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Minding the Form That Transforms: Using Kegan’s Model of Adult Development to Understand Personal and Professional Identity Formation in Medicine

Lewin, Linda Orkin MD; McManamon, Alyssa MD; Stein, Michael T.O. MD; Chen, Donna T. MD, MPH

doi: 10.1097/ACM.0000000000002741
Perspectives
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The formation of a physician’s professional identity is a dynamic process shaped by and intertwined with the development of that person’s larger adult identity. Constructive-developmentalist Robert Kegan’s model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities.

When people use a particular lens to construct meaning, Kegan describes them as being “subject” to that lens: The lens “has them,” and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan’s lenses that are relevant to medical educators are called instrumental—focused on rules and rewards; socialized—attending to social norms and expectations; self-authoring—seeking to build internal values; and self-transforming—seeing gaps in one’s closely held value systems and being open to those of others.

When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan’s model can help educators provide more effective support to groups of learners as well as individuals, support learners’ transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.

L.O. Lewin is professor of pediatrics, Emory University, Atlanta, Georgia; ORCID: http://orcid.org/0000-0001-6028-3960.

A. McManamon is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

M.T.O. Stein is assistant professor of medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

D.T. Chen is associate professor of biomedical ethics, public health sciences, and psychiatry and neurobehavioral sciences, and director of the iTHRIV Scholars curriculum, University of Virginia, Charlottesville, Virginia; ORCID: http://orcid.org/0000-0003-1081-1053.

Funding/Support: D.T. Chen is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award numbers KL2TR003016 and UL1TR003015. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimer: The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, the University of Virginia, or Emory University.

Previous presentations: A previous version of this topic was presented as a workshop at the Learn Serve Lead: the Association of American Medical Colleges Annual Meeting, Boston, Massachusetts, November 4, 2017.

Correspondence should be addressed to Donna T. Chen, Center for Biomedical Ethics and Humanities, University of Virginia Health System, Box 800758, Charlottesville, VA 22908; email: dtc6k@virginia.edu.

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.