A Critical Review of Professional Socialization Models for Medical Students

Professionalism is the underlying factor in strengthening the social contract between professions and the society. Failure to adhere to this principle in healthcare providers (including nurses) reduces the quality of patient care and endangers community health, while also diminishing public trust and weakening the social image of healthcare professions. In recent decades, researchers of health science education have focused on the nature of professionalism and planning for training in this regard in order to achieve this important outcome in health science graduates. Despite the applications of the study results and the efforts to train students on the basic concepts of professional ethics, the expected outcomes have not yet been realized in terms of the performance of graduates. Today, numerous researchers believe that achieving professionalism is not possible merely through education and the evaluation of its principles, and the required competencies should also be cultivated to facilitate the process of professional socialization, so that a proper professional identity could be attained in medical science graduates. However, further studies should be focused on the top of Millerchr('39')s pyramid (Does) pertains to the process of developing competencies and their components and has reached the stages of developing a competency-based curriculum, along with the formation of a professional identity, which is equivalent to the "Is" part added to the Millerchr('39')s model by Cruess et al. (2016). In a study in this regard, the concept of professional socialization was analyzed, and professional identity was introduced as the main outcome of this process. The present study aimed to critically review the current literature regarding socialization and the development of professional identity in health science students.

This critical review was conducted based on the Carnwell and Daly structure, which consists of six steps, including determining the objectives of the critical literature review, defining the scope of the review, identifying the sources of relevant information, literature review, writing the review, and applying the literature to the proposed study. At the stage of review writing, we followed the three steps proposed by Schutz. Initially, a systematic search was performed to obtain the available conceptual models and frameworks of socialization and professional identity formation in primary scientific databases, such as EBSCO CINAHL, Web of Science, Eric, PubMed, Scopus, and Google Scholar, using relevant keywords with "OR" and "AND" to combine the main concepts. The article search had no time limit until 2019. The eligibility criteria for article selection were proposing a model/conceptual framework, medical sciences, free access, and publication in English language. The exclusion criteria were duplicates and the experimental studies aimed at the measurement, comparison or production of tools. In the second phase of the search and to obtain citations and criticisms for each selected conceptual model/framework, the key concepts of each was systematically searched in the aforementioned databases using "AND" in combination with concepts such as "Criticism, Problems, Challenges, Advantages, Disadvantages". To ensure access to all the possibly relevant reviews, all the citations to each model were tracked through Google Scholar.

In total, 2,112 articles were retrieved in the first stage of the search in terms of the title, followed by the abstract. After reviewing the full texts of the selected articles, nine articles were selected based on the research criteria in the fields of nursing, social work, medicine, paramedicine, and student affairs. These articles were categorized in terms of the study design, model type, model focus, and outcomes. Following that, the selected models were examined chronologically based on the three steps proposed by Schutz, which are the description of the model by its providers, providing the viewpoints of their critics/promoters (if any), and presenting the critical views of the authors of the article. After the analysis of the elements and content/structure of the conceptual models/frameworks, the key concepts of each model were extracted and presented in a table. The studied conceptual models and frameworks consisted of four categories (descriptive, normative-descriptive, causal-explanatory, and descriptive-prescriptive), which described the process of socialization and the role of the influential factors. Some of the findings were mainly focused on the cognitive and psychological dimensions, as well as the social dimension of the process in some cases. In the cases where both the psychological (internal) and social dimensions (external) of the process were considered, a structural approach was not observed regarding the elements and components of each dimension. In addition, the assessment of the content and description of the models revealed various theoretical approaches to this process, some of which were based on a functional structuralism approach and emphasized the role of organizational factors. The other cases involved the cognitive and interactive dimensions and the role of student agencies in this process, as well as the combination of the two approaches. In addition to the role of institutional factors, the active role of students and the impact of interactions were also discussed with regard to the development of professional identity without determining its dimensions and components. The key concepts extracted from the selected models in the present study could be classified into two psychological and social dimensions. The psychological dimension could be classified as cognitive (principles, values, and professional norms), affective (descriptive [sense of belonging to the profession], evaluative [self-confidence], and normative [attitude toward the profession]), and volitive (job motivation). Similarly, the social dimension could be categorized into the communicative domain (effective professional communication), cohesive domain (mutual respect and commitment), and operative domain (professional behavior and effective role performance).

Presenting the components of professional identity based on psychological and social dimensions could lay the groundwork for designing a comprehensive, static, structural model of professional identity for medical students, thereby resulting in the development of structured interventions for the management of professional identity formation in further investigations.