Elements and Determinants of Professional Identity During the Pandemic: A Hermeneutic Qualitative Study

Phenomenon: The construct of professionalism in undergraduate medical education is a core outcome that is included in the wider concept of professional identity formation. The former is grounded in the more general concept of identity, intended as an internalized set of role expectations. Some have proposed frameworks based on psychological or sociological approaches, but empirical research is still scarce and often limited to the exploration of the role of specific learning activities. The pandemic imposed adaptations that produced an artificial setting for a social experiment, suitable to observe how the deprivation of the social component of a student's life, such as in presence teaching and practical training, unveiled the elements and determinants of the developing identity of medical students. Approach: This research was the extension of a previous phenomenological study about medical students' lived experience of distance learning during the lockdown phase in Italy. We adopted a hermeneutic approach to furtherly deepen the analysis of the phenomenon at stake, in dialogue with the relevant literature. Eight 6th year medical students underwent an in-depth interview, themes were inductively generated and used to identify elements and determinants of the developing identities. Findings: Four themes developed, synthetized in the overarching theme "From crawling to standing on your feet and walking toward an uncertain future". The themes were: "social places and practices that make me feel like a student and a medical student", "toward self-regulation", "an emotional journey", "threats to the identity". The elements of the perceived identity as a medical student were autonomy and learning self-regulation, professional knowledge, competence, and sense of belonging to a community. The determinant factors which influenced the identity as a medical student were living environment, learning spaces and architectures, the social networks, the attendance of the healthcare facilities, the relationship with teachers, the social acknowledgement as a medical student, and as a doctor. Insights: It was possible to identify the generation of both constitutive elements of identity and determinants influencing identity development and this distinction is an added value of the research. According Gilles Deleuze's concept of "empty square" (the sudden lack of an object one used to have at hand: sociality in this case), this research highlighted the ambivalent nature of identity. Individualization and socialization are the "uneven sides" of that same paradoxical object which is identity.