Professional Identity in the Caring Professions

Meaning, Measurement and Mastery

Roger Ellis, Elaine Hogard, Roger Ellis, Elaine Hogard

• Verlag: Routledge
• Jahr: 2020
• ISBN:
  9781000338454
• Auflage: 1
• Thema: Medizin
• Thema: Medizinische Weiterbildung

Professional identity is a central topic in all courses of professional training and educators must decide what kind of identity they hope their students will develop, as well as think about how they can recruit for, facilitate and assess this development.

This unique book explores professional identity in a group of caring professions, looking at definition, assessment, and teaching and learning. Professional Identity in the Caring Professions includes overviews of professional identity in nursing, medicine, social work, teaching, and lecturing, along with a further chapter on identity in emergent professions in healthcare. Additional chapters look at innovative approaches to selection, competency development, professional values, leadership potential and reflection as a key element in professional and interprofessional identity. The book ends with guidance for curriculum development in professional education and training, and the assessment of professional identity.

This international collection is essential reading for those who plan, deliver and evaluate programs of professional training, as well as scholars and advanced students researching identity in the caring professions, including medicine, nursing, allied health, social work and teaching.

1 Introduction

Professional identity: issues and approaches

Roger Ellis and Elaine Hogard

This chapter is intended as an introduction to the other 20 chapters in the book, linking them to the book's title and its themes. The book's title was of course intended to be clearly indicative of its content; however, its apparent clarity flatters to deceive. Identity, profession and caring are all quite difficult to pin down. What makes a particular activity worthy of the title profession? How do we describe identity at the interface of an individual and a profession? Which professions can be described as caring and which excluded?

One simple definition is that a profession is a paid occupation that involves a prolonged formal training. Even simpler is the idea that a profession is a job with good remuneration together with social responsibilities. All true. However, there is more to it than that.

Flexner (1910)¹ identified six characteristics of a profession and its professionals, and he is still widely quoted. The six characteristics he believed are: (1) ‘professions involve essentially intellectual operations with large individual responsibility’, (2) ‘they derive their raw material from science and learning’, (3) ‘this material they work up to a practical and definite end’, (4) ‘they possess an educationally communicable technique’ (their own language), (5) ‘they tend to self-organisation’ and (6) ‘they are becoming increasingly altruistic in motivation’. This is alright so far as it goes, and it has certainly stood the test of time. However, it is mainly cognitive and intellectual in orientation. A professional is defined primarily by ‘intellectual operations’ and these operations must be based on science and learning to which the profession has contributed giving it responsibility for its own knowledge and a communicable language in which it is expressed. However, this intellectual- and research-based material must be worked up to a practical and definite end. Here we begin to see the practical behaviours and competencies which are the professional's manifest stock in trade. Professionals have to do things not just think about them. Professionals must also have ‘large individual responsibility’ and tend to ‘self-organisation’. So, autonomy is an important aspect of being a professional. Professionals must also become ‘increasingly altruistic’ that is dedicated to the good of others. This is a window into the ethical values which are the third important element of professionalism.

We would suggest, therefore, that the three main features of a profession are knowledge, competency and values. A professional is defined by what they know, what they can do and the values that underpin this. Training curricula reflect this with classroom teaching and learning covering an appropriate knowledge base and activities in the university and work placements developing a set of complex skills and competencies. By the end of the programme, students must have demonstrated knowledge and competencies through the assessment programme. In this structure, values are a significant Cinderella. While their importance is recognised, there are problems when it comes to their teaching, learning and assessment. These problems first appear when students are selected for a programme when it is thought important that students have the right values for the profession. This leads to attempts at so-called values-based recruitment.

Adding the word identity to profession brings these issues into a sharper focus and at the same time makes them more complex. Identity is open to a number of definitions depending on the theoretical perspective adopted. One theorist (Weinreich and Saunderson 2013)² suggests identity might be conceived as the totality of values, attitudes, memories, convictions, aspirations and reflections that are unique to an individual. However, professional implies some selection or reorientation from such a list relevant to the individual's role as a member of a recognised profession which adheres to generally recognised standards and involves an extended training and preparation.

For this book, the recognised professions would be ones considered to be ‘caring’. Does that help our focus? – conventionally – yes. Caring is certainly used commonly to describe social and health professions such as medicine nursing, and social work that are involved with looking after people who are ill or who need help in coping with their lives. Teaching has probably sneaked into the category although it is largely provided for pupils who are neither ill nor having problems coping, although some certainly will. The category is by no means watertight. Other professions might reasonably claim they are there to help people, including law, the church and even accountancy and estate agency. Caring also has several connotations one indicating not only that the professional cares for people with health or social needs but also indicating that the professional cares about what they are doing and that they discharge their duties with care.

Perhaps this analysis is unnecessary when we have defined caring ostensively through the choice of medicine, nursing, social work and teaching. However, the label certainly influences what needs to be known, what skills are employed and particularly what values should underpin action.

