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Educators, experiences, and environment: exploring Doctor of Physical Therapy student perceived influences on professional identity formation
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Educators, experiences, and environment: exploring Doctor of Physical Therapy student perceived influences on professional identity formation
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Content
Educators, Experiences, and Environment: Exploring Doctor of Physical Therapy Student
Perceived Influences on Professional Identity Formation
Gina Rachelle’ Gang
Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education
May 2023
© Copyright by Gina Rachelle’ Gang 2023
All Rights Reserved
The Committee for Gina Rachelle’ Gang certifies the approval of this Dissertation
Courtney Malloy
Kimberly Hirabayashi
Heather Davis, Committee Chair
Rossier School of Education
University of Southern California
2023
iv
Abstract
This study applies the social cognitive theory to understand doctor of physical therapy student
perceptions of professional identity formation (PIF). The purpose of this study was to determine
what factors students, in various educational stages, perceived to influence their professional
identity development during didactic curricula. Also, this study sought to understand the lived
experiences students perceived as supportive or threatening to individual PIF while on campus.
Using a survey with closed and open-ended questions, data from eighty participants, representing
three cohorts were analyzed using a mixed methods approach. Quantitative findings from this
study indicate that factors students perceived impactful align with previous research in other
healthcare education sectors and included faculty as the greatest impact. There was no
correlation between factors perceived important and cohort. Emergent themes from open-ended
questions about lived experiences revealed that what faculty gave; time, compassion,
vulnerability, authentic learning experiences, and inspiration to be the most significant positive
impact on PIF. Experiences negatively impacting PIF were primarily external, with limited
faculty encounters and program features impeding PIF. The impact of experiences supporting
PIF impacted student thinking, feelings, and future behavior while experiences threatening PIF
created reduced self-efficacy. When questioned about the greatest barrier to PIF, students
perceive themselves to be the greatest barrier. This study contributes to the paucity of research in
professional identity formation of doctor of physical therapy students and informs program
development to support professional identity formation as an educational objective in doctor of
physical therapy curricula.
v
Acknowledgements
First, I would like to express my gratitude to my dissertation committee chair, Dr.
Heather Davis, for her kind and steady guidance thorough this journey. I would also like to thank
my dissertation committee members, Dr. Kimberly Hirabayashi, and Dr. Courtney Malloy for
their invaluable time and feedback. I would like to acknowledge my colleagues and friends who
encouraged, advised, gave me time for writing, and understood when I could not respond to their
texts during class. It is important for me to recognize the participants of this study as well. The
generous gift of their time and willingness to vulnerably share personal experiences was
inspiring and enlightening. It is these beautiful students I am privileged to journey with that
inspired my passion for researching professional identity development in physical therapy
curricula. An additional thank you to my friend, Dr. Kelton Rhoads, who generously provided
statistics expertise and patiently explained concepts in relatable terms.
Thank you “OCL 18 super study group” and our awesome “Tuesday evening crew.” You
generously shared your stories, knowledge, and hints as we navigated the program together.
Your laughter and tears made this journey so unforgettable and this journey is richer because of
you. Kevin and Divya, how blessed I have been by your kindness, vulnerability, and joy. Divya,
you always had my back, your feedback improved my writing, your texts motivated me for
excellence, and you paced me to the finish line. Each of you have been a constant source of
support, compassion, and motivation.
I would like to thank my parents for their support, encouragement, and love throughout
my life and career. You are my role-models for working hard, loving well, and giving grace. You
made sure I was always pointed me to the ultimate foundation of peace, knowledge and growth,
a relationship with the God who loves me and knows me best. This accomplishment would not
vi
have been possible without my family’s unconditional love and support. Jeff, you washed and
folded my clothes, cooked delicious home-cooked meals, made sure I had an extra computer
monitor, found the right spot to register for classes on the cathedral steps in Toledo, Spain, and
provided unwavering patience and understanding. Thank you Madison for always asking “How
was your class?,” Braden for allowing me to re-arrange your room for quiet study space, and
McKenna for the ever-present smell of homemade chocolate chip cookies as a reward to making
it through a long night of classes. I am full of gratitude for lifelong learning and my own
transforming journey of professional identity.
vii
Table of Contents
Abstract ........................................................................................................................................... iv
Acknowledgements ......................................................................................................................... v
List of Tables ................................................................................................................................... x
List of Figures ................................................................................................................................. xi
Chapter One: Introduction to the Study ........................................................................................... 1
Context and Background of the Problem ............................................................................ 2
Stakeholder Group for the Study ......................................................................................... 3
Purpose of the Project and Research Questions .................................................................. 3
Importance of the Study ...................................................................................................... 4
Overview of Theoretical Framework and Methodology ..................................................... 5
Definition of Terms ............................................................................................................. 6
Organization of the Dissertation .......................................................................................... 7
Chapter Two: Review of the Literature ........................................................................................... 8
An Historic Perspective of Professional Identity Formation ............................................... 9
Definition of Professional Identity Formation ..................................................................... 9
The Process of Professional Identity Formation ................................................................ 11
Factors Impacting Student Professional Identity Development ........................................ 14
Benefits of Strong Professional Identity ............................................................................ 18
Measurement of Professional Identity ............................................................................... 18
Professional Identity in Healthcare Education .................................................................. 19
Existing Strategies Incorporating PIF in Healthcare Education ........................................ 20
Professional Identity in Physical Therapy Education ........................................................ 21
Research Gaps Existing in Physical Therapy Education ................................................... 23
Previous Theoretical Frameworks Applied to Professional Identity Formation ............... 24
viii
Social Cognitive Theory .................................................................................................... 27
Conceptual Framework ...................................................................................................... 29
Summary ............................................................................................................................ 35
Chapter Three: Methodology ......................................................................................................... 37
Research Questions ............................................................................................................ 37
Overview of Design ........................................................................................................... 37
Research Setting ................................................................................................................ 38
The Researcher .................................................................................................................. 39
Data Source ........................................................................................................................ 40
Credibility and Trustworthiness ........................................................................................ 43
Validity and Reliability ..................................................................................................... 44
Ethics ................................................................................................................................. 44
Chapter Four: Findings .................................................................................................................. 46
Research Question 1: What Factors Do Physical Therapy Students at Various
Educational Levels Perceive as Impacting Their Professional Identity
Development During Didactic Education? ........................................................................ 47
Research Question 2: What Lived Experiences With Faculty and Peers During
Didactic Education Do Physical Therapy Students Understand to Influence Their
Professional Identity Development? .................................................................................. 54
Summary ............................................................................................................................ 69
Chapter Five: Discussion ............................................................................................................... 71
Findings ............................................................................................................................. 72
Recommendations for Practice .......................................................................................... 86
Limitations and Delimitations ........................................................................................... 95
Recommendations for Future Research ............................................................................. 96
Conclusion ......................................................................................................................... 98
References ................................................................................................................................... 100
ix
Appendix A: Informed Consent .................................................................................................. 117
Appendix B: Student Survey ....................................................................................................... 119
Appendix C: Codebook for Qualitative Analysis ........................................................................ 124
x
List of Tables
Table 1: Survey Response Frequencies per Cohort 48
Table 2: Frequencies for Perceived Factors Impacting Student Professional
Identity Formation
49
Table 3: Frequencies for Perceived Importance of Factors Impacting Student
Professional Identity Formation
50
Table B1: Table of Survey Questions With Associated Responses and Research
Questions
119
Table B2: Qualitative Research Questions From Survey 123
Table C1: Codebook for Two Most Important Student-Perceived Influences on
PIF
124
Table C2: Codebook for Experiences Positively Impacting Student PIF 125
Table C3: Codebook for Impact of Experiences Positively Impacting Student PIF 126
Table C4: Codebook for Experiences Negatively Impacting PIF 127
Table C5: Codebook for Impact of Negative Experiences 128
Table C6: Codebook for Student: Perceived Barriers to PIF 128
xi
List of Figures
Figure 1: Conceptual Framework 32
Figure 2: Most Important Perceived Influences on Professional Identity Formation
From Qualitative Responses
52
Figure 3: Lived Experiences Positively Impacting Professional Identity Formation 56
Figure 4: Impact of Lived Experiences Positively Impacting Professional Identity
Formation
59
Figure 5: Lived Experiences Negatively Impacting Professional Identity
Formation
62
Figure 6: Impact of Lived Experiences Negatively Impacting Professional Identity
Formation
64
Figure 7: Student-Perceived Barriers to Professional Identity Development 66
Figure 8: Recommendations Aligned With Social Cognitive Theory
87
1
Chapter One: Introduction to the Study
Strong professional identity formation is critical for healthcare students for effective
clinical practice. Professional identity formation is defined as the internalization of values,
attitudes, and conduct within a specific profession and perception of oneself within those values
and professional role (Cruess et al., 2014; Sarraf-Yazdi et al. 2021). It is a lifelong
developmental process, and beyond assimilation of professional virtues, includes a commitment
to the profession, and envisioning their future professional self (Jensen & Jetten, 2016; Sarrif-
Yazdi et al., 2021; Wald, 2015). Leaders in healthcare education reform have increasingly
advocated for including student professional identity development as an explicit educational
objective in healthcare education (Cruess et al., 2014; Irby et al., 2010; Noble, McKauge, &
Clavarino, 2019; Wilkins, 2020). Inclusion of professional identity formation in healthcare
education is critical because a strong professional identity is linked to increased resilience,
decreased burnout, improved compassion, and increased persistence and retention during
healthcare program education (Boehm et al., 2015; Edwards & Dirette, 2010; Schreiner et al.,
2011; Wagner & Jackson, 2021; Worthington et al., 2013). A developed professional identity
also correlates with increased job satisfaction and supports a successful transition from student to
clinician (Noble et al., 2014; Scanlan & Hazelton, 2019). Moreover, consequences of poor
student professional identity include increased stress, poor patient care, compromised clinical
decision making, decreased self-confidence, loss of motivation and perceived academic
achievement (Fitzgerald, 2020; Jensen & Jetten, 2016). Adding to the evidence, a
recommendation paper by American Council of Academic Physical Therapy (ACAPT) and
supported by The American Physical Therapy Association (APTA) asserts that professional
identity formation be a primary focus of physical therapy education (ACAPT, n.d., APTA, n.d).
