Development of professional identity in medical students through interprofessional simulation: a qualitative study

Background
Professional identity development in doctors is associated with confidence, resilience and alignment with professional values. Empirical study has found that Interprofessional Simulation-based Education (IPSE) is associated with professional identity development in medical students but does not demonstrate how. An IPSE curriculum is in place within the University of Plymouth medical curriculum. Using reflexive thematic analysis of participating medical student's interview data, subsequently triangulated with theory from sociological and psychological literature, potential mechanisms of professional identity development through IPSE are discussed and implications for educational design explored.

Methods
A qualitative approach was adopted utilising semi-structured interviews. Purposive sampling was used to select 10 final-year medical students undertaking the IPSE curriculum. Participants were asked about experiences contributing to their perceptions of professions, interprofessional learning and their experiences of the IPSE curriculum. Data were transcribed, coded and analysed using Thematic Analysis. Further interpretative analysis was then conducted using two theoretical perspectives: Social Identity Theory and Identity Theory.

Main findings
Pre-IPSE experiences were found to have contributed to professional identity development in the participants studied. Participants’ perceptions of what it is to ‘be’ a doctor or nurse identified clear distinctions between groups, notably relating to role and status.

In performing as a ‘doctor’ and engaging with ‘nurses’ as ‘doctors’ through IPSE, participants experienced increased confidence and perceived competence in ‘being’ a doctor, and reformulated their understanding of roles and their approach to interprofessional practice. Positive developments were initially limited by challenges with inter-group communication and feelings of pressure that align with phenomena described in theoretical literature such as intergroup anxiety.

Conclusions
This study reinforces that engagement in IPSE can develop the professional identity of final-year medical students. Mechanisms suggested by the data include strengthened role identity, reformulated conceptions of other professionals’ roles through tacit identity enactment, and the development of a superordinate professional identity shared with nursing students. Analysis of the data presented also gives insight into features of IPSE that may mitigate limiting factors of interprofessional learning occurring in-vivo such as a sociologically informed debrief. Implementing sociological models such as mutual intergroup differentiation may allay intergroup anxiety and status differentials, thus enabling further professional identity development.