Professional identity has both internal and external aspects. On the one hand, it is the way the individual sees themselves; on the other, it is the way they are seen. A comprehensive view of professional identity includes all the knowledge that a professional is expected to have and all the things they are able to do to help their patients and clients. The professional curriculum reflects this with components dedicated to knowledge and competence. However, underpinning what is done and what is known is a set of values which determine ethical standards for practice. Developing a professional identity including the right values is both fundamental to the curriculum but also the most challenging for teaching, learning and assessment.

Both professional identity and values are slippery concepts. Neither are directly observable but have to be inferred from observable behaviour. Rather than being objective entities that can be recorded and quantified, they are hypothetical constructs open to different interpretations. Notwithstanding these problems, we will aim in this book to offer some practical findings, advice and suggestions – regarding meaning, measurement and mastery through the curriculum.

The kind of knowledge we have of professional identity tends to be implicit rather explicit. This can come to a head in professional training when supervisors feel that a student is falling short of the professionalism required but find it difficult to say exactly why. They are making a judgement which might be both valid and reliably shared with other supervisors but difficult to objectify in the way an assessment scheme requires.

Meaning, measurement and mastery were chosen to highlight the three themes of the book that is clarifying the meanings attached to professional identity, addressing the problems of measuring it and informing the challenges faced by curricula which aim to develop it. If meaning is problematic, measurement is consequently and inherently more difficult. Mastery depends on clarity in both. So, the three themes are interdependent. In the absence of some form of measurement (of which more anon), meaning will remain imprecise and the curriculum and mastery no more than an aspiration.

We are using ‘measurement’ as both a general and a would-be precise term. Generally, I would suggest that measurement begins with reliable and objective recognition. Recognition then has to be captured in description. Objective and reliable description may lead to quantification and then true measurement.

So, we might claim to be able to recognise whether or not a practitioner has developed an appropriate professional identity. Recognising is one thing and describing the cues that underpin recognition is another. If the indicators of identity can be described objectively (that is making them apparent to others) and reliably identified, then the next step might be to apply some kind of numerical value to them.

We would argue that some form of measurement is essential for two reasons. First, in addressing professional identity, it makes what can be intangible and implicit more objective and grounded. Second, measurement is essential to assess the outcomes of professional training where we ask – have the students developed an appropriate professional identity, how do we know and how do we validly and reliably assess it.

Returning to meaning, the terms profession, professional, professional identity and professionalism are, as pointed out by Stuart Lane in Chapter 2, used widely in the caring professions but often interchangeably. Definition and empirical grounding are essential to clarify this potentially confusing melange. All the chapters in the book are intended to contribute to this clarification. In particular, there are chapters concerning medicine, nursing, social work, school teaching and university lecturing which consider what professional identity means in that profession.

We were keen that each of these chapters should express individual views from an authority in the profession concerned rather than responding to specific editorial questions. It is interesting to see how each chapter approaches professional identity and how it is conceived and described. How does it balance private and public identity and individual and collective identity? How has identity developed historically and how does it develop in each individual? What social and political factors contribute to the identity? This description and analysis explore our concern with meaning. Additionally, each chapter addresses the problems of measuring and assessing professional identity and finally how identity can be mastered, developed, encouraged, taught and assessed in the curriculum.

So, each of these contributors was asked to address meaning, measurement and mastery for their chosen profession. Chapters include Stuart Lane's chapter on PI in Medicine, Carol Hall's on PI in Nursing, Chris Wilkins’ on PI in School Teaching, Audrey Roulston's on PI in Social Work and George Brown's on PI in Higher Education Lecturing. This is by no means an exhaustive list of possible professions, but arguably a representative sample of caring professions. We hoped that each chapter would be not only interesting for its own profession but also raising issues and ideas of relevance to other caring professions. We believe issues of and approaches to meaning, measurement and mastery transfer readily across professions.

Complementing these central chapters are explorations of aspects or contexts for professional identity. Competence is one important aspect of identity. Adrian Furnham explores competence in Medicine as an aspect of PI and Julie Gustavs and Theanne Walters look at the development of competency-based approaches to the accreditation of medical programmes. Marta Erdos and Tomi Gomery compare and contrast PI in Social Work in the United States and Hungary. Stuart Lane identifies the importance of reflection in professional identity. New emergent professional identities are considered by Damian Day, and Stuart Lane and his colleagues look at interprofessional identities.

The second major theme, measurement is covered by three methodological chapters. Roger Ellis and Elaine Hogard look at psychometric approaches to measurement or rather one in particular, Weinreich's ISA/Ipseus, which they apply in a nurse identity instrument and which they anticipate for a medical instrument. Medi-Match Measurement figures also in three other chapters: Marta Erdos and colleagues describe an instrument to explore social work identities in Hungary, Colin McNeill reports on an instrument to measure leadership potential in nursing and Graham Passmore an instrument to explore identity crisis in school teaching.

