Digital learning and medical professional identity – are they compatible?

Multiple reports are questioning universities’ value and purpose in the wake of the global transition to emergency online and remote teaching. In the case of healthcare education, the future and extent of online education is particularly noteworthy given the critical reliance on human interaction for successful healthcare practice and medical outcomes.

So, what's the role of online and remote education in medical student preparation for their future careers?

The answer to this question, in part, relies on what doctors see as their own role in healthcare. This is also known as medical professional identity.

Professional identity has been described as: “How we perceive ourselves as professionals based on … attributes, beliefs, values, motives and experiences in relation to our profession.”

Within medicine, professional identity development (PID) begins during medical school. Students enter medical training with preconceived ideas of doctors’ professional identity – namely, as professionals who are empathic, motivated to do good, ethically sound, hardworking and honest.

However, once exposed to the work of a doctor, many describe the time constraints, high workloads, lack of work-life balance and loss of valued interpersonal relationships as significant stressors that may make it challenging to fulfil their expectations as the ideal doctor.

This mismatch between medical students’ pre-existing values and beliefs and the real-world medical profession can create a professional identity crisis.

These crises, and thus professional identity development, are increasingly linked to burnout and psychological distress, with Australian doctors, particularly junior doctors, at significantly higher risk of psychological distress. There is hope, however, and the answer appears to lie with the educational approaches we use.

How do we support healthcare professional identity in medical school?

Explicit teaching methods, those clearly communicated through learning objectives and educational task instructions, appear to have limited impact on professional identity development when implemented alone.

In fact, studies of medical students and junior doctors show that PID is most impactful via implicit processes. These “hidden” and “informal” lessons are learned through watching, observing and interacting with peers, teachers and healthcare professionals.

While an educator might not directly communicate a learning objective on how to greet people in healthcare settings, for example, a medical student might passively learn this by watching how other healthcare professionals greet their patients, and also how these same people interact with their colleagues.

In this way, medical student PID is developed when they are immersed in, and accepted by, the community of professional practice they aspire to join. This is because, when medical students and junior doctors undertake formal medical training, clinical placements, and/or specialty rotations, they're exposed to role models, and are encouraged to participate in experiential learning factors strongly linked to PID.

Importantly, PID occurs through both positive and negative experiences. Medical students and junior doctors begin to learn both what they do want to become, and also what they don't want to be, based on their experiences within these communities of professional practice.

In fact, this latter aspect may be the reason Dr Yumiko Kadota (and others) have left the medical profession. In the case of Dr Kadota, her experiences in the surgical community of practice were observations of bullying, gender bias and an exploitative power-dynamic between junior doctors and attendings. These moments of professional identity dissonance are of great significance in directing professional identity development in doctors, often helping them not select a specialty training pathway or a career.

While workplace bullying and unprofessional behaviours are never OK, the educational system can help address appropriately representative differences between students’ healthcare workforce perceptions and practice realities.

Online and remote learning’s impact on medical professional identity

A year into the pandemic, and universities are challenged with their own identity crises. There are reports that the online and remote teaching deployed during this past year created challenges for those in pre-clinical and clinical medical education in preparation for work.

Read more: Learning the value of face-to-face STEMM teaching during COVID-19

In face-to-face teaching, PID and communities of professional practice form naturally. In preclinical education, for instance, medical students’ experiences in anatomy education (including how human dissection donors are interacted with by their peers and educators) plays a role in their PID.

Medical students are, whether we like it or not, informally observing educators’ and peers’ professional interactions, forming their professional identities from these experiences.

These same types of informal learning opportunities continue during medical students’ clinical rotations. Shared across all years of pandemic remote medical teaching, however, was the reduction (and often removal) of communities of professional practice engagement opportunities, particularly here in Victoria and in the UK, where lockdowns forced the closure of university campuses and face-to-face clinical rotations.

This remote learning resulted in greater emphasis on discipline knowledge, and less emphasis on communities of practice and PID.

Remote, online learning opportunities are typically relegated only to the time of the scheduled teaching activity, with the chance for informal observation all but eliminated. These lockdowns forced many medical students to observe interactions only during the scheduled online teaching activity, but their ability to examine and engage in the less formal educational opportunities was severely limited.

Even more challenging were opportunities to engage in their professional communities of practice.

Rethinking online learning to foster professional identity development

From these debates, it’s easy to conclude that all healthcare education must be face-to-face, or we risk adversely affecting medical students’ PID. However, when we consider that the future of medicine may include artificial intelligence and telehealth, this assumption becomes less of a foregone conclusion.

Rather, universities may want to consider how to foster communities of practice and PID in remote and online learning contexts, in addition to in-person.

Some recent evidence suggests that engaging online social networks may help students‘ PID – though this may not be a wholesale solution in medicine, considering a study suggesting that social network interactions between doctors and patients may be ethically challenging.

Regardless, the brave new world of universities in healthcare education may not be educators who are content developers, nor a reversion entirely back to face-to-face teaching.

Read more: ‘The Flu Squad’: Student pair on a mission to boost vaccination uptake

Instead of looking at online teaching as a “cheap and easy” option for education, universities should be investing in mechanisms to support communities of practice (such as social media platform development), and PID, both online and in-person.

In this context, academics’ roles are beyond simply teaching discipline knowledge, and should instead focus on fostering and supporting professional communities of practices alongside their teaching in a manner that improves alignment between students’ perceived doctors’ identity and the reality of the profession.