Cornerstones of professional identity formation: Developing a language to express requirements, provide feedback, and establish standards in medical education

Due to the complexity of professionalism, medical education programs worldwide have implemented several new support and assessment tools based on unprofessional behavior to help students form their professional identities. Despite several attempts to conceptualize professionalism, providing a framework for faculty members and students is still challenging. To provide a simple yet clear framework to support and assess clinical and preclinical settings, we used four domains for professional identity formation: Involvement, Integrity, Interaction, and Introspection. These domains were previously suggested for describing unprofessional behavior. In creating the novel professional identity formation (PIF) framework, each domain was filled by denominators of professionality transformed from denominators of unprofessional behavior. By characterizing professional qualities rather than unprofessional ones, we intended to shift the focus to desirable traits to be used for PIF. The framework of cornerstones was first introduced as a formative and summative assessment in clinical rotations, used for feed-forward during reflection groups, and associated written reflections discussing experiences during clinical rotations and then also in preclinical tutorial groups for medical students. The framework enables faculty members to give constructive, concrete feedback and coach students in developing their future professions. The framework is not resource-sensitive and can be implemented without technological or system barriers in a variety of environments and was therefore easy to implement in both a preclinical and clinical setting. The cornerstone framework can easily be adapted to other health professionals and cultural contexts. The four domains and their denominators are generic and not limited to PIF for medical students. A longitudinal study is planned to evaluate its long-term impact on professional development.