Identity as a subject of human and social sciences

For more than half a century, identity has been in the focus of human and social studies that deal with various aspects of human existence, personal development, self-actualization, responding to challenges and crises, and building life-style resources. Classic psychoanalytic works approached identification as a psychological defense mechanism [1, 2]; in contrast, E. Erikson in his epigenetic theory defined the search for identity as a developmental stage in adolescence [3]. As a phenomenon, identity is explored by philosophy, linguistics, culture and social studies of human beings and their social nature. Recent linguistic research has demonstrated that an increasing use of semiotic resources in shaping and expressing identity is one of key characteristics of this complex phenomenon [4]. In psychology, the concept of identity is also enjoying a surge of interest. Terms like personal, gender, group, ethnic, professional and organizational identities have entered the lexicon of psychologists and are widely used in psychotherapy and psychological consulting. The program of the 16th European Congress of Psychology held in Moscow in July 2019 included the symposium on Personal identity in the conditions of multi-vector changes in the society. This signals a profound interest in the phenomena of identity and identification across the scientific community. The participants of the discussion pointed out that multivector changes sweeping through the globe are complicating the process of personal identification affected by new social and technological challenges brought about by the advent of the digital era. The speakers talked about a new phenomenon of online identity [5] and about national identity that comes into being as a group of individuals reflects on its historical experience [6]. Risks for social failure are increasing, as seen from the rising number of cases of unconfirmed identity [7] and gender identity crisis [8].

Professional identity of a medical doctor: the mystery of formation

To understand what a doctor’s professional identity really is, one has to identify a stage of medical training it starts to shape at, the factors involved and the intensity of the process. For a long time, little effort has been channeled into this field of research. On the whole, our foreign colleagues have paid more attention to this problem. Specifically, there have been persistent attempts to shed light on the nature and mechanisms of professional identity formation in the early stages of professional development. In medical students, professional identity is seen as a result of resolving difficult ethical dilemmas [9] and as an intrinsic part of a student’s personality [10]. Some Russian authors have studied professional identity in the context of daily routine of young Russian physicians working in different environments (cities, towns or villages) [11]. Those authors discriminate between 3 types of professional identity, depending on which view on the profession dominates the mindset of a young physician: being a helper (a doctor is a helping profession), being an expert (a doctor is an expert in a medical field), or being a researcher (a doctor is a researcher focusing on academic science).

The concept of professional identity holds a central place in the contemporary labor psychology and is loaded with a wide range of meanings [12]. One of them is particularly important for grasping the essence of professional development: professional identity is an indicator of how well an individual, their expertise and professional achievements meet the healthcare demands posed by society, professional community and its corporate culture [12] Seeing professional identity as an ability to self-identify in a profession can be used as a methodological landmark in research studies exploring the complexity of psychological aspects pertaining to the development of professional identity in healthcare workers [12]. Just like motivation, professional identity determines professionalism.

We face a lot of barriers in different stages of our career that put our professional identity at risk for shattering. Overcoming these barriers helps us to self-identify professionally at younger age and facilitates self-actualization later in life [13]. The barriers make one’s professional path nonlinear and thereby create a prerequisite for redefining the vectors of the chosen carrier, prevent one from professional stagnation, and enhance their professional identity. Some of the barriers are purely individual experience; however, others are common to the entire medical profession. The latter include professional crises that need to be overcome in order to self-actualize [14].

The first barrier is the problem of choice: a young individual torn by a conflict of motives and preferences creates a professional self-image and eventually decides in favor of a medical carrier. This crisis is a powerful stimulus: the decision to become a doctor means one has to accept responsibility, mobilize their internal resources and set off on a long and difficult journey of professional education. Achieved professional identity is a reward for overcoming this first barrier.

Other crises that will follow help an individual to build their confidence as a professional and to transform their self-image into a profession-related self-concept. Normative crises occurring in a medical carrier include crises in year 1 and 3 of medical training, a crisis related to the choice of specialty, a crisis at the start of a professional carrier, a crisis related to maintaining and improving qualifications, and a crisis of retirement.

The professional path of a medical doctor is also filled with obstacles that cause a risk for destroying his/her professional identity that include the so-called supernormative and extraordinary crises. An example of such a barrier is a crisis experienced when a doctor has to change their specialty or job. In this case, a typically normative crisis a person has to go through when starting a new job becomes supernormative or even acquires features of the extraordinary crisis that puts the doctor under a lot of stress. Such crises strike when a physician is offered a senior management position in a healthcare institution [15]. It is accompanied by frustration of a professional self-concept dissonant with a new identity (I as a senior executive). Studies have shown that in terms of confidence, “I in the present” becomes weaker than “I in the past”, the person feels the lack of competencies required for a new position, engages in negative coping strategies, etc. [15, 16]. Introducing the psychology of management into the curriculum taught to healthcare workers who study organization of healthcare and public health could help to overcome this barrier. Lectures and workshops on the psychology of management help students to develop standard competences that a senior executive is expected to demonstrate in their new position [17]. The essays and reports prepared by the graduates of the Department of Public Health and Healthcare (the Faculty of Continuous Professional Education, Kuban State Medical University) reveal a positive shift from frustration to realizing the points of integration between two professional identities: I as a physician and I as a senior executive.

CONCLUSIONS

Professional identity is the core of a person’s self-image. This core not a monolith. It is subject to various interventions arising from changes, challenges and demands from both within and without. In order to succeed in medical profession and to overcome the barriers occurring in all stages of their professional career and throughout life, one has to understanding the meaning of those barriers. The significance of the problem discussed at the symposium necessitates research into the mechanisms, factors involved and patterns of professional identity formation in medical doctors living in contemporary society.