2
Despite this evidence, Whole University’s physical therapy program does not include
professional identity formation as an educational outcome or intentionally designed curricula
with student professional identity development as a priority.
Context and Background of the Problem
Currently in the United States there are 271 accredited physical therapy programs
(Commission on Accreditation of Physical Therapy Education, n.d.). A national study of
physical therapy of action items deemed critical for physical therapy education excellence
included professional formation emphasis with a continuum of professional performance
expectations embedded in curriculum (Jensen et al., 2017). Whole University (WU), a
pseudonym, is a private parochial accredited institution of higher learning with eight schools in
healthcare education. The school of allied health includes a physical therapy program. Part of the
mission of the program is to advance physical therapy practice through education, scholarship,
and professional service. A prerequisite for acceptance into the 3 year doctoral physical therapy
program at WU is a completed B.S degree. Eighty hours of clinical observation is an additional
prerequisite. During the program students are required to successfully complete two 4-week
clinical experiences integrated in the first 2 years of the program. The final year is entirely
clinical work and includes three 12-week clinical affiliations. A new cohort begins yearly and
averages sixty students. Thirteen core faculty, three female and 10 male, provide didactic
education in preparation for clinical education and report to the program director. The core
faculty are primary instructors and advance establishment of educational priorities and outcomes
within the program. The accrediting body, the Commission of Accreditation in Physical Therapy
Education (CAPTE), requires graduates to meet the expected outcomes defined by the program
however specific educational outcome goals are not mandated and no guidelines exist for goal
3
determination (CAPTE, n.d.). Because there are no guidelines, each school develops unique
educational outcomes aligned with the mission of the school. Matching WU’s status, an
unstructured random sample of ten physical therapy programs in the United States revealed that
no schools listed professional identity development as an educational outcome during online
exploration of listed educational outcomes. The underutilization of professional identity
formation as an educational priority in physical therapy education is apparent despite it being an
accreditation recommendation and professional organization priority, providing an opportunity
for further exploration.
Stakeholder Group for the Study
There are two primary stakeholders in the process of professional identity formation:
faculty and students. First the faculty, who determine educational outcomes, inform curricular
design, and use knowledge and organizational resources to support students and outcomes.
Second, the students, who must actively participate and manifest the internal process of
professional identity formation. Furthermore, these stakeholders’ interactions with each other
during the 2 years on campus critically impact student professional identity development. Both
stakeholders contribute to the success of student professional identity formation however student
perception will be the stakeholder of focus for the scope of this study. This study will examine
student perceptions of factors impacting professional identity formation and note the extent to
which those factors align with what previous research reveals about student professional identity
formation development.
Purpose of the Project and Research Questions
The purpose of this study was to understand physical therapy students’ perceptions of
factors affecting professional identity development at various educational stages during didactic
4
on-campus education. It also aims to explore what lived experiences, with peers and faculty,
students understand to have influenced their professional identity development and the resulting
impact. Revealing factors perceived by students contributing to or influencing student
professional identity development is required for development of educational outcomes and
supporting interventions. Results will inform program professional identity initiative design
ultimately supporting successful physical therapy student development and transition into
professional role.
As such, the research questions guiding this study include:
1. What factors do physical therapy students at various educational stages perceive as
impacting their professional identity development during didactic education?
2. What lived experiences with faculty and peers during didactic education do physical
therapy students understand to influence their professional identity development?
Importance of the Study
There are a three primary reasons it is important to study the underutilization of
professional identity formation as an educational priority. First, a strong professional identity
facilitates improved provider well-being with increased compassion, resilience, self-awareness,
job satisfaction, reduced burnout, and successful student transition to the clinic (Edwards &
Dirette, 2010; Lawrence et al., 2020; Noble et al., 2014; Scanlan & Hazelton, 2019; Wagner et
al., 2021). Second, professional identity is correlated with strong communication skills,
improved moral reasoning, and higher responsibility for patient care resulting in improved
patient care (Kalet et al., 2021; Sawatsky et al., 2020). Supporting improved patient care, in the
clinical setting a strong professional identity is correlated with a stronger sense of responsibility
to the patient, awareness in limitations of clinical reasoning, and improved well-being in a
5
practicing community (Chandran, 2019; Wyatt et al., 2021). Finally, it is important to study
student professional identity formation because underutilization of PIF in healthcare education
exists in direct opposition to healthcare education reform recommendations supported by
research (APTA; Irby et al., 2010; Jensen et al, 2017). The complexity of healthcare and
pandemic burden requires healthcare providers possess tools, such as a strong professional
identity, for protection from burnout and stress (Edwards & Dirette, 2010; Wagner et al, 2021).
The consequences of not addressing student professional identity development are significant
and include ineffective student transition to professional role, stress, burnout, and poor resilience.
Most importantly, neglecting professional identity formation potentially compromises effective
future patient care (Kalet et al., 2021; Sawatsky et al., 2020). Not prioritizing professional
identity formation creates malalignment with the mission to advance physical therapy practice
through education and professional service. Mission malalignment could potentially impact
student enrollment through abandoning WU as a choice for an effective educational professional
journey. Comprehensively, this problem is important to address to produce compassionate,
resilient students who effectively transition into the clinic and provide exceptional patient care in
the complex world of healthcare.
Overview of Theoretical Framework and Methodology
The framework guiding this study is the social cognitive theory. The central component
of the social cognitive theory is the reciprocal interaction between the individual, behavior, and
environment as well as social interaction affecting learning and behavior (Bandura, 1986a;
Schunk & Usher, 2019). This theory is ideal for analysis of professional identity formation
because environmental (culture), behavioral (interaction between faculty and students), and
personal (experiences/cognition) factors reciprocally interact impacting student engagement and
6
effectiveness in this transformational process. Generation of assumed influences for the
conceptual framework were based on themes revealed during review of foundational literature.
The research strategy includes collecting data to ascertain student perceived PIF influences. Data
collection will comprise anonymous surveys including both quantitative and qualitative
questions. Drawing on both closed-ended questions and open-ended questions with a convergent
approach will provide stronger insight into student perceptions (Cresswell, 2018). Qualitative
data from open-ended survey questions will serve to understand meaning of impactful
experiences and will inform strategies consistent with healthcare education reform
recommendations.
Definition of Terms
To ensure clarity and alignment, the following section presents key terms and definitions
related to this study.
American Council of Academic Physical Therapy
The American Council of Academic Physical therapy is a non-profit organization which
the “principal voice representing academic physical therapy” and endorses excellence in physical
therapy education (ACAPT, n.d., para. 1).
American Physical Therapy Association
The American Physical Therapy Association (APTA) is professional organization that
represents U.S. member physical therapists and student physical therapists. It is considered a
leading professional organization for supporting physical therapy in the U.S. and was established
in 1921. (APTA, n.d)
Educational Outcome
7
The term educational outcome is broader than test results and is “more encompassing,
and more far-reaching educational results, including the impact that education has on individuals
and society” (Glossary of Education Reform, n.d., para. 6).
Professional Identity Formation (PIF)
Professional identity formation is the complex transformational process of self-identity
merging with a professional identity within the context of a specific profession (Sarraf-Yazdi et
al., 2021). It is the internalization of a set of values, code of conduct, and perception of oneself
within those values and professional role with resulting attributes, behaviors, and attitudes
(Cruess et al., 2014; Sarraf-Yazdi et al. 2021). This process is a lifelong developmental process
and includes a commitment to the profession, assimilation of professional traits and virtues, and
envisioning of future professional self as transformation from student to professional occurs
(Jensen & Jetten, 2016; Sarrif-Yazdi et al., 2021; Wald, 2015).
