medical Students - A Qualitative Analysis of What Students Attribute to their Success Professionally and Academically","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 10:08:10","doi":"10.21203/rs.3.rs-6371871/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-19T10:05:08+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"41402661665705440542178459159667099467","date":"2025-07-11T17:34:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-20T16:36:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130403983981467489791622173579765597372","date":"2025-06-19T12:01:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T00:21:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-21T07:53:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-15T20:06:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-04-15T20:05:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d42baa1c-d2ea-4a07-aa29-ebd095dd0c17","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-07T03:53:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 10:08:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6371871","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6371871","identity":"rs-6371871","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}