Constructing Professional Identity: The Role of Work and Identity Learning Cycles in The Customization of Identity Among Medical Residents

Critical Analysis

Pratt et. al argue that in an educational context, students continually find themselves confronted with collisions between the work they are doing and their sense of self, and these “work-identity integration violations” provide a tension that must be resolved (235). Resolution can come from a change of self or a change of work, and successful change requires some form of permission, volition, and skill. A student must want to change the work, have the freedom to change it, and the skill to change it. Similarly, they must be allowed to “change themselves,” want to make a change, and have abilities to do so.

The authors state that “when who you are does not match what you do, you can improve your performance and/or how you view yourself” (253). This offers a curious positioning of identity-development as something that is largely voluntary and controllable. Throughout school, a design student experiences a significant identity shift, yet it’s difficult to imagine that they are fully in control of this shift—that becoming designerly is a choice. Yet the authors claim that this is most common—"identity is more likely to change to fit the work than vice versa” (254). They argue that “making sense of identification within a social group is a pragmatic choice.” Those learning to be professionals, the authors argue, often compare what they do to expectations about who they are, as a way to “motivate the construction process” of identity” (256). Stories help explain this claim of pragmatism and active construction of identity, as stories are “the raw materials of a wide ‘identity set’ that individuals can draw upon to construct identity” (255). Storytelling offers an opportunity for students to try on the language associated with a unique identity. Perhaps more important than the content of stories is the language of those stories—the use of words of risk, failure, pain, suffering, trust and collaboration provides a mechanism for control over identity, in the face of a lack of control over work tasks.

Unique to creative professions is the leeway afforded students in changing the work tasks themselves. In studio, to change the work is to change the “container” of a project, which include things like what type of problem they are to solve, the types of material and processes they may, the deadlines and schedule that they are to follow, the amount of time they are expected to spend working, and so-on. To make these changes requires a great deal of freedom, and also a large amount of confidence, as these requirements are tied to grades and are provided by a figure of authority. Unique to studio learning is that attempts to make these changes—characterized as risk-taking—are often encouraged.

A unique defining quality of a designer is that they are someone who takes risks, as risk-taking is tied to innovation; producing something no-one has ever seen or tried before has a risk of adoption, and at stake is time, money, reputation, and so-on. Studio, then, is encouraging students to change both themselves and the work they are tasked with doing. Pratt et al argue that “when one receives (mostly negative) feedback, one is expected to improve performance” (253). This provision of negative feedback is formally structured in design as critique, implying that students are structurally urged to resolve a performance-identity disconnect.

The authors summarize by questioning the extensive practices used in high-intensity professional training to change identity. They explain that a perception of choice is afforded to students as a way to “customize” their identity, but “the customization process described herein appears more akin to mass customization, a process whereby goods are produced on an assembly line but tailored to an individual’s needs. Here, members can be said to have been able to pick and choose from various identity elements—as if choosing from an identity ‘menu’—to make sense of their work, but these choices were highly constrained by the organizational context” (257).

The authors refer to this as encapsulation, and indicate that common forms of this encapsulating in high-profile educational contexts (like medicine) have come into question. In response to the long hours common in medical school, they note that “To the extent that such physical encapsulation aids an organization’s ability to control how physicians’ construct their identities, one may wonder whether and how fewer hours might influence identity customization and perceived competence.” The propose that “medical organizations concerned about these potential outcomes should look to alternative ways of encapsulating their members such as establishing strong interpersonal bonds (social encapsulation) and fostering belief systems that discourage members from seeking advice from nonmembers (ideological encapsulation)” (257). They additionally question the need for “two years of ‘scut work’” (257) to achieve integration of identity, and propose that institutions of learning like this “might discourage validating professional identity via biting criticism” (257).

Ultimately, the authors argue the importance of “understanding ‘what they do’ in order to gain a richer appreciation of ‘who they are’ in the identity construction of professionals” (259), as the two qualities are intertwined—students continually work to resolve when these are in tension, and “what they do” is largely controlled by instructors.