Education Research: A Qualitative Study of Transformative Experiences in Neurology Residency.

Background and Objectives: Professional identity formation during residency is often catalyzed by emotionally complex experiences that extend beyond structured curricula. This study explores how neurology residents navigate autonomy, mentorship, and workload during training, using transformative learning theory to examine identity formation beyond skill acquisition. Methods: We conducted a qualitative study at a US academic neurology residency program. Participants included current PGY-3 and PGY-4 residence and recent alumni (graduated 208-2021) from a single four-year ACGME-accredited neurology program. Individuals were recruited through email and completed demographic surveys before participating in a 45-minute Zoom interview. Interviews were guided by a semistructured protocol and explored expectations, stressors, mentorship, and pivotal learning moments. Transcripts were analyzed thematically using MAXQDA. Two independent, blinded coders applied a shared codebook and achieved interrater reliability (Cohen κ ≥ 0.70). Reflexive journaling and interdisciplinary team debriefs enhanced analytic rigor. Results: Twenty-one participants (mean age 35.4 ± 5.3 years; 57% female; 48% White; 38% DO, 43% MD) completed interviews. Three intersecting domains of transformation emerged (1) balancing autonomy and mentorship, (2) adapting to high workload, and (3) discovering meaning in clinical work. Most participants described their development as nonlinear, driven by "selective emulation" of mentors and emotionally charged scenarios requiring reflection and adaptation. The majority (67%) reported growth through a blend of autonomy and mentorship. Coping strategies for workload were predominantly self-reliant (62%) or relational (57%), with fewer citing institutional supports (33%). Meaning was most often derived from patient-centered care (67%), followed by alignment with a subspecialty (43%) or systemic contributions through teaching or advocacy (33%). Discussion: This study provides a theoretically grounded framework for understanding identity formation in neurology residency. High-responsibility clinical moments were reframed as developmental turning points when paired with reflection and supportive mentorship. Findings underscore the value of psychologically attuned environments that facilitate adaptive coping, meaning-making, and progressive autonomy. Limitations include single-site sampling and potential recall bias among alumni. Future research should explore longitudinal identity trajectories and examine how early meaning-making predicts later professional fulfillment and resilience.