Organization of the Dissertation
Five chapters were used to structure the content of this study. The current chapter is a
contextual overview of the problem of practice, stakeholders, and brief description of the theory
used to explore the problem. The second chapter presents a detailed review of relevant literature,
and discussion of previous theories used to analyze professional identity formation, ending with
presentation of the conceptual framework underpinning the study. Chapter Three includes
detailed presentation of the methodology, participants included, and explanation of data
collection and analysis. In Chapter Four data analysis and results are presented. Finally, based on
the data results and literature, Chapter Five presents recommendations to address professional
identity formation in physical therapy curricula and concludes with further research
opportunities.
8
Chapter Two: Review of the Literature
Reform in healthcare education has progressively advocated for including student
professional identity development as an explicit educational objective (Cruess et al., 2014; Irby
et al., 2010; Noble et al., 2019; Wilkins, 2020). It is important to include professional identity
formation in healthcare education because a strong professional identity is linked to increased
compassion, increased resilience, decreased burnout, and increased persistence and retention in
education (Boehm et al., 2015; Edwards & Dirette, 2010; Schreiner et al., 2011; Wagner &
Jackson, 2021; Worthington et al., 2013). A developed professional identity also correlates with
increased job satisfaction, and successful transition from student to clinician (Noble et al., 2014;
Scanlan & Hazelton, 2019). Consequences of poor student professional identity include loss of
motivation and perceived academic achievement, increased stress, poor patient
care, compromised clinical decision making, and decreased self-confidence (Fitzgerald, 2020;
Hensen & Jetten, 2016). The educational goal of professional identity formation in healthcare
education is critical for effective transition and practice into the complex world of healthcare.
This chapter will review the relevant literature pertaining to the development of student
professional identity and the critical role of professional identity in healthcare education. The
history of professional identity formation and calls to healthcare educational reform are
presented. The benefits of a strong professional identity as well as barriers to this
transformational process are included. Previous theories used to examine professional identity
formation and existing literature gaps are described. The chapter concludes with the conceptual
framework introducing assumed factors potentially impacting physical therapy student
professional identity development.
9
An Historic Perspective of Professional Identity Formation
Professional identity is anchored in sociological historical context with rising prevalence
in healthcare education. This foundation begins with Dewey’s (1938) influential work
postulating that authentic learning is both experiential and social. Merton (1957) scaffolded off
of Dewey’s social construction of learning in a seminal work in medical education and asserted
that the role of medical education, beyond creating a practitioner, was to provide a professional
identity. He stated that to “think, feel, and act” like a physician was the goal of medical
education (Cruess et al, 2014, p. 1447; Merton, 1957). This phrase has anchored the defining
concepts of professional identity formation and some healthcare education programs are
replacing the term professionalism with professional identity formation (PIF). The re-framing of
student professionalism to professional identity formation within healthcare education is evident
in the literature (Cruess et al., 2014; Jensen et al., 2017; Janke et al., 2021; Maitra et al., 2021).
Using the term professional identity formation additionally presents students with an effective
language and framework to reflect on this process during healthcare education (Miatra et al.,
2021).
Definition of Professional Identity Formation
Professional identity formation is a complex process moving beyond behavior to the
longitudinal internalization of professional beliefs and values. Professional identity has been
defined as the transformation of a student’s actions, values, and attitudes into a profession
through socialization (Kendall et al, 1957). Leaders in defining and advancing professional
identity formation in healthcare education assert that this is a dynamic, iterative process, and
evolves over time (Cruess et al., 2015; Wald, 2015). A concept analysis of literature in
healthcare by Fitzgerald (2020) clarified the definition of PIF. The analysis concluded that
10
professional identity is the integration of personal identity, professional group identity,
professional skills and knowledge, and the beliefs, values, and ethics within a specific context of
care (Fitzgerald, 2020). In alignment, a recent scoping review of literature on PIF in medical
education determined that construction of professional identity involves embedding
“professional beliefs, value systems and codes of conduct into a pre-existent concept of
personhood” (Sarraf-Yazdi et al., 2021, p. 3516). Professional identity formation advocates argue
that the process is complex and impacted by the community of practice. For healthcare students
the community of practice is the academic world, centering this concept as critical for educators
to embrace (Cruess et al., 2015; Trede et al., 2012; Wald, 2015). Finally, it is contended that
development of professional identity incudes the virtue to act ethically and with morality
(Holden et al., 2012; Wald, 2015). In agreement, research supports that moral development,
ethics, and giving account for actions are also defining characteristics of professional identity
(Fitzgerald, 2020; Haghighat et al., 2020; Hammond et al., 2015). For example, research of
nursing students found a significant positive correlation between professional identity formation
and moral development highlighting moral agency as a defining construct (Haghighat et al.,
2020).
In summary, the definition of professional identity formation is a complex process which
occurs over time with internalization of beliefs, values, and attitudes through socialization,
experiences, and modeling into a pre-existent personal identity with moral development in a
professional context. This process impacts the behavior, thinking, and feelings of the individual
developing their professional identity.
11
The Process of Professional Identity Formation
Many factors contribute to professional identity formation. Elements of professional
identity formation include a continuous process evolving over a lifetime, internally constructed,
occurs individually and collectively, and is profoundly impacted by socialization. These
components are addressed in the sections below.
A Lifelong Process
As opposed to professionalism, professional identity development is considered a lifelong
developmental process which critically changes the focus from doing to being, or becoming
(Cruess et al., 2014; Jarvis-Selinger et al., 2012). This dynamic, iterative process which occurs
over time is transformational and involves the internalization of the values of a profession which
is reflected in the attitudes, feelings, and thinking of the individual within a particular community
of practice (Cruess et al., 2015; Wald, 2015). Student professional identity formation is
considered a defining process of who students envision themselves becoming in the professional
future or “future possible selves” (Jensen & Jetton, 2016, p. 1030; Yakov et al., 2021).
An Internal Process
It is argued that professional identity formation is an internal process, rather than external
behavior, which further complicates assessment of student professional identity formation
(Garza, 2021; Wald, 2015). In partial agreement, Moseley et al. (2021) compared the constructs
of professionalism and professional identity formation and suggested an amalgamation of the
two. Instead of emphasizing one or the other, Moseley et al. (2021) stipulates that
professionalism and professional identity formation are inextricably linked; professionalism as
the external component evidenced by behavior, communication, and performance, with
professional identity formation as the internal manifestation of values, attitudes, feelings, and
12
thinking. Accordingly, opportunities for self-reflection and enhanced self-awareness positively
impact the internal process of PIF during healthcare education (Maitra et al., 2021; Sarraf-Yasdi,
2021; Yakov et al., 2021).
Process Occurring at the Individual and Collective Level
In addition to being considered an internal process, professional identity formation is
suggested to occur individually and collectively. Jarvis-Selinger et al. (2012) assert that
professional identity occurs at the individual level and collective level as students begin to
participate in professional roles (Jarvis-Selinger et al., 2012). Professional identities, intertwined
with personal identities, evolve during educational experiences and impact students’ professional
identity (Hammond et al., 2016; Sonday, 2021; Yakov et al., 2021). Personal attributes and
experiences contribute to development of professional identity formation (Adams et al., 2006;
Ashby et al., 2016, Yakov et al., 2021). Adams et al. (2006) determined factors impacting
professional identity formation prior to initiation of training. Results revealed that gender,
previous healthcare work experiences, knowledge of profession, and learner adaptability to
situationally structure knowledge all impacted professional identity development (Adams et al.,
2006). The impact of individual identity highlights that each student’s professional identity
formation journey is unique and student experiences and view of the professional self differs
despite analogous educational levels (Grey et al., 2020; Holden et al., 2012; Moseley et al., 2021;
Sonday, 2021).
Process of Socialization/Role Modeling
In addition to convergence of personal and professional identities, student professional
identity formation is situated in social interaction where role models, observation of instructors,
professional culture, and learning communities impact development. A scoping review of
13
professional identity formation in medical education by Sarraf-Yazdi et al. (2021) revealed
socialization is a significant facilitator of PIF but also discovered it is a potential barrier with
respect to insufficient university support. This review compared themes from editorials,
perspectives, and non-research sources to peer-reviewed literature and found that the significance
of emphasis on socialization to support identity development was identical (Sarraf-Yazdi et al,
2021). Reviews of literature in healthcare education suggest that professional identity formation
should not be left to chance (Chandran, 2019; Cruess et al., 2014; Janke et al., 2021; Sarraf-
Yazdi et al., 2021). Instead, research supports that future healthcare education should include
assessment tools and intentional design of experiential and didactic opportunities to support
student PIF (Chandran, 2019; Garza et al., 2021a, Garza et al. 2021b, Janke et al., 2021). The
professional identity development process is not solitary and requires supportive strategies,
relationships, intentional curricular design, and learning environment to enhance the integration
of the student's personal and professional identity (Foster & Roberts, 2016; Janke et al., 2021,
Keshmiri et al., 2020; Sarraf-Yazdi et al., 2021).
