Identity negotiation in medical students: a comparison between the UK and USA


  1. Gabrielle M Finn*
  2. Wojciech Pawlina
  3. Varun Shahi
  4. Fred Hafferty


International Dimensions


School of Medicine, Pharmacy and Health, Durham University, UK
The Mayo Clinic, Rochester, Minnesota, USA


Medical students grapple with negotiating their personal and professional identities (1). Whether this negotiation is cultural and context dependent is unknown.

This study explores how undergraduate medical students in two different educational settings, Durham University in the UK and the Mayo Clinic in the USA negotiation their identities.

Summary of Work

Year 1 and 2 medical students at each institution participated in semi-structured interviews or focus groups

(Mayo: n= 35, Durham: n= 45)

Data were collected and analysed in accordance with grounded theory; interative cycles, constant comparison, member checking, open, axial and selective coding. 

Summary of Results

Similarities in how students negotiated their professional idenitiy formation were: The professionalism bar is always moving – uncertain what’s expected 

Students have multiple facets of self – modulate ‘version of self’ depending on who is present and the environmental context

Virtual context of identity always considered 

Role-modeling- important factor in identity formation, positive and negative examples  

Medicine results in a loss of personal identity

Scruitny of behaviour leads to resentment 

The Hidden Curriculum significantly impacts how students negoitiate their identities- this includes environmental factors too 


Differences were:

USA- stronger organisational culture and thus organisational identity. Identity was validated by dressing the part. 

UK - identity informed, in part, by their own experiences as a patient. Less emphasis on the organisational culture of their Higher Education institution or the NHS. 


There is an ever increasing expectation for medical students to become mini-doctors from day one of medical school. Often, this makes students unable to go through a transitional or developmental period. Subsequently, they struggle to negotiate their personal and professional identities. Despite some cultural differences, medical students in the UK and USA experiences similar scrutiny and thus anxieties.



Take-home Messages

Despite differing societal expectations, educational settings and cultures, all medical students struggle with identity negotiation and formation. Work needs to be done to aid students in their transition from student to clinician. Examples of positive role-modelling and positive aspects of organisational culture need signposting to students to enable their identities to be positvely reinforced. 


Thanks to Fred Hafferty and Wojciech Pawlina for hosting Gabrielle at the Mayo Clinic. 


Finn, Gabrielle Maria, Garner, Jayne & Sawdon, Marina (2010). "You're judged all the time!" Students' views on professionalism: A multi-centre studyMedical Education 44(8): 814-825.

Summary of Work
Summary of Results

Dressing the part...

“It [wearing professional dress] is as drastic as like Superman putting on his costume. When I put on the suit and put the stethoscope around my neck, you know I just kind of remember like ‘Whoa, I’m going to be a doctor’ and I’m sure that for other students at other schools when they put on the white coat it’s the same experience for them as well. So they look the part and now you have to act the part.”


Moderating behaviour outside of the clinical environment...

  “There are also just like weird social situation things that I don’t do anymore. I used to go running in a sports bra and shorts and like not have a problem with this. I won’t do that anymore, because there’s a very good chance I’m going to see people I work with, I might see as patients so I just don’t that because I feel that I don’t want them being confused about what my image is...”

Facets of self... 

“I tone myself down quite a bit when I’m kind of with patients so even though I do act professionally I also try to act on the basis that it is, they’re [patients] talking to me as an individual not just like a robot which I’ve noticed some people just turn into kind of quite static people where they’re, you know they don’t seem as approachable. In some ways you could say it’s a different me, does that sound bad?


Take-home Messages
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