Volume 33, Issue 126 (October 2020)                   IJN 2020, 33(126): 82-102 | Back to browse issues page

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Yazdani S, Sadeghi Avval Shahr H, Afshar L. A Critical Review of Professional Socialization Models for Medical Students. IJN 2020; 33 (126) :82-102
URL: http://ijn.iums.ac.ir/article-1-3330-en.html
1- Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3- Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: +982188773521 Email: leilaafshar@sbmu.ac.ir
Abstract:   (2318 Views)
Background & Aims: Professionalism is the underlying factor in strengthening the social contract between professions and the society. Failure to adhere to this principle in healthcare providers (including nurses) reduces the quality of patient care and endangers community health, while also diminishing public trust and weakening the social image of healthcare professions. In recent decades, researchers of health science education have focused on the nature of professionalism and planning for training in this regard in order to achieve this important outcome in health science graduates. Despite the applications of the study results and the efforts to train students on the basic concepts of professional ethics, the expected outcomes have not yet been realized in terms of the performance of graduates. Today, numerous researchers believe that achieving professionalism is not possible merely through education and the evaluation of its principles, and the required competencies should also be cultivated to facilitate the process of professional socialization, so that a proper professional identity could be attained in medical science graduates. However, further studies should be focused on the top of Miller's pyramid (Does) pertains to the process of developing competencies and their components and has reached the stages of developing a competency-based curriculum, along with the formation of a professional identity, which is equivalent to the "Is" part added to the Miller's model by Cruess et al. (2016). In a study in this regard, the concept of professional socialization was analyzed, and professional identity was introduced as the main outcome of this process. The present study aimed to critically review the current literature regarding socialization and the development of professional identity in health science students.
Materials & Methods: This critical review was conducted based on the Carnwell and Daly structure, which consists of six steps, including determining the objectives of the critical literature review, defining the scope of the review, identifying the sources of relevant information, literature review, writing the review, and applying the literature to the proposed study. At the stage of review writing, we followed the three steps proposed by Schutz. Initially, a systematic search was performed to obtain the available conceptual models and frameworks of socialization and professional identity formation in primary scientific databases, such as EBSCO CINAHL, Web of Science, Eric, PubMed, Scopus, and Google Scholar, using relevant keywords with "OR" and "AND" to combine the main concepts. The article search had no time limit until 2019. The eligibility criteria for article selection were proposing a model/conceptual framework, medical sciences, free access, and publication in English language. The exclusion criteria were duplicates and the experimental studies aimed at the measurement, comparison or production of tools. In the second phase of the search and to obtain citations and criticisms for each selected conceptual model/framework, the key concepts of each was systematically searched in the aforementioned databases using "AND" in combination with concepts such as "Criticism, Problems, Challenges, Advantages, Disadvantages". To ensure access to all the possibly relevant reviews, all the citations to each model were tracked through Google Scholar.
Results: In total, 2,112 articles were retrieved in the first stage of the search in terms of the title, followed by the abstract. After reviewing the full texts of the selected articles, nine articles were selected based on the research criteria in the fields of nursing, social work, medicine, paramedicine, and student affairs. These articles were categorized in terms of the study design, model type, model focus, and outcomes. Following that, the selected models were examined chronologically based on the three steps proposed by Schutz, which are the description of the model by its providers, providing the viewpoints of their critics/promoters (if any), and presenting the critical views of the authors of the article. After the analysis of the elements and content/structure of the conceptual models/frameworks, the key concepts of each model were extracted and presented in a table. The studied conceptual models and frameworks consisted of four categories (descriptive, normative-descriptive, causal-explanatory, and descriptive-prescriptive), which described the process of socialization and the role of the influential factors. Some of the findings were mainly focused on the cognitive and psychological dimensions, as well as the social dimension of the process in some cases. In the cases where both the psychological (internal) and social dimensions (external) of the process were considered, a structural approach was not observed regarding the elements and components of each dimension. In addition, the assessment of the content and description of the models revealed various theoretical approaches to this process, some of which were based on a functional structuralism approach and emphasized the role of organizational factors. The other cases involved the cognitive and interactive dimensions and the role of student agencies in this process, as well as the combination of the two approaches. In addition to the role of institutional factors, the active role of students and the impact of interactions were also discussed with regard to the development of professional identity without determining its dimensions and components. The key concepts extracted from the selected models in the present study could be classified into two psychological and social dimensions. The psychological dimension could be classified as cognitive (principles, values, and professional norms), affective (descriptive [sense of belonging to the profession], evaluative [self-confidence], and normative [attitude toward the profession]), and volitive (job motivation). Similarly, the social dimension could be categorized into the communicative domain (effective professional communication), cohesive domain (mutual respect and commitment), and operative domain (professional behavior and effective role performance).