Beyond socialization and deliberate curricular strategies, support of PIF is significantly
influenced by educators through mentoring and role-modeling (Ashby et al., 2016; Sarraf-Yasdi
et al., 2021). Relationships and strong role models have been asserted as one of the most critical
factors in professional identity development (Foster & Roberts, 2016; Holden, 2012). The impact
of faculty behavior, faculty student communication, and professional culture created as role
models have an “enduring impact” on the professional identity of healthcare students (Foster &
Roberts, 2016, p. 9; Schreiner et al., 2011). Research on occupational therapy students
determined that social relationships and acquisition of instructors as role models encouraged
development of student professional identity (Ashby et al., 2016; Grey et al., 2020).
14
Observation, a component of social learning, is another factor that significantly impacts
the construction of professional identity (Yakov et al., 2021). Chandran et al., (2019) contend the
profound significance of socialization and observation for student learning. Research supports
that students observe professional behavior and through behavior patterning and imitation
internalize and develop their own professional identity (Hammond et al., 2016; Johnson &
Chauvin, 2016). Therefore, construction of professional identity is impacted powerfully by
socialization through relationships, role modeling, and observation. Despite research supporting
the impact of the educators’ role, educators may not understand the significant influence they
have on students’ perception of themselves in a professional context (Sternszus et al., 2020). The
call within healthcare education exists to create environmental learning spaces, intentional
relationships, and curricular design to support the transformational process of student
professional identity formation (Cruess et al., 2015; Janke et al., 2021; Sonday, 2021; Wald,
2015). For example, in a national study of educational reform in physical therapy education,
Jensen et al. (2017) called for professional formation to be “deeply embedded” in curricula (p.
880). The educational priority of professional identity development in healthcare education can
be incorporated with intentional curricular design, mentoring, clear outcomes, and socialization
within healthcare education (Wilkins, 2020).
Factors Impacting Student Professional Identity Development
Many factors can facilitate or function as barriers to the complex process of developing
student professional identity. These barriers and facilitators are addressed in the following
section.
Facilitators
15
The facilitation of student identity formation is supported by socialization, observation,
intentional curricular design, and supportive educational culture. Socialization, including
mentoring and role models, is one of the most critical components impacting students (Foster &
Roberts, 2016; Holden, 2012; Noble et al., 2019). A scoping review of literature in the field of
pharmacy education reveals that social experiences strongly impact student professional identity
(Noble et al., 2019). Faculty who connect authentically with students improve student success
and students perceive these interactions with educators as a defining factor in their professional
identity development (Jenson & Jetton, 2018; Schreiner et al., 2011). The impact of faculty and
authority figures is significant, particularly during the early developmental process of
professional identity (Ashby et al., 2016; Grey et al., 2020; Johnson & Chauvin; 2016). The
formation and ownership of identity occurs socially, with relationships in particular contexts, and
as students individually and collectively navigate roles and responsibilities (Hammond et al.,
2016; Jarvis-Selinger et al., 2012).
Coupled with social learning, observation, also influences the transformative process of
PIF. Student observation of faculty as role models and authority figures heavily influence student
professional identity development, particularly early in healthcare education (Ashby et al., 2016;
Johnson & Chauvin; 2016).
Likewise, intentional educational design impacts students’ professional identity
development. To bridge the gap from student to healthcare professional, a holistic process of
identity development must be incorporated with intentional curricular design, clear outcomes,
and socialization within the learning environment and healthcare field (Noble et al., 2019;
Wilkens, 2020). Curricular design with space for reflection on learning, self-awareness, and
practical experience impacts student professional identity development (Chandran et al., 2019;
16
Maitra, 2021; Sarraf-Yazdi, 2021; Sonday, 2021; Wagner & Jackson, 2021). Intentionally
designing curriculum with self-reflection space, patient encounters, self-awareness opportunities,
and identity knowledge embedded throughout an educational program supports professional
identity development.
Similarly, the values in the educational practice and culture of the learning environment
also shapes professional identity development. Culture, created by the dynamics of the health
care team and interprofessional educational experiences contribute to supporting professional
identity (Maitra, 2021; Sonday, 2021). A study designed to understand how learning culture and
curriculum impact medical student PIF at Harvard established that explicitly revealing values in
curriculum and culture is an institutional process that crucially supports professional identity
development (Gaufberg et al., 2017). Additionally, a learning culture of supportive and “caring
relationships” of peers and faculty was effectual (Gaufberg et al., 2017, p. 258). For this reason,
a recent report by the American Association of Colleges of Pharmacy calls for a culture change
within pharmacy education including intentional and explicit student and faculty support for
professional identity as an educational goal (Janke et al., 2021).
Barriers
The aforementioned factors which support professional identity development can
potentially be barriers to student growth as well. Prevalent in research is a paucity of role
modeling and mentoring which negatively impacts professional identity development. Review of
literature suggests actual teaching occurs through socialization implicitly, and negative role-
modeling erodes values and professionalism (Fitzgerald, 2020; Martimianakis et al., 2015;
Sarraf-Yazdi, 2021). Inconsistent faculty role and limited role modeling undermines student
professional development during healthcare education (Del Prato, 2013; Keshmiri et al., 2020;
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Noble et al., 2014; Sarraf-Yazdi, 2021; Silveira et al., 2019). Factors impacting educator
engagement include uncertainty professional identity formation definition and underestimation
of influence on the process (Sternszus et al., 2020). In addition, limited time for mandatory
curricular content during didactic training limits opportunities for observation of role models,
feedback, and time for student self-assessment of professional identity (Noble, 2014).
Limited feedback and reduced opportunities for reflection additionally minimize student
professional identity development. If students do not have time to self-assess their own
professional identity and are not provided ample opportunities for feedback student professional
identity growth is diminished (Noble et al, 2014; Sarraf-Yazdi, 2021). During curricular learning,
instructor uncertainty and commitment, lack of connection of relevance of content to future
practice, absence of patient centeredness in care, and poor organizational support are additional
barriers to professional identity formation (Keshmiri et al, 2020; Sarraf-Yazdi, 2021).
Dissonance between hidden and explicit curriculum is detrimental to development of
student professional identity formation. Inconsistent messages between faculty teaching and
modeling and incongruence between role modeling and institutional values lead to student
confusion, frustration, disassociation, and silence (Mackin et al., 2019; Phillips & Clarke, 2012).
Furthermore, malalignment between faculty teaching and actions produces negative student
emotion and learning impacting professional identity development (Phillips & Clarke, 2012;
Silveria et al., 2019). All in all, the research reveals the significant influence, whether as barriers
or facilitators, that faculty relationships, institutional culture, and curricular alignment have on
shaping students’ professional development.
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Benefits of Strong Professional Identity
There are many benefits for developing a strong professional identity in healthcare
education students. The benefits include increased resilience, enhanced provider well-being,
educational retention, decreased burnout, job satisfaction, and improved transition from student
to clinician. Development of professional identity contributes to healthcare provider well-being
and diminished stress (Jennings, 2009; Mavor et al., 2014). Additionally, in the high burnout
healthcare sector, a strong professional identity is linked to reduced risk of burnout and increased
resilience (Edwards & Dirette, 2010; Mavor et al., 2014). Researchers found that reduced
professional identity was correlated with three components of burnout: depersonalization,
emotional exhaustion, and lack of personal accomplishment (Edwards & Dirrette, 2010). On the
other hand, students with a strong professional identity demonstrated increased grit, greater
compassion, and more effective transition into the clinic and professional role (Noble et al.,
2014; Silveira et al., 2019; Sternszus et al., 2020; Wagner & Jackson, 2021). Finally, job
satisfaction is higher in clinicians with stronger professional identity (Scanlan & Hazelton,
2019). It is clear in the literature that developing a strong professional identity supports student
well-being and transition to clinician.
Measurement of Professional Identity
The quantitative measurement of student professional identity is limited by few measures
and weak psychometric support. A systematic review of measures of professional identity in
healthcare education identified eight tools in allied health, nursing, and medicine (Matthews,
Bialocerkowksi, & Molineux, 2019). Findings included limited psychometric evidence for most
measures and the authors concluded the revised Nurses’ Professional Values Scale and the
Macleod Clark Professional Identity Scale (MCPIS) had the strongest psychometric properties to
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support use (Matthews et al, 2019). Because the MCPIS, Professional Identity Five Factor Scale,
and the Professional Self Identity Questionnaire have been tested on health students in a variety
of fields, they can be used in numerous healthcare fields (Johnston & Bilton, 2020; Matthews et
al., 2019). Instead, focused only in medical education, the developing scale (DS) was created to
quantitatively evaluate medical trainees’ professional identity development by measuring
attitudes, reflection, emotional control, and perceived role (Tagawa, 2019). An additional
technique applied in medical education includes professional identity essays which are correlated
with Kegan's stages of development and student feedback given (Kalet et al., 2017). Overall,
professional identity can be measured but is limited by psychometrically-sound support which
may contribute to underutilization of professional identity formation in education.
Professional Identity in Healthcare Education
Higher education has a responsibility in student professional identity development. A
systematic literature review of identity development in higher education, supports the university
role in facilitating professional identity formation stating “Universities need to claim their role in
professional identity development to prepare graduates for global citizenship, leadership and
future practice” (Trede, 2012, p. 379). Studies have shown that prior to graduate school,
university students express the perceived need to develop a professional identity regardless of
field of study (Jensen & Jetton, 2016).
