Abstract
Within professional education, a fundamental goal is the appropriate formation of students’ professional identity: the set of values and priorities which influence their understanding of their role, their approach to ethical dilemmas, and the extent to which they perceive an event to represent career success. On entering work, graduates encounter a complex environment that includes shared decision-making, interprofessional team working and increasingly well-informed clients. This complexity necessitates adaptation of university-acquired knowledge, may challenge professional behaviours and can result in identity dissonance and confusion. Traditional notions of professionalism education describe the teaching of ethics and of attributes such as altruism, integrity and humanism. However, this focus neglects the challenges of context, and fails to support students in developing an identity that is appropriate for practice.The veterinary profession is increasingly affected by poor mental health and career dissatisfaction, particularly amongst new graduates. There is no compulsory post-graduate training, and most graduates practice with no formal supervision. They are thus responsible for their own patients, as well as for decisions that impact the client relationship, business and their own career satisfaction. The teaching of Veterinary Professional Skills is challenged by an intense clinical curriculum and students’ preferences for studying more overtly clinical material. Deficiencies are evidenced not only by poor graduate retention, but also by frequent critiques of competence in decision-making and business acumen.
This research, performed for the purpose of curriculum improvement, sought to define the professional identity that enables new graduates to thrive in veterinary practice, and to explore the processes by which this identity is formed. The entry to the profession of twelve new graduate veterinarians was studied by narrative inquiry, using discussion in a closed Facebook group to follow their experiences of entering the profession. Stories shared on this social media platform were collected over an 8-month period and were analysed using a combined approach of narrative text analysis followed by narrative reconstruction. Data collection, analysis and dissemination were approved by the institutional ethics committee.
Preliminary text analysis revealed two versions of veterinary professional identity. In one version, priorities and values were narrowly focused on the technical elements of the role: achieving a diagnosis and implementing “best practice” treatments. In the alternative version, priorities and values were more broadly constructed: diagnosis and treatment were valued,
but so were relational care, working with clients’ needs and wishes to determine the best course of action for each case, and negotiating the challenges of the veterinary practice context (a busy workload, clients’ financial limitations and high emotions, limited availability of equipment or expertise). The employment environment of the new graduates provided few opportunities for those with a narrow identity construction to act in accordance with their values. They saw contextual complexity as obstructive to reaching their goals and showed signs of frustration and career dissatisfaction. In contrast, the environment provided many opportunities for those with a broader identity understanding to align their values and actions, and they showed evidence of career satisfaction and mental wellbeing.
The biomedical focus of the narrow identity variant can be attributed in part to the hidden curriculum, including teaching and assessment priorities and emphases in clinical discussions. Further narrative exploration revealed additional contributors to this identity formation. It appears to precede a notion, widespread in professional culture, of the client as “enemy” to the veterinarian and the source of their poor mental health and suicide risk. A socially reinforced view of the client as external to professional identity may undermine the potential for graduates to develop a more relational focus, contribute to the narrow understanding of veterinary identity, and worsen career satisfaction and wellbeing. During narrative analysis a fragile, intermediate form of identity was also identified, in which graduates recognised the value of a relational focus but struggled to eschew the biomedical priorities of their educators. Distress resulted from an inability to commit to a re-constructed, context-informed relational identity, which was exacerbated by a professional culture (even in general practice) that places the relational, broader constructed identity as subordinate to the biomedical identity variant. Social validation of the emerging relationally-focused identity was therefore lacking, and the narrow variant persisted.
The superior career satisfaction of those with a broader identity construction reinforces the need for education interventions to support students’ development of this identity. Teaching and assessment should be reshaped to widen the focus beyond disease and incorporate the needs of the various stakeholders in clinical practice. Advanced levels of cognitive development and complex thinking are required to reason the conflicting needs of different stakeholders, recognise the context-dependence of problem-solving and rationalise actions that conflict with “self” but align with “other”. For this to be achieved, it is essential to have whole-institution commitment to the principles of the broad identity variant, as well as to developing the necessary advanced level of cognitive reasoning in students.
| Date of Award | 2018 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Kelly Coate (Supervisor) & Sharon Markless (Supervisor) |