After psychometrics, two other approaches are described. Elaine Hogard and Roger Ellis consider four key consultative methods and Elaine and Norma Reid Birley look in greater depth at one consultative method, the Delphi technique. The third approach considered is naturalistic observation and this is addressed by Jo Cecil and Calum Mc Hale.

Not only do these chapters consider the three major approaches methodologically but also they all report on empirical studies carried out by the authors and each includes a substantial case study. We believe these studies together with studies reported in other chapters by Marta Erdos, Graham Passmore and Colin McNeill make up a unique set of research studies involving the measurement and elucidation of professional identity and ranging across nursing, school teaching, social work and medicine.

In this book, we will take a comprehensive view of professional identity suggesting that it has three main components: knowledge, competence and values, that is what the professional knows, what they can do and what they believe. Developing and measuring knowledge and latterly competence are well established in the teaching–learning and assessment procedures of the professional curriculum. When it comes to the values which are the core of professional identity, there are difficulties both in developing and assessing them. The problem of assessing and measuring values surfaces first when students are selected for a program.

As indicated previously, a number of chapters in the book address the measurement of professional identity and values and several describe studies which employ a particular method to measure identity: Identity Structure Analysis and its linked psychometric measure Ipseus. Other chapters concerned with the measurement of PI include ones on observational methods, consultative methods and the Delphi technique. As it has turned out, then measurement and methods of investigation have proved a major emphasis in the book. This reflects our present state of knowledge of professional identity and the need for further studies to provide the firm basis of empirical material required.

The third theme of the book is mastery that is the development of a professional identity through the curriculum. Clarifying meanings and measuring identity and values should all contribute to the curriculum. Contributors were asked to suggest ways in which their chapter might contribute particularly, and their guidance and their views are brought together into a new curriculum model in the final chapter on professional identity and the curriculum. One chapter by Joel Lanphear and Marie Matt addresses the first stage in curriculum, selection and how selection processes can be geared to assessing factors that harmonise with the school's mission. This chapter relates to the outline of Medi-Match in Ellis and Hogard's psychometric chapter where the developments of instruments for selection are described.

After mentioning each of the chapters in the context of the book's design, we will now conclude with a fuller abstract of each chapter.

1. Introduction: professional identity: issues and approaches

This chapter will outline the issues and challenges implied by the title of the book. These include problems of definition and operationalisation of professional identity, problems of measurement and assessment of professional identity, and problems in teaching and learning professional identity. The chapter will consider the ways in which the book addresses these issues and introduces each chapter.

2. Professional identity in medicine

The terms profession, professional, professional identity and professionalism are quoted many times in medicine and are often used interchangeably. This can lead to confusion as to what the concepts really are, and we therefore need to be careful what we mean when we quote them, and, more importantly, what we understand about how they relate to our personal clinical practice. Medical students and doctors are constantly being told in lectures, tutorials and workshops, that they need to demonstrate professionalism in their future careers, so what is vital in their professional development is that they understand not only how everybody else defines professionalism, but most importantly what it means to them, that they have got it right and they keep getting it right throughout their careers.

To achieve this, clinicians need to be aware of concepts that will allow them to develop and truly understand professionalism and professional identity, along with role modelling the types of behaviour that are expected of them. Some of the most pertinent and beneficial to harness the development of one's beliefs and attitudes towards professionalism and professional identity are intellectual humility, growth mindset, belonginess and situational awareness. These concepts are integral to how st...

Inhaltsverzeichnis

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Contents
• Figures
• Tables
• Boxes
• Contributors
• 1 Introduction: Professional identity: issues and approaches
• 2 Professional identity in medicine
• 3 Professional identity in nursing
• 4 Professional identity in social work
• 5 “Social workers” professional identity in its social context: A comparative analysis
• 6 Professional identity in teaching
• 7 Changes of academic identities in UK universities
• 8 Evolving professional identities in healthcare: The case of associate professions
• 9 Professional identity and competence to practise in medicine
• 10 The future starts now – the identity and competence of doctors and the impact of accreditation
• 11 The measurement of leadership qualities as an aspect of nursing identity
• 12 Are we admitting the right students?: Seeking the “best fit” with institutional values and professional identity development and professionalism in US medical school admission processes
• 13 Identity structure analysis as a means to explore social worker professional identity
• 14 Reflective practice and professional identity
• 15 Crisis in teacher identity: ISA guided mentorship and teacher turnover
• 16 Interprofessional education and interprofessional identity
• 17 Psychometric measurement of professional identity through values in nursing and medicine
• 18 Explicating professional identity through consultative methods
• 19 The potential contribution of the Delphi technique to the study of professional identity
• 20 Observing identity: Measuring professional identity empirically in the healthcare professions
• 21 Professional identity and the curriculum
• Index