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Emotional Learning and Identity Development in Medicine: A Cross-Cultural Qualitative Study Comparing Taiwanese and Dutch Medical Undergraduates

Helmich, Esther MD, PhD; Yeh, Huei-Ming MD, MPH; Yeh, Chi-Chuan MD, MEd; de Vries, Joy MSc; Fu-Chang Tsai, Daniel MD, PhD; Dornan, Tim MD, PhD

doi: 10.1097/ACM.0000000000001658
Research Reports

Purpose Current knowledge about the interplay between emotions and professional identity formation is limited and largely based on research in Western settings. This study aimed to broaden understandings of professional identity formation cross-culturally.

Method In fall 2014, the authors purposively sampled 22 clinical students from Taiwan and the Netherlands and asked them to keep audio diaries, narrating emotional experiences during clerkships using three prompts: What happened? What did you feel/think/do? How does this interplay with your development as a doctor? Dutch audio diaries were supplemented with follow-up interviews. The authors analyzed participants’ narratives using a critical discourse analysis informed by Figured Worlds theory and Bakhtin’s concept of dialogism, according to which people’s spoken words create identities in imagined future worlds.

Results Participants talked vividly, but differently, about their experiences. Dutch participants’ emotions related to individual achievement and competence. Taiwanese participants’ rich, emotional language reflected on becoming both a good person and a good doctor. These discourses constructed doctors’ and patients’ autonomy in culturally specific ways. The Dutch construct centered on “hands-on” participation, which developed the identity of a technically skilled doctor, but did not address patients’ self-determination. The Taiwanese construct located physicians’ autonomy within moral values more than practical proficiency, and gave patients agency to influence doctor–patient relationships.

Conclusions Participants’ cultural constructs of physician and patient autonomy led them to construct different professional identities within different imagined worlds. The contrasting discourses show how medical students learn about different meanings of becoming doctors in culturally specific contexts.

E. Helmich is senior researcher, Center for Education Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

H.-M. Yeh is assistant professor, Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.

C.-C. Yeh is attending physician, Department of Medical Education/Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

J. de Vries is a PhD student, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.

D.F.-C. Tsai is professor, Research Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, and attending physician, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.

T. Dornan is professor, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, United Kingdom.

Editor’s Note: This New Conversations contribution is part of the journal’s ongoing conversation on global health professions education—how ideas, experiences, approaches, and even resources can be shared across borders and across cultures to advance health professions education around the globe.

To read other New Conversations pieces and to contribute, browse the New Conversations collection on the journal’s Web site (, follow the discussion on AM Rounds ( and Twitter (@AcadMedJournal using #AcMedConversations), and submit manuscripts using the article type “New Conversations” (see Dr. Sklar’s and Dr. Weinstein’s May 2016 editorials for submission instructions and for more information about this feature).

Funding/Support: This research was supported by an Association for Medical Education in Europe Research Grant, awarded to E. Helmich in 2014. Financial support for the Taiwanese part of the project was granted by the Ministry of Science and Technology (102-2511-S-002-001-MY2).

Other disclosures: None reported.

Ethical approval: For the Dutch part of this study, ethical review was granted by the ethical board of the Dutch Association for Medical Education (file numbers 279 and 466). In Taiwan, ethical approval was obtained from the ethical committee of National Taiwan University Hospital (file number 20130864RINB).

Correspondence should be addressed to Huei-Ming Yeh, Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan; telephone: (886) 2-23123456, ext. 65512; e-mail:

© 2017 by the Association of American Medical Colleges