There has been an evolution of professional identity formation in healthcare education
with calls for professional identity formation to become an educational objective in healthcare
education (Cruess et al., 2019; Noble et al., 2019; Wilkins, 2020). A seminal study by the
Carnegie Foundation for the Advancement of Teaching suggested four areas of change
supporting healthcare educational reform. One of these changes included a strong emphasis and
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goal of professional formation in medical curricula (Irby et al., 2010). In agreement with the
Carnegie report, leaders in professional identity development assert that an educational objective
of professional identity development in healthcare education is a necessity in the complex world
of healthcare (Wald, 2015; Wilkins, 2020). For students to bridge the gap from student to
healthcare professional a holistic process of identity development must be incorporated with
intentional curricular design, mentoring, clear outcomes, and socialization within their learning
environment and the healthcare field (Sarraf-Yazdi et al., 2021; Wagner & Jackson, 2021; Wald,
2015; Wilkins, 2020). Research continues to expand on PIF in healthcare education however the
primary sources of research have been in the fields of medicine, nursing, pharmacy, and
occupational therapy (Edwards & Dirette, 2010; Haghighat et al., 2020; Noble et al., 2014;
Noble et al., 2019; Ong et al., 2020; Sarif-Yazdi et al., 2021; Scanlan & Hazelton, 2019; Walder
et al., 2021).
Existing Strategies Incorporating PIF in Healthcare Education
In a scoping review of literature in the field of occupational therapy, Walder et al. (2021)
suggests movement from discussing PIF to actionable implementation that can help students
overcome challenges to professional identity formation. The literature reveals numerous
strategies have been used to establish PIF as a priority in healthcare education. Establishing a
professional identity thread woven throughout curriculum to guide student growth is noted in
research (Chandran et al., 2019; Janke et al., 2021; Sarraf-Yazdi et al., 2021). Other effective
strategies implemented include individual student professional identity formation portfolios or
students charting their personal PIF throughout curriculum (Cruess et al., 2019; Kalet et al.,
2017; Sarraf-Yazdi et al., 2021). Establishing an explicit educational goal and using the term
“professional identity formation” can provide students with an effective framework and language
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to reflect on this critical transformational process (Cruess et al., 2019; Janke et al. 2021; Maitra
et al., 2021; Noble et al., 2019; Wald, 2015). Because socialization is such a key component of
professional identity development, mentoring is another leading approach included to facilitate
PIF as an educational priority (Moseley et al., 2021; Wilkens, 2020).
Adding to curricular pathways and mentoring, alignment of faculty with program goals
combined with explicit educational design and intentional PIF teaching strategies have been
successfully used in healthcare education to develop professional identity (Garza et al., 2021;
Johnson & Chauvin, 2016; Kalet et al., 2017; Mukhalalati & Taylor, 2020). Adjusting
curriculum to include narrative medicine, humanities, and interprofessional education promotes
student PIF as well (Blanton et al., 2020; Ginsberg, 2017; Harman et al., 2021). Studies
demonstrate that with curricular adjustments, measurement of and assessment of PIF additionally
encourages professional identity development (Ginsberg et al.; Kalet et al., 2017; Tan et al.,
2017). Furthermore, strengthening student PIF occurs with opportunities for student self-
reflection and explicit institutional values and culture (Gaufberg et al., 2017; Janke et al., 2021;
Sonday et al., 2021; Wagner & Jackson, 2021). In summary, research supports multiple effective
existing strategies woven into healthcare education to ensure student PIF as an educational goal
and facilitate student success (Garza et al., 2021).
Professional Identity in Physical Therapy Education
In contrast to research in other healthcare professions on professional identity, research
on professional identity in physical therapist education is limited. Of the few studies noted, one
study examined a study abroad experience and identity development, another examined
practicing physical therapists rather than students, and one combined physical, occupational, and
speech therapy students’ perceptions of factors that shaped their professional identity during
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education (Hammond et al., 2015; Hayward, 2014; Sonday, 2021). However, two recent studies
focused only on physical therapy students (Harman et al., 2021; Wagner & Jackson, 2021). The
first was a qualitative study of 1st year physical therapy students examining interprofessional
education and other factors impacting student professional identity formation from the student
perspective (Harman et al., 2021). The second study, by Wagner & Jackson (2021), examined
physical therapy students in a single cohort to determine if structured educational strategies and
guided reflection impacted professional identity formation.
Limited research of professional identity development in physical therapy education
exists despite national physical therapy educational reform leaders calling for educational
emphasis in PIF. The National Study of Excellence and Innovation in Physical Therapist
Education in 2017 included nine action items that were deemed critical for excellence in physical
therapy education (Jensen et al., 2017). One of the critical items, on which the study called for
immediate implementation, was professional formation emphasis with a continuum of
professional performance expectations embedded in curriculum (Jensen et al., 2017). A
recommendation paper by the America Physical Therapy Association asserts that professional
formation be a primary focus of education with intentional mentoring throughout education to
facilitate inculcation of professional values and morals (American Physical Therapy Association,
n.d.). Physical therapy program learning outcomes are required by the accrediting body, however
there are currently no guidelines reflecting determination of outcomes. Prior to the call for
including professional formation in curricula, Grignon et al. (2014) analyzed the educational
outcomes of seventy-five physical therapy programs and of the ten guideline themes that
emerged in programs at that time “professional role,” “professionalism,” “professional
commitment,” and “professional growth and development” were noted. These four themes relate
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to PIF, however, the conceptual process of professional identity formation was never mentioned
(Grignon et al, 2014). Despite the recommendation supporting the advancement of professional
identity in physical therapy curricula, professional identity formation is not a current educational
goal in some programs. Outside of physical therapy, other healthcare education programs have
demonstrated success in supporting student PIF through implementation of explicit curricular
pathways, PIF portfolios, reflection, PIF assessment, narrative and humanities in curricula,
faculty development, PIF as a formalized educational goal and as an aspirational goal for
students (Blanton et al., 2020; Cruess et al., 2014; Garza et al., 2021a; Garza et al., 2021b; Janke
et al., 2021; Sarraf-Yazdi et al., 2021). These previously-used interventions potentially inform
interventions and opportunities within physical therapy education as well.
Research Gaps Existing in Physical Therapy Education
Secondary to the dearth of research in the healthcare education field of physical therapy,
a gap exists to further understand student professional development during physical therapy
education. Examining student voice may reveal how socialization and faculty-student interaction
impacts PIF. Congruently, a gap in the literature is noted regarding student perspective of
influences impacting PIF and suggests need for further research of socialization impact on
professional identity development (Cruess et al, 2014; Sarraf-Yazdi, 2021). In agreement,
Johnson and Chauvin (2016) state previous works do not address the “nature of intentional
interactions between faculty and students” supporting professional identity formation (Johnson &
Chauvin, 2016).
Recommendations for research have included examining how students recognize
educators and interpersonal interactions with faculty impacting identity formation potentially
changing how students feel about themselves and their identity (Jensen & Jetton, 2018). Other
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recommendations include researching cultural and organizational issues impacting faculty
engagement and explicit inclusion of professional identity in curricula (Sternszus et al., 2020).
This research attempts to meet this recommendation by examining student perceptions of factors
impacting student professional identity development in physical therapy education.
Previous Theoretical Frameworks Applied to Professional Identity Formation
Determining one theoretical framework through which to view professional identity
formation is difficult because of the many factors shaping an individual’s professional identity
including; personal identity, group identity, curriculum, socialization, relationships, role-models,
reflective ability, feedback, and personal experiences (Fitzgerald, 2020; Sarraf-Yazdi et al., 2021
Sonday, 2021; Wald, 2015; Yakov et al., 2021). In a recent synthesis of PIF Moseley et al.
(2021) suggest theories relevant to examining professional identity development in healthcare
education including the social identity theory, social learning theory, self-determination theory,
self-authorship theory, and social constructivism theory to help educators understand
professional identity within the context of healthcare education. Many theories have previously
been used to conceptualize the challenging concept of professional identity formation. The
following section examines a variety of previously used theories and their contribution to the
understanding of professional identity development.
The social identity theory has been used as a lens to research professional identity
development in healthcare (Jensen & Jetton, 2018; Willetts and Clarke, 2012). The primary
concepts of the social identity theory posit that social identity, group belongingness, and an
individual’s sense of respect within a group impacts individual self-esteem (Tajfel & Turner,
1979). Overall, the emphasis of this theory anchors professional identity in the context of an
organizational group with categorization of “us” and “them” and social identification and
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meaning however does not give attention to the personal factors that may impact professional
identity development.
Comparatively, Cruess et al. (2019) assert that relevant educational or learning theories
are needed to situate and frame professional identity formation. They suggest the situated
learning theory and communities of practice, both part of the sociocultural theory, as frameworks
for educators to make intentional decisions about interactions to support identity development
(Cruess et al., 2019). The situated learning theory emphasizes how individuals learn as they
progressively participate in a group or community of practice (Lave & Wenger, 1991).
