I AM a Doctor: Negotiating the Discourses of Standardization and Diversity in Professional Identity Construction

Frost, Heather D. PhD; Regehr, Glenn PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e3182a34b05
Rime
Abstract

Purpose: Medical educators have expressed concern that students’ professional identities do not always align with their expectations or with professional standards. The authors propose that, in constructing appropriate professional identities, medical students today are affected by the competing discourses of diversity and standardization.

Method: Between March and May 2012, the authors conducted a critical review of seminal publications to highlight the discourses of diversity and standardization in the medical education literature. They surveyed the social sciences literature on identity construction and drew examples from medical education to demonstrate how a social constructionist approach could inform the discussion about how medical students’ professional identities are affected by these discourses.

Results: The discourse of diversity emphasizes individuality, difference, and a plurality of possibilities and advances the notion that heterogeneity is beneficial to medical education and to patients. In contrast, the discourse of standardization strives for homogeneity, sameness, and a limited range of possibilities and conveys that there is a single way to be a competent, professional physician. Thus, these discourses are in tension, a fact that medical educators largely have ignored. A social constructionist approach to identity suggests that medical students resolve this tension in different ways and construct different identities as a result.

Conclusions: To influence medical students’ professional identity construction, the authors advocate that educators seek change across the profession—faculty must acknowledge and take advantage of the tension between the discourses of standardization and diversity.

Author Information

Dr. Frost is a postdoctoral fellow, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Dr. Regehr is professor, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Acknowledgments: The authors wish to thank Dr. Brett Schrewe, who helped to advance our thinking about the importance of the discourses of standardization and diversity within medical education. We also wish to thank the anonymous reviewers for their insights.

Funding/Support: None.

Other disclosures: None.

Ethical approval: Not applicable.

Previous presentations: Early thoughts on the importance and implications of the discourses of diversity and standardization were published in Academic Medicine (Schrewe B, Frost H. Finding potential in balance: Navigating the competing discourses of diversity and standardization. Acad Med. 2012;87:1479) and were presented at the Association of American Medical Colleges’ Research in Medical Education 2012 Conference in San Francisco, California, on November 6, 2012. Dr. Frost presented an early version of this review at the Centre for Health Education Scholarships’ Medical Education Research Rounds in Vancouver, British Columbia, Canada, on November 21, 2012.

Correspondence should be addressed to Dr. Frost, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Jim Pattison Pavilion North Suite 3300, 910 W. 10th Ave., Vancouver, BC, Canada V5Z 1M9; e-mail: heather.frost@ubc.ca.

© 2013 by the Association of American Medical Colleges