Conclusion: Presenting the components of professional identity based on psychological and social dimensions could lay the groundwork for designing a comprehensive, static, structural model of professional identity for medical students, thereby resulting in the development of structured interventions for the management of professional identity formation in further investigations.
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Type of Study: Review | Subject: Midwifery
Received: 2020/07/17 | Accepted: 2020/10/16 | Published: 2020/10/16

1. Spiwak R, Mullins M, Isaak C, Barakat S, Chateau D, Sareen JS. Medical students' and postgraduate residents' observations of professionalism. Educ Health. 2014;27(2):193-9. [DOI:10.4103/1357-6283.143790] [PMID]
2. Cruess SR & Cruess RL. Professionalism and medicine's social contract with society. V.M. 2004; 6(4): 185-88.
3. Mughal Z, Mughal F. The junior doctor contract in the National Health Service. J Fam Med Prim Care. 2016;5(2):225-7. [DOI:10.4103/2249-4863.192329] [PMID] [PMCID]
4. Becker GJ. Understanding and applying the principles of contemporary medical professionalism: illustration of a suggested approach, part 2. J Am Coll Radiol. 2015;12(1):12-4. [DOI:10.1016/j.jacr.2014.09.004] [PMID]
5. Afshar L. Medical Oath: The Educational Impact. Med. Educ. 2016; 15(1): 1-13.
6. Razzaghi MR, Afshar L. A conceptual model of physician-patient relationships: a qualitative study. J Med Ethic Hist Medic. 2016;9(14):1-7.
7. Cruess SR, Cruess RL. Professionalism must be taught. Bmj. 1997;315(7123):1674-7. [DOI:10.1136/bmj.315.7123.1674] [PMID] [PMCID]
8. Sivalingam N, Mal M. Teaching and learning of professionalism in medical schools. Ann Acad Med Singapore. 2004;33(6):706-10.
9. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med. 2015;90(6):718-25. [DOI:10.1097/ACM.0000000000000700] [PMID]
10. Seifrabei MA, Esna Ashari M, Maghsoodi F, Esna Ashari F. The Effect of Early Clinical Exposure Program on Attitude Change of Undergraduate Medical Students toward their preparation for At-tending Clinical Setting in Internal Medicine, Surgery and Pediatrics Wards during 2013-2014. Avicenna Journal of Clinical Medicine. 2016;22(4):323-30.
11. Yazdani S, Momeni S, Afshar L, Abdolmaleki M. A comprehensive model of hidden curriculum management in medical education. J Adv Med Educ Profess. 2019;7(3):123-30.
12. Afshar L. Faculty Development; Prerequisite for Medical Student's Professional Formation. Afzalipour Journal of Clinical Research. 2017;2(3-4)):124-9.
13. Yazdani S, Lake MA, Ahmady S, Forootan A, Afshar L. Critical interpretive synthesis of the concept of value in medical education. Research and Development in Medical Education. 2014;4(1):31-4. [DOI:10.15171/rdme.2015.005]
14. Beagan BL. "Even if I don't know what I'm doing I can make it look like I know what I'm doing": becoming a doctor in the 1990s. Canadian Review of Sociology/Revue canadienne de sociologie. 2001;38(3):275-92. [DOI:10.1111/j.1755-618X.2001.tb00974.x] [PMID]
15. Cooke M, Irby DM, O'Brien BC. Educating physicians: a call for reform of medical school and residency. John Wiley & Sons; 2010 Jun 1.
16. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing medical education to support professional identity formation. Academic Medicine. 2014;89(11):1446-51. [DOI:10.1097/ACM.0000000000000427] [PMID]
17. Bebeau MJ. Evidence based character development. In: Kenny NP, Shelton WN, eds. Lost Virtue: Professional Character Development in Medical Education. Oxford, England: Elsevier; 2006.
18. Jones EA, Voorhees RA. Defining and Assessing Learning: Exploring Competency-Based Initiatives. Report of the National Postsecondary Education Cooperative Working Group on Competency-Based Initiatives in Postsecondary Education. Brochure [and] Report. 2002.
19. Blais K, Hayes J, Kozier B, Erb G. Socialization to professional nursing roles. Upper Saddle River, NJ: Prentice Hall; 2002.
20. Yazdani S, Akbari-Farmad S. Providing the Meta-Model of Development of Competency Using the Meta-Ethnography Approach: Part 1: Reviewing the Available Models of Competency Development. Journal of Medical Education. 2016;15(2):65-74.
21. Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J, International Competency-based Medical Education Collaborators. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019;94(7):1002-9. [DOI:10.1097/ACM.0000000000002743] [PMID]
22. Cruess RL, Cruess SR, Steinert Y. Amending Miller's pyramid to include professional identity formation. Acad Med. 2016;91(2):180-5. [DOI:10.1097/ACM.0000000000000913] [PMID]
23. Shahr HS, Yazdani S, Afshar L. Professional socialization: an analytical definition. J Med Ethics History Med. 2019;12(17): 1-14.
24. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Infor libr J. 2009;26(2):91-108. [DOI:10.1111/j.1471-1842.2009.00848.x] [PMID]
25. Carnwell R, Daly W. Strategies for the construction of a critical review of the literature. Nurse Educ Pract. 2001;1(2):57-63. [DOI:10.1054/nepr.2001.0008] [PMID]
26. Atkins S, Lewin S, Smith H, Engel M, Fretheim A, Volmink J. Conducting a meta-ethnography of qualitative literature: lessons learnt. BMC Med Res Method. 2008;8(1):1-10. [DOI:10.1186/1471-2288-8-21] [PMID] [PMCID]
27. Edens GE. Professional Socialization in Nursing. Paper presented at the Annual Research in Nursing Education Conference, San Francisco, CA; 1987.
28. Weidman J. Undergraduate socialization: A conceptual approach. Higher education: Handbook of theory and research. 1989;5(2):289-322.
29. Weidman JC, Twale DJ & Stein EL. Socialization of graduate and professional students in higher education: A perilous passage? ASHE-ERIC Higher Education Report 28 (3). Washington, DC: George Washington University, School of Education and Human Development. 2001.
30. Miller SE. A conceptual framework for the professional socialization of social workers. J Human Behav Social Environ. 2010;20(7):924-38. [DOI:10.1080/10911351003751934]
31. Devenish A, Clark M, Fleming M. Experiences in becoming a paramedic: the professional socialization of university qualified paramedics. Creat Educ. 2016;7(6):786-801. [DOI:10.4236/ce.2016.76081]
32. Perez RJ. A conceptual model of professional socialization within student affairs graduate preparation programs. J Study Postsecon Tertiary Educ. 2016 14;1:35-52. [DOI:10.28945/2344]
33. Atherley AE, Hambleton IR, Unwin N, George C, Lashley PM, Taylor CG. Exploring the transition of undergraduate medical students into a clinical clerkship using organizational socialization theory. Perspect Med Educ. 2016;5(2):78-87. [DOI:10.1007/s40037-015-0241-5] [PMID] [PMCID]
34. Byram JN. The professionalization of medical students: a longitudinal analysis of professional identity formation and professionalism perceptions in second and third year medical students (Doctoral dissertation). Indiana, USA: Indiana Univ.; 2017.
35. Kaplan A. The Conduct of Inquiry: Methodology for Behavioral Science. New Brunswick, NJ: Transaction Publishers; 1998; 269.
36. Fawcett J, Desanto-Madeya S. Contemporary Nursing Knowledge. Analysis and Evaluation of Nursing Models and Theories. 2nd ed. F.A. Davis, Philadelphia, PA; 2005.
37. Youngblut JM. A consumer's guide to causal modeling: Part I. J Pediat Nurs. 1994;9(4):268-71.
38. Turban E, Sharda R, and Delen D. Decision Support and Business Intelligence Systems, 9th ed. Upper Saddle River, NJ, USA: Prentice-Hall; 2011.
39. Dillon SM. Descriptive decision making: Comparing theory with practice. InProceedings of 33rd ORSNZ Conference, University of Auckland, New Zealand 1998 Aug 31.
40. Safiullin NZ, Safiullin BL. Static and dynamic models in economics. Journal of Physics: Conference Series. 2018;1015(3):032117. [DOI:10.1088/1742-6596/1015/3/032117]
41. Barretti M. What do we know about the professional socialization of our students? J Soc Work Educ. 2004;40(2):255-83. [DOI:10.1080/10437797.2004.10778493]
42. Reutter L, Field PA, Campbell IE, Day R. Socialization into Nursing: Nursing Students as Learners. J Nurs Educ 1997; 36(4):149-55. [DOI:10.3928/0148-4834-19970401-04] [PMID]
43. Bauer TN & Erdogan B. "Organizational socialization: the effective on boarding of new employees". In: Zedeck S (Ed.), APA Handbook of Industrial and Organizational Psychology, Vol. 3, American Psychological Association, Washington, DC; 2011: 51-64. [DOI:10.1037/12171-002] [PMID] [PMCID]
44. Weidman JC, DeAngelo L, Bethea KA. Understanding student identity from a socialization perspective. New Directions Higher Educ. 2014;2014(166):43-51. [DOI:10.1002/he.20094]
45. Pascarella ET, Terenzini PT. How College Affects Students: A Third Decade of Research. Volume 2. Jossey-Bass, An Imprint of Wiley. 10475 Crosspoint Blvd, Indianapolis, IN 46256; 2005.