Prominent in the community of practice theory is the concept that individuals become who they
are through social engagement as opposed to this theory stressing impact of individual or
organizational characteristics (Wenger, 1998). The informal community of practice and
individual’s social participation or engagement over time shapes learning and who they become
(Wenger, 1998). Wenger (1998) describes construction of individual identity stating “Learning
transforms who we are and what we can do, it is an experience of identity. It is not just an
accumulation of skills and information, but a process of becoming” (p. 215). It is asserted that
the community of practice theory leaves space for other learning theories within it and is able to
explain the process for identity development and the strategies that support it (Cruess et al.,
2019). This theory continues to evolve and emphasizes individual engagement and the passage of
time impacting development, however has limited account for personal factors and potential
organizational factors which impact identity development.
In addition to the community of practice theory, Johnson and Chauvin (2016) applied the
self-authorship theory to pharmacy student reflections revealing alignment to self-authorship
theory phases. Results indicated that students progressed from being influenced primarily by
26
authority progressively to the influence of self as their professional identity strengthened
(Johnson & Chauvin; 2016). The Baxter Magolda (2008) self-authorship theory based on
Kegan’s (1994) work is described as an internal complex and iterative process and as the
“internal capacity to define one’s beliefs, identity, and social relations” (p. 269). This theory
argues that the internalization of identity, beliefs, and social relationships is the mechanism for
how individuals construct meaning and therefore respond to the world (Baxter Magolda, 2008).
Within this theory both the individual and the interaction in the world is how the individual
constructs meaning.
The anticipatory socialization theory has also been applied to examine how physical
therapy students construct professional identity. A study of 1st year physical therapy students
revealed that relationships with peers, lab instructors, faculty, and other students from other
healthcare programs had the most significant impact particularly early in the educational
program (Harman et al., 2021). The anticipatory socialization theory highlights the process of an
individual aligning personal behaviors, values, standards, and attitudes with the particular group
they desire to join (Merton, 1968). The social interactions occurring in the group the learner
desires to join, formally and informally, feelings of belonging, expectations, and the created
culture are critical to student development of professional identity (Harman et al., 2021).
Although this theory highlights socialization, it does not describe the impact of personal
characteristics which have the potential to impact professional identity.
Harman et al. (2021) also applied the identity formation theory to physical therapy
students. The theoretical framework of identity formation is based on Erikson’s (1980) identity
theory. This theory was expanded upon by Kegan (1982) as establishing the lifelong process of
meaning-making and role acquisition. The effective transition from student to healthcare
27
provider requires more than professional behavior, but additionally embraces professional
identity development; the internalization of beliefs, values, morals, and attitudes of a healthcare
practitioner (Wilkens, 2020, Cruess et al. 2016). Using the identity theory to explore student
professional formation moves beyond behavior to explore the lifelong process of becoming a
professional.
Despite the differences between the aforementioned theories’ perspectives, they are
mutually informative and have a shared basis using components of the social cognitive
framework to address the process of professional identity development within a constructivist
development framework. Constructivism argues that learning and knowledge are created based
on individual’s experiences (Piaget, 1977). Because the social cognitive theory is broad and
encompasses the interaction of the environment, individual, and behaviors, this theory is used for
this research analyzing the complex factors impacting student professional identity development.
Social Cognitive Theory
The social cognitive theory began as the social learning theory, developed by Bandura,
asserting that learning primarily occurs through observation and modeling (Bandura, 1977).
Reflecting increased emphasis on internal cognitive learning impacting behavior in his published
work in 1986, he adjusted the name to the social cognitive theory (Bandura, 1986a). With a
broad perspective, the social cognitive theory recognizes both the internal and external factors
contributing to individual behavior (Bandura, 1986a). The central component of the social
cognitive theory is the influence of social exchange and the reciprocal interaction of individual
cognition, behavior, and environment affecting learning and behavior (Schunk & Usher, 2019).
This constant interaction between environment, individual, and behavior and impact on each
other is called triadic reciprocity (Bandura, 1986). The following section provides foundational
28
research to support connection between key aspects of social cognitive theory; the socialization
and observational learning in environment, behavior secondary to self-efficacy, and individual
knowledge, expectations, and experiences pertaining to the potential ramifications on
professional identity development in physical therapy students.
Environment: Observational Learning and Socialization
The social cognitive theory emphasizes environment as one of the foundational
components of triadic reciprocity. According to Bandura, the environment impacts an
individual’s thinking and learning which affects behavior (Bandura, 1986a). This behavior then
reciprocally impacts the environment as well. A component of environment is social interactions
and observational learning. The social cognitive theory postulates that learning occurs vicariously
through socialization, observation, and credible role modeling which guides future behavior
(Bandura, 1977; Bandura 1986a). For example, a Harvard study analyzing the processes that
underpin professional identity formation in a medical clerkship revealed that the caring
relationships and environment that faculty created with patients and students were models that
students emulated when treating their own patients (Gaufberg et al., 2017). Students valued the
care they observed and received from faculty which impacted student thinking and behavior.
This example of reciprocal interaction of environment, thinking, and behavior aligns with the
social cognitive theory (Bandura, 1986a).
Behavior: Self-Efficacy and Motivation
In addition to learning through environment, Bandura acknowledges that motivation
impacts the complex process of learning and behavior (Bandura, 1986a). Personal or individual
factors such as perception of self-efficacy and confidence to execute certain behaviors are
important constructs in the social cognitive theory and contribute to engagement and motivation,
29
which impact each other and are additionally impacted by the environment (Bandura, 1986a;
Bandura, 1986b; Bandura & Cervone, 1986). Bandura’s theory addresses the inherent
motivational processes to learning with the construct of self-efficacy (Bandura, 1986a).
Individual: Knowledge and Expectations
An individual’s knowledge, processing of previous experiences, and expectations also
regulate behavior and learning within the social cognitive theory. Bandura (1999) suggests that
individuals use personal agency and thinking that is both generative and reactive. Cognition and
expectations interact bidirectionally on behavior patterns and the environment influencing the
individual’s behavior and learning (Bandura, 1999). In essence, the social cognitive theory with
the reciprocally interacting components of environment, behavior, and individual expectations
allows effective analysis student perceptions of student professional identity development.
Conceptual Framework
A conceptual framework synthesizes the relationships and interrelated components of the
theories and empirical findings from the literature to highlight the relevant variables of this
study. The constructs and key theoretical principles used to design the conceptual framework are
noted in the following section.
Theoretical Foundations
The conceptual framework for this research is anchored within the social cognitive theory
describing the influence of others, personal experiences, and environmental factors on individual
learning and behavior (Bandura, 1986a). Empirical factors impacting student professional
identity development from environment, behavior, and individual experience align with the
social cognitive theory.
30
An additional theory applied to conceptualize this study is the identity development
theory. The identity development theory acknowledges that the internal process of identity
development is both a social and individual endeavor (Erickson, 1980). Development of
professional identity and understanding of self is critical for physical therapy students as they
transition into the clinic developing a sense of future, goals, and who they are within the
professional role (Adams & Marshall, 1996). Consistent with research on identity theory, the
conceptualization of this research incorporated the identity theory which ensures that the
individual, iterative, longitudinal process of professional identity formation remains central to
the study. Moreover, it underscores the key principle that identity formation is an internal
process of meaning-making which occurs as students move through physical therapy education.
Core Concepts and Graphic Representation
A conceptual framework within the social cognitive theory, examining factors impacting
student professional identity is presented with core concepts relevant to this study. Core concepts
reflect the previously presented review of literature of factors impacting student professional
identity formation. These core concepts include student active engagement, self-reflection, role-
modeling, feedback, lived experiences, and assessment. These concepts are positioned
graphically in the three domains of the social cognitive theory representing the reciprocal
interaction of the person, environment, and behavior in Figure 1.
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Figure 1
Conceptual Framework
Assumed Influences in Conceptual Framework
The problem of underutilization of PIF as an educational priority is multi-faceted and
informed by analysis of student perceived factors impacting professional identity formation
during didactic curricula. The following sections include presentation of the assumes influences
noted in the conceptual framework using the social cognitive theory impacting student PIF based
on literature review.
Behavioral Influence: Active Engagement
The process of PIF is internal and requires students to actively engage in the aspirational
goal of development of professional identity (Hammond et al., 2015; Moseley et al., 2021).
Identity development includes how an individual sees themselves now and, in the future, and is
32
unique to each student incorporating personal with professional identity (Cruess et al., 2014;
Cruess et al., 2019; Jarvis-Selinger et al., 2012). Supporting learners’ autonomy in discovering
their roles is evident (Gaufberg et al. 2017). Students must have knowledge of their role and self-
determination to actively engage in the process of PIF. Understanding student awareness and
perceived role in this process is instrumental to potential future program development.
