How clinical problem-based medical education sets the scene for social identity formation in medical students
DOI:
https://doi.org/10.7146/dut.v21i41.156975Abstract
This article examines how clinical problem-based medical education (PBL) shapes medical students’ social identity formation and influences how they learn in clinical practice. Drawing on an ethnographic study comprising 240 hours of observations and eight hours of individual interviews with seven medical students, the analysis identifies three prominent and dynamically shifting identity positions: medical student, nearly physician and colleague. These identities structure how students participate in clinical work, the degree of autonomy they assume and how they interpret their professional responsibilities. Through the lens of social identity theory, the study shows that high-quality learning arises not from a single identity position but from the dynamic balance between them. The findings highlight how identity salience affects deep learning, reflective practice and patient safety, and point to the need for curriculum designs that scaffold progressive autonomy, strengthen inclusive clinical cultures, and integrate structured reflection to prepare students for clinical practice.
References
Barnett, R. (2009). Knowing and becoming in the higher education curriculum. Studies in Higher Education, 34(4), 429-440.
https://doi.org/10.1080/03075070902771978
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
https://doi.org/10.1191/1478088706qp063oa
Burford, B. (2012). Group processes in medical education: learning from social identity theory. Medical Education, 46(2), 143-152.
https://doi.org/10.1111/j.1365-2923.2011.04099.x
Clifford, J., & Marcus, G. E. (2005). Writing culture: The poetics and politics of ethnography. California: University of California Press.
Crossley, V., Vivekananda-Schmidt, P. (2009). The development and evaluation of a Professional Self Identity Questionnaire to measure evolving professional self-identity in health and social care students. Medical Teacher, 31(12), 603-607.
https://doi.org/10.3109/01421590903193547
Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2014). Reframing Medical Education to Support Professional Identity Formation. Academic Medicine, 89(11), 1446-1451.
https://doi.org/10.1097/ACM.0000000000000427
Dolmans, D.H.J.M., Loyens, S.M.M., Marcq, H., Gijbels, D. (2016) Deep and surface learning in problem-based learning: a review of the literature. Adv Health Sci Educ Theory Pract., 21(5), 1087 -1112.
https://doi.org/10.1007/s10459-015-9645-6
Dolmans, D.H.J.M., W., Wolfhagen, I. H. A. P., & Van Der Vleuten, C. P. M. (2005). Problem-based learning: future challenges for educational practice and research. Medical Education, 39(7), 732-41.
https://doi.org/10.1111/j.1365-2929.2005.02205.x
Dornan, T. (2019) Experience Based Learning (ExBL): Clinical teaching for the twenty-first century. Med Teach., 41(10):1098-1105.
https://doi.org/10.1080/0142159X.2019.1630730
Gadamer, H., Weinsheimer, J., & Marshall, D. G. (2013). Truth and method. New York: Bloomsbury Academic.
Gillespie, H., McCrystal, E., Reid, H., Conn, R., Kennedy, N., & Dornan, T. (2021) The pen is mightier than Sword. Reinstating. Patient care as the object of prescribing education. Medical Teacher, 43(1), 50-57.
https://doi.org/10.1080/0142159X.2020.1795103
Hammersley, M. & Atkinson, P. (2007). Ethnography Principles in practice, 3rd ed. New York: Routledge.
Haslam, S. (2017). The social identity approach to education and learning: Identification, ideation, interaction, influence and ideology. In: Mavor, K., Platow, M., & Bizumic, B., editors. Self and social identity in educational contexts (p.19-53). New York: Routledge.
Hmelo-Silver, C. E. (2004). Problem-based learning: What and how do students learn? Educational Psychology Review, 16, 235-266.
https://doi.org/10.1023/B:EDPR.0000034022.16470.f3
Jenkins, R. (2008). Social Identity. 3rd ed. New York: Routledge.
Johansson, Nøhr, S. B., & Stentoft, D. (2020). A Scoping Review of the Relation between Problem-Based Learning and Professional Identity Development in Medical Education. Journal of Problem Based Learning in Higher Education, 8(2), 25-41.
