Professional Identity Formation Metaphors: Old Problems and New Promises.

Introduction: While medical education scholars have made important contributions to our understanding of professional identity formation (PIF), some ways of thinking stubbornly endure despite being repudiated in the literature. We argue that two metaphors embedded in the PIF discourse contribute to obstructing change: PIF IS A JOURNEY and PIF INVOLVES FITTING INTO A MOLD. PIF IS A JOURNEY: This metaphor assumes that each learner's PIF work starts the day they enter medical school; that their pre-matriculation PIF work isn't part of their PIF journey; and that the paths to PIF are equally accessible for all. We argue that this is not the case. Drawing on Appadurai's theories of aspiration, we critique this metaphor for neglecting each medical learner's unique cultural backgrounds and aspiration journeys. PIF INVOLVES FITTING INTO A MOLD: This metaphor perpetuates expectations that medical learners and practicing physicians ought to adopt medicine's norms. It places the blame for the crises and dissonance individuals experience when adapting to medicine's culture on the individual-their failure to fit in. While standardization is necessary for maintaining professional standards, it should not suppress individuality, limit diversity, nor constrain adaptability. PIF AS FUNCTIONAL CRAFTING: We propose that this new metaphor balances standardization with individuality in PIF. It makes room for both the enjoyable and challenging aspects of PIF, and allows for unique, personalized professional identities within the medical field. We propose that this new metaphor aligns with subjectification, an orientation that can encourage flexibility and respect diversity in professional identities.