Personal Influence: Self-Reflection
Metacognition is knowledge about one’s own thinking and cognition or knowledge about
oneself and is necessary for students (Krathwohl, 2002). A component of metacognition is
reflective practice, commonly used in PIF curriculum, described as “critical thought and self-
examination” and a metacognitive strategy used for learning (Barley, 2012, p. 273). Studies
exploring medical students reveal that self-awareness and reflective practice strengthen student
professional identity development (Maitra et al., 2021; Yakov et al., 2021). Holden et al. (2012)
maintains self-awareness is a component of PIF. Reflecting on actions or experiences allows
students to evaluate their thinking and choices, identify areas for growth, and impacts
professional development (Wilson, 2008). Because PIF is an internal process, students require
opportunities for self-reflection to strengthen professional identity (Noble et al., 2014, Sonday,
2021). The self-reflection construct will be explored as a factor impacting student PIF.
Environmental Influence: Role-Modeling
An additional factor impacting student professional identity development is role-
modeling. Physical therapy students spend 2 years on campus with faculty participating in
designed lecture and lab experiences. This provides opportunities for faculty-student
socialization and student observation of faculty as professionals. Literature confirms that one of
the most critical factors supporting student professional identity development is the socialization
33
components of observation and role modeling (Ashby et al., 2016; Grey et al, 2020).
Accordingly, observation and role-modeling of faculty, as vicarious experiences, informs
student’s self-efficacy and motivation impacting behavior as professional identity is developed.
Exploring the construct of role-modeling provides an opportunity to understand faculty role in
student on-campus experiences impacting professional identity development.
Environmental Influence: Feedback
The environmental influence of feedback on professional identity will also be explored.
Feedback is a construct that supports motivation (Bandura, 1997). Individuals who receive
feedback on behavior or performance experience significantly greater increases in self-efficacy
than those receiving no feedback (Karl et al., 1993). Literature supports feedback as a key player
in student professional development (Noble et al., 2014; Sarraf-Yazdi, 2021). Accurate credible
feedback (aka social persuasion) on observed strengths and on areas for improvement can
increase student self-efficacy and motivation for professional identity development.
Consequently, faculty feedback supports professional identity development improving student
self-efficacy.
Environmental Influence: Assessment
An environmental influence impacting student professional identity development
supported in literature is formal assessment. What is measured is valued and a crucial component
in developing a culture reflecting values and a pathway to learning and communication. Schein
(2017) states that the “most powerful mechanism” that leadership has as a resource for
communicating what is important is “what they systematically pay attention too” (p. 184).
Consistently creating opportunities to measure and gauge student growth in a particular area
signals import and value with resulting culture change. A review of the literature imparts that
34
student professional identity can be measured (Johnston & Bilton, 2020; Kalet et al, 2017;
Tagawa, 2019). Literature calls for curricular design to include professional proficiencies along
the learner continuum which requires measurement (ACAPT, 2021). Measuring professional
identity development throughout the curriculum allows students to take ownership of and track
their progress over time. Intentional curricular design and outcomes with corresponding
assessment woven throughout programs are seen as cultural strategies impacting perceived value
and engagement in supporting student professional identity development (Sarrif-Yazdi,
2021;Wald, 2015; Wilkins et al, 2020). Explicit measurement of professional identity formation
during didactic curricula is explored as an environmental influence on student professional
identity development.
Environmental Influence: Lived Experiences
A final environmental influence impacting student professional identity formation are the
lived experiences occurring during didactic education. Research propounds that student
discovery of responsibility and roles is impacted by caring relationships and experiences (Del
Prato et al., 2013; Gaufberg et al., 2017; Sonday, 2021). Establishing an environmental culture
where these caring relationships, socialization, and values are made explicit supports student
professional identity development (Chandran et al., 2019; Gaufberg et al., 2017). Understanding
the lived experiences during didactic curricula that students perceive to impact professional
identity development as an environmental influence informs program PIF initiative development.
In summary, literature review identified numerous influences on student PIF including
active engagement, self- reflection, role modeling, lived experiences, feedback, and assessment.
These constructs, framed by the social cognitive and social identity theory, are graphically
represented in the conceptual framework and are the presumed factors explored in this study.
35
The study will additionally note the extent to which these factors align with previous research
and explore the lived experiences that physical therapy students understand to influence their
professional identity development.
Summary
The problem addressed in this research is the underutilization of student professional
identity formation as an educational objective. Professional identity formation is the internal life
long process of integrating personal identity with the beliefs, ethics, values, of a particular
profession which although impacts behavior and anchors professional identity in “being” as
opposed to “doing” (Cruess et al., 2014, p. 1448; Cruess et al., 2015; Fitzgerald, 2020; Sarraf-
Yazdi et al., 2021; Wald, 2015). The research indicates that process is supported by socialization,
observation and role modeling, intentional curricular design, and supportive educational culture
(Noble et al., 2019; Wilkens, 2020). The call within healthcare education exists for programs to
support the transformational process of student professional identity formation making it a
foundational component and explicit educational objective of healthcare education (Cruess et al.,
2015; Cruess et al., 2019; Noble et al., 2019; Wilkins, 2020; Wald, 2015). Including PIF
explicitly in healthcare education is critical because strong professional identity in healthcare
students is associated with improved student transition from classroom to the clinic, increased
retention during educational programs, improved healthcare provider well-being, decreased
stress, reduced risk of provider burnout, increased resilience, and decreased future lapses in
professionalism (Edwards & Dirette, 2010; Mavor et al., 2014; Noble et al., 2014). Professional
identity impacts healthcare student, clinical transition, and ultimately patient care and is vital to
include in physical therapy curricula (Kalet et al., 2021; Sawatsky et al., 2020). The purpose of
this study is to understand the student voice by exploring physical therapy students’ perceptions
36
of factors affecting the longitudinal process of professional identity development. There is well-
timed relevance of exploring professional identity formation in healthcare education with the
current emphasis beyond doing to being. A gap exists in the field of physical therapy education
in development of professional identity with limited research on physical therapy student
perceptions of impacting factors. Understanding student perception is vital to establish
professional identity formation as an educational priority and inform program development of
educational initiatives. The systematic methodological approach is detailed in the following
methodology section.
37
Chapter Three: Methodology
This study intends to identify perceived influences and explore the experiences of
physical therapy students impacting student professional identity formation in WU’s physical
therapy program during didactic education. This research will use the social cognitive theoretical
framework accompanying a convergent mixed methods design.
This chapter restates the research questions and will review components of the research
design and methodology. Research design is presented first, followed by a description of the
setting and researcher to improve transferability. Next, methodology is addressed with data
sources, methodology details, comprehensive instrumentation and data collection, and data
analysis. Finally, the limitations and delimitations of the research study are addressed.
Research Questions
The following research questions guide this study:
1. What factors do physical therapy students at various educational stages perceive as
impacting their professional identity development during didactic education?
2. What lived experiences with faculty and peers during didactic education do physical
therapy students understand to influence their professional identity development?
Overview of Design
The methodological design for this study was mixed methods. The data collection
included student surveys with both open-ended and closed questions to gather quantitative and
qualitative data. A convergent approach was implemented. Online surveys were completed by
students to discover perceived influences and trends including open-ended questions to provide
qualitative data for the purpose of deeper understanding of experiences, explanation of process,
and meaning making (Merriam & Tisdell, 2016). The intent of this strategic inquiry design
38
structure was to provide data to answer the research questions and reveal a richer understanding
of student perceived influences and experiences on PIF.
Research Setting
The physical therapy program at Whole University (WU) is accredited at the national and
state level. The university is a private parochial institution in California and is a constituent of
the school of allied health. WU’s physical therapy program is one of two hundred thirty
accredited physical therapy programs in the United States. The doctoral physical therapy
program at WU is a 3-year program with integrated clinical experiences. The first 2 years are
primarily didactic with the final year all clinical education. A new cohort begins yearly and
averages 60 students. Typical cohorts are 55% female, and 45% male. Many students live on or
near the campus and attend lab or classroom activities 4 to 5 days a week on campus. The
program consists of fifteen core faculty who teach courses and includes numerous contract
instructors. Purposive setting selection was enacted as the primary researcher is employed at this
institution. This program is an ideal research setting as it does not have educational outcomes
explicitly addressing student PIF despite educational reform recommendations. Participants will
include physical therapy students at various levels of education within one physical therapy
program. Students were chosen as participants because PIF is an internal student process and
student perspective and meaning-making is required to understand what experiences are
impactful to students for program development. Students invited to participate in the study
included three cohorts: 2nd year, 3rd year, and recent graduates as they have experienced more
time on campus with more opportunities for interacting with faculty, potentially influencing PIF.
39
The Researcher
Salient identities inform my approach and understanding of this problem. I am a core
faculty member of the researched program impacting study interest, research design, and
questions. This study required anonymity to mitigate potential assumptions and bias from
affecting research quality due to my role within the program and as an instructor to some
participants. A concerted effort was made to assure participants of the voluntary nature of this
research based on accurate information, guaranteeing anonymity, and absence of retaliation. To
further mitigate bias my role as a doctoral research student was explained and use of a third party
to generate emails with survey link on my behalf was illuminated. A potential advantage to data
collection through an anonymous survey encouragement of disclosure resulting in deeper, richer
qualitative data.