Johansson, N., Nøhr, S., Klitgaard, T.L., Stentoft, D. & Vardinghus-Nielsen, H. (2022). Clinical problem-based medical education: A social identity perspective on learning. Dansk Universitetspædagogisk Tidsskrift, 17(33), 79-96
https://doi.org/10.7146/dut.v17i33.132130
Kiger, M., & Varpio, L. (2020) Thematic analysis of qualitative data: AMEE Guide No. 131. Medical Teacher. Published Ahead of Print.
https://doi.org/10.1080/0142159X.2020.1755030
Klitggard, T. L., Stentoft, D., Johansson, N., Grønkjær, M., & Nøhr, S., B. (2022) Collaborators as a key to survival: an ethnographic study on newly graduated doctors' collaboration with colleagues. BMC Medical Education, 22(1), Article 604.
https://doi.org/10.1186/s12909-022-03655-6
Klein, H. K., & Myers, M. D. (1999). A Set of Principles for Conducting and Evaluating Interpretive Field Studies in Information Systems. MIS Quarterly, 23(1), 67-93.
https://doi.org/10.2307/249410
Leung, W. (2002). Why is evidence from ethnographic and discourse research needed in medical education: the case of problem-based learning. Medical Teacher, 24(2), 169-172.
https://doi.org/10.1080/01421590220125268
Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample Size in Qualitative Interview Studies: Guided by Information Power. Qualitative Health Research ,26(13), 1753-60.
https://doi.org/10.1177/1049732315617444
Maudsley, G., & Strivens J. (2000) Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical Education, 34(7), 535-44.
https://doi.org/10.1046/j.1365-2923.2000.00632.x
McNeill, K. G., Kerr, A., & Mavor, K. I. (2014). Identity and norms: the role of group membership in medical student wellbeing. Perspectives on Medical Education, 3(2), 101-112.
https://doi.org/10.1007/S40037-013-0102-Z
Monrouxe, L. (2009) Negotiating professional identities: dominant and contesting narratives in medical students' longitudinal audio diaries. Current Narratives, (1), 41-59.
Moore, D. S., & McCabe, G. P. (2006). Introduction to the practice of statistics (5th ed.). W. H. Freeman.
Moradimokhles, H., Hwang, G.J., Zangeneh, H., Pourjamshidi, M., Hossein Amooeirazani, A. (2024) Study of Deep Learning in Medical Education: Opportunities, Achievements and Future Challenges. J Adv Med Educ Prof., 12(3), 148-162.
Passi, V., Doug, M., Peile, E., Thistlethwaite, J., & Johnson, N. (2010). Developing medical professionalism in future doctors: a systematic review. International Journal of Medical Education, 1, 19-29.
https://doi.org/10.5116/ijme.4bda.ca2a
Savery, J. (2006). Overview of problem-based learning: Definitions and distinctions. Interdisciplinary Journal of Problem-Based Learning, 1(1), 9-20.
https://doi.org/10.7771/1541-5015.1002
Schmidt, H., Rotgans, J., & Yew, E. (2019) Cognitive constructivist foundations of problem-based learning. In: Moallem, M., Hung, W., & Dabbagh, N., editors. The Wiley handbook of problem-based learning (p.25-51). Hoboken: New Jersey John Wiley & Sons, Inc.
https://doi.org/10.1002/9781119173243.ch2
Sharpless, B. N., Cook, R., Kofman, A., Morley-Fletcher, A., Slotkin, R., & Wald, H. S. (2015). The Becoming: Students' Reflections on the Process of Professional Identity Formation in Medical Education. Academic Medicine, 90(6), 713-717.
https://doi.org/10.1097/ACM.0000000000000729
Stentoft, D. (2019) Problem-based projects in medical education: extending PBL practices and broadening learning perspectives. Advances in Health Science Education: Theory and Practice, 24(5), 959-69.
https://doi.org/10.1007/s10459-019-09917-1
Tan, C., Van Der Molen, H., & Schmidt, H. (2016). To what extent does problem-based learning contribute to students' professional identity development? Teaching and Teacher Education, 54(1), 54-64.
https://doi.org/10.1016/j.tate.2015.11.009
Turner, J. C. (1987). A self-categorization theory. In: Turner, J.C., Hogg, M.A., Oakes, P.J., Reicher, S.D., Wetherell, M.S., editors. Rediscovering the social group: A self-categorization theory (p. 42-67). Oxford: Blackwell.
Turner, J. C., & Onorato, R.S. (1999). Social identity, personality, and the self-concept: a self-categorization perspective, in Tyler, T.R., Kramer, R.M. & John, O.P. (Eds), The Psychology of the Social Self (pp.11-46). New York: Psychology Press.
Wenger-Trayner, E., Fenton-O'Creevy, M., Hutchinson, S. (eds.) (2015): Learning in landscapes of practice: Boundaries, identity and knowledgeability in practice-based learning. Routledge.
https://doi.org/10.4324/9781315777122
Wenger-Trayner, E. & Wenger-Trayner, B. (2020). Learning to Make a Difference: Value Creation in Social Learning Spaces. Cambridge University Press.
https://doi.org/10.1017/9781108677431
Øhrstrøm, E. L., Bøgild, H., Johansson, N., Klitgaard, T. L., Leutscher, P. D. C., & Arenholt, L. T. S. (2026) Clinical work perception and mental health in Danish resident doctors. Danish Medical Journal, 73(3):A05250361.
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