Emerging Concepts in Medical Education II: Professional Identity & Emotion

The updated CanMEDS 2015 Framework  was released for consultation last week.  This version (series 1 of 4) included new / refreshed competencies.  As part of the process to update CanMEDS, a review of emerging themes in the medical education (grey) literature was completed.  Last month, Elaine van Melle posted an outline of the themes that she discovered.  Today, Elaine expands on two of the eight themes. Stay tuned for the remaining posts in this series. See here for Part 1: Process to identify emerging concepts in medical education 

–  Jonathan (@sherbino)

By Elaine Van Melle (@elainevanmelle)

Professional Self Identity

What kind of physician do you want to become?

How can you be sure that being a physician will provide a satisfying life long career?

These are the kinds of questions captured within the concept of professional self identity (PSI). They are very important questions. How you come to think of yourself as a physician determines the values you bring to your practice and ultimately how you provide treatment. In short, professional self identity is about internalizing the deeper values of the profession. It allows us to ask “What kind of physician will this person be when she is ready for independent practice?1

Within the 2005 CanMEDS Framework, values such as altruism, integrity, honesty compassion and caring, responsibility to society are prominent elements included under the role of professionalism. A focus on PSI however, requires us to be explicit about how medical education actively shapes these values and their related behaviours.2 Referred to as “non-competency” constructs, values and behaviours form a critical element of assessing resident performance.3 The challenge in revising the 2005 Competency Framework is to ensure that physicians are equally competent in describing “This is who I am” as they are in demonstrating “This is what I do.”

Emotions as a Form of Competence

Tues post_emotions

Competence is about being able to make the judgment about whether or not expressing a certain emotion does or does not advance patient centered goals and is distressing for the patient the physician or both. (p. 327)4

Emotions are always present. How we feel can serve as an important modifier influencing how we learn, make clinical decisions and the quality of the doctor-patient relationship. One example is the role of empathy. Defined as “the capacity for understanding, being aware of, being sensitive to, and vicariously experiencing the feelings thoughts and experience of another” 5, the ability to empathize has been equated with positive patient care outcomes.6 Conversely, the lack of empathy has been associated with suboptimal patient care and behaviour.7 Indeed, empathy is included within the communicator role within the current CanMEDS 2005 Framework. 

Empathy however, is just one example of emotional competence. As illustrated by the above quote, effective practice requires developing the ability to manage all emotions as they impact on daily care and practice. Described as Emotional Regulation,8 the challenge in revising the 2005 Competency Framework is to incorporate this broader perspective of emotional competence.

So… do you agree?  Should a framework that describes a competent physician includen “professional self-identify” and “emotion” as competencies to be taught and assessed?


1. Jarvis-Selinger S, Pratt DD, Regehr G. 2012. Competency is not enough: Integrating identity formation into the medical education discourse. Acad Med 87(9):1-6.
2. Goldie J. 2012. The formation of professional identity in medical students: Considerations for educators. Med Teach 34:e641-e648.
3. Ginsburg S, McIlroy J, Oulanova O, Eva K, Regehr G. 2010. Toward authentic clinical evaluation: Pitfalls in the pursuit of competency. Acad Med 85(5):780-786.
4. Shapiro J. 2011. Does medical education promote professional alexithymia? A call for attending to the emotions of patients and self in medical training. Acad Med 86: 326-332.
5. Medical Dictionary, 2011
6. Neumann M, Edelhauser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, Haramati A, Scheffer C. 2011. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Acad Med 86: 996-1009.
7. West CP. 2012. Empathy, distress and a new understanding of professionalism. Med Ed 46:243- 244.
8. McNaughton N, LeBlanc V. 2012. The central role of emotional competence in medical training. Chapter 3 In: Hodges B, Lingard L. (eds) The Question of Competence. Ithaca, New York: Cornell University Press.
Image 1 courtesy Max Pixel be freely distributed with a Creative Commons Zero – CC0

Image2  courtesy of stockimages/FreeDigitalPhotos.net