46. Engberg ME. Educating the workforce for the 21st century: A cross-disciplinary analysis of the impact of the undergraduate experience on students' development of a pluralistic orientation. Res Higher Educ. 2007;48(3):283-317. [DOI:10.1007/s11162-006-9027-2]
47. Ozaki CC. College impact theories past and present. New Directions for Community Colleges. 2016;2016(174):23-33. [DOI:10.1002/cc.20200]
48. Pike GR, Kuh GD, Gonyea RM. The relationship between institutional mission and students' involvement and educational outcomes. Res Higher Educ. 2003;44(2):241-61. [DOI:10.1023/A:1022055829783]
49. Weidman JC. Socialization of students in higher education: Organizational perspectives. The Sage handbook for research in education: Engaging ideas and enriching inquiry. 2006:253-62.
50. Wheeler JM. How do Social Work Students Develop their Professional Identity? (Doctoral dissertation, University of Plymouth); 2017.
51. Locklear CE. Professional socialization and identity development of social work students. Doctor of Social Work Banded Dissertations, 2017;10.
52. Domenici A, Donno F. Static and dynamic data models for the storage resource manager v2. J Grid Comput. 2009;7(1):115-33. [DOI:10.1007/s10723-008-9110-3]
53. Silveira GL, Campos LK, Schweller M, Turato ER, Helmich E, de Carvalho-Filho MA. "Speed up"! The influences of the hidden curriculum on the professional identity development of medical students. Health Prof Educ. 2019;5(3):198-209. [DOI:10.1016/j.hpe.2018.07.003]
54. Fergus KB, Teale B, Sivapragasam M, Mesina O, Stergiopoulos E. Medical students are not blank slates: Positionality and curriculum interact to develop professional identity. Perspect Med Educ. 2018;7(1):5-7. [DOI:10.1007/s40037-017-0402-9] [PMID] [PMCID]
55. van den Broek WS, Wijnen-Meijer M, Ten Cate O, Van Dijk M. Medical students' preparation for the transition to postgraduate training through final year elective rotations. GMS j Med Educ. 2017;34(5):1-14.
56. Barone MA, Vercio C, Jirasevijinda T. Supporting the development of professional identity in the Millennial learner. Pediatrics. 2019;143(3):e20183988. [DOI:10.1542/peds.2018-3988] [PMID]
57. Higgs J. Professional socialisation. InEducating health professionals 2013 Jan 1 (pp. 83-92). [DOI:10.1007/978-94-6209-353-9_8]
58. Charmaz K. The power and potential of grounded theory. Medical Sociology Online. 2012;6(3):2-15.
59. Saldana J. The Coding Manual for Qualitative Researchers 2nd Ed. London: Sage; 2013.
60. Long DN. Out of the silo: A qualitative study of paramedic transition to a specialist role in community paramedicine (Doctoral dissertation, Queensland University of Technology); 2017.
61. Sober E. The principle of parsimony. Br J Philos Sci. 19811;32(2):145-56. [DOI:10.1093/bjps/32.2.145]
62. Vandekerckhove J, Matzke D, Wagenmakers EJ. Model comparison and the principle of parsimony. eScholarship, University of California; 2015. P:300-19. [DOI:10.1093/oxfordhb/9780199957996.013.14]
63. Perez RJ. Exploring developmental differences in students' sensemaking during the transition to graduate school. J College Stud Develop. 2016;57(7):763-77. [DOI:10.1353/csd.2016.0077]
64. Baxter Magolda MB. Self‐authorship: The foundation for twenty‐first‐century education. New Direct Teach learn. 2007;2007(109):69-83. [DOI:10.1002/tl.266]
65. Hart AW. Leader succession and socialization: A synthesis. Rev Educl Res. 1991;61(4):451-74. [DOI:10.3102/00346543061004451]
66. Heck RH. Organizational and professional socialization: Its impact on the performance of new administrators. The Urban Review. 1995;27(1):31-49. [DOI:10.1007/BF02354334]

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