An additional power issue requiring acknowledgement is researcher role as the study’s
beneficiary (Merriam & Tisdell, 2016). The study provided the current student voice of one
physical therapy program which benefited the program with future implementation of
professional identity initiatives within the organization. Furthermore, the university and future
students will benefit from this research.
Researching and understanding student perceived factors and meaning-making through
lived student experiences requires anonymity, reflexivity, and transparency. My research role
was impacted by my values. My personal value of the social role in support of student learning
and growth influenced the choice of the constructivist paradigm of inquiry. Reciprocally, this
paradigm also affected interpretation of revealed factors and experiences impacting the physical
therapy student professional identity formation experience. My personal values of high faculty
accountability, professionalism, obligation to mentor the next generation of healthcare
40
professionals, and my ethical assumption that the most important contribution faculty offer
students is themselves, shaped this research design. Additionally, my personal value of
professional identity formation potentially impacted data analysis and findings.
Data Source
This mixed methods study used the convergent approach with quantitative and qualitative
data collected and analyzed during the same timeframe. Because anonymity was required, data
collection occurred through student surveys only. The data source is described below with
corresponding details regarding participants, instrumentation, and data collection procedures.
Consent forms embedded within the survey email were acknowledged by participants as the
survey link was entered (See Appendix A).
A survey was used to gather quantitative and qualitative data about student beliefs and
perceived factors impacting professional identity formation (Merriam & Tisdell, 2016). Data
from close-ended survey questions distributed through Qualtrics revealed factors student
perceived impacting PIF. The personal on-campus experiences and impact of those experiences,
whether supporting or undermining PIF, was explored through data collected from open-ended
questions (Merriam & Tisdell, 2016). Email reminders by a third party representing the
researcher were sent with a 40% completion rate goal (Robinson & Leonard, 2019).
Participants
Purposive sampling was used for student participants within one physical therapy
program to gather data from the individuals who are closest to the phenomenon and can provide
the greatest insight (Merriam & Tisdell, 2016). Student participant criterion included students
enrolled in the 2nd year doctor of physical therapy cohort, 3rd year cohort embarking on a year
of clinical education, and recent June 2022 graduates of the program. Exclusion criteria included
41
the first year cohort as they had experienced limited time in the program. A total of 179 students
were invited to participate. A link to an online Qualtrics survey was emailed to the three cohorts
in July 2022 prior to 3rd year clinical education to encourage higher completion rate.
Instrumentation
The survey consisted of 37 questions comprised of close-ended or Likert-scale questions
and open-ended questions. Intentional design process ensured the tool accurately captured data
needed to answer research questions (Robinson & Leonard, 2019). This was accomplished by
aligning questions to influences on student professional identity formation determined through
literature review and situated within the conceptual framework of the study. Ambiguous
wording, jargon, and leading questions were avoided for clarity (Robinson & Leonard, 2019). In
an iterative process questions were piloted on four post-professional physical therapy students to
ensure participants understood questions as intended (Robinson & Leonard, 2019). Adjustments
to question clarity were made from feedback provided. Close-ended questions provided
quantitative data about factors impacting development of student professional identity and open-
ended questions provided insight and meaning into specific experiences students perceived as
impactful (Merriam and Tisdell, 2016). Open ended questions were additionally used to
minimize predetermined responses and facilitate use of participants own words (Patton, 2002).
Questions were designed with neutrality for prevention of perceived researcher agreement or
disagreement and responses aligned to the constructs in the proposed theoretical framework
(Patton, 2002). Both quantitative and qualitative survey data answered the research questions
about influential factors, importance of those factors, and provided insight into the lived
experiences supporting or threatening student professional identity formation while on campus.
The survey questions for students are included in Appendix B.
42
Data Collection Procedures
Data collection occurred over a 5 week period in July and August of 2022. The survey
was accessed online through Qualtrics and voluntary participation and description of the study
was made clear in the invitation email sent by a third party not associated with the study.
Acknowledgement of informed consent prior to completion occurred by participant choosing to
launch survey link after reading the informed consent. The approximate time for completion was
20 minutes. The survey link was sent to a total of 179 doctor of physical therapy student in three
cohorts. This included students entering the 2nd year of curriculum, students entering the 3rd
year with completed didactic education, and recent graduates of the program. The link to the
anonymous survey was sent from a third party not associated with the research study on July 7,
2022. It was open for a total of 38 days and closed on August 14, 2022. After the initial email,
two email reminders were sent, one on July 25 and one on August 8. Additionally, a verbal
reminder was given to the 2nd year cohort during in-person coursework by a third party not
associated with the research when they were on campus. A total of 87 students responded. A
number of respondents began the survey and left it primarily uncompleted. Prior to data analysis
an engagement rule was set that participants complete one-third of the quantitative questions for
sufficient engagement to improve validity of results. This resulted in a filtered dataset with an N
of 80 and a loss of seven participants a priori from analysis. With a 43% completion rate, the
40% completion rate goal was achieved.
Data Analysis
For quantitative survey data, descriptive analyses included determining frequencies for
variables and percentages for each factor. Correlations between variables and cohort were
explored to examine potential differences of perceptions of factors impacting student
43
professional identity. Qualitative questions provided data about how these beliefs, experiences,
and factors shape student PIF and provided more extensive insights into perception and meaning
(Merriam and Tisdell, 2016). The open ended questions were the data source for understanding
the phenomenon of student professional identity formation from student perspective (Merriam &
Tisdell, 2016).
Credibility and Trustworthiness
Different methods to ensure validity and reliability were used for qualitative and
quantitative research. Qualitative research relies on consistency and transferability to
demonstrate rigor and trustworthiness which was provided through study rationale (Merriam &
Tisdell, 2016). Transparent researcher positionality or reflexivity ensured clarity of potential
influence on study conclusions (Merriam & Tisdell, 2016). For further consistency, a clear audit
trail regarding how data was collected and decisions made was created during qualitative data
analysis (Merriam & Tisdell, 2016). Detailed description of the setting and participants of the
purposeful sampling was another strategy used to increase transferability (Merriam & Tisdell,
2016). Although purposeful, the sampling was additionally convenience-based because only
students from one physical therapy program were included (Merriam & Tisdell, 2016). During
instrument development, alignment of survey questions with research questions and the
theoretical framework was ensured to contribute to trustworthiness of the study (Merriam &
Tisdell, 2016). Beyond aligning questions to the conceptual framework, further study rigor was
accomplished by embracing an exploratory approach during qualitative data analysis leaving
open the possibility of finding additional factors and themes. Finally, during analysis of open-
ended questions, another physical therapy colleague discussed congruency of emerging codes
44
and possible interpretation of data as peer review to promote trustworthiness (Merriam & Tisdell,
2016).
Validity and Reliability
The strategy for this study was to establish clarity and coherency, rather than
reproducibility, as is typical for qualitative data analysis (Merriam & Tisdell, 2016). However,
because the quantitative method of survey is additionally used, strategies were used to maximize
the survey reliability and content validity (Salkind, 2014). Reliability was also increased through
clear standardized questions (Salkind, 2014).
Validity is the certainty that a tool measures what it intends to measure and was also
considered (Salkind, 2014). Although difficult to measure, effort to establish construct validity
was accomplished through ensuring alignment between study theoretical rationale and the survey
items based on the theoretical constructs included in the framework (Salkind, 2014). Survey
items were created by the researcher using constructs which emerged from foundational
literature on student professional identity formation to improve face validity. Finally, the survey
was launched when most of the students were on campus allowing a verbal reminder to students
in the 2nd year cohort, maximizing response rates and therefore minimizing the threat to external
validity.
Ethics
The emphasis of this research was to determine student perceptions with the critical
cornerstone of high data collection ethicality while maintaining participant anonymity. This was
accomplished through an anonymous survey with both closed and open-ended questions. Further
ethical considerations contribute to the trustworthiness of this qualitative research through
procedural and relational ethicality (Merriam & Tisdell, 2016). Maintaining high researcher
45
integrity and values with transparency contributes to trustworthiness (Merriam & Tisdell, 2016).
Recruitment of participants was voluntary and participants were informed of the voluntary nature
of participation with no obligation and acknowledged informed consent by choosing to enter
survey link (Glesne, 2011; Merriam & Tisdell, 2016).
Beyond procedural ethicality, relational ethicality was required as the researcher has
established relationships with the participants (Merriam & Tisdell, 2016). The researcher is an
instructor to some of the participants. Consequently, collection of participant data occurred
anonymously minimizing researcher influence on participant response and mitigating potential
power dynamics contributing to trustworthiness. Reciprocally, the relationship of researcher as
instructor to participants has potential to impact interpretation of qualitative data from open-
ended questions and must be illuminated. In order to minimize biases and assumptions only
surveys with both open and close-ended questions were used. Open-ended questions resulting in
qualitative data were understood through the researcher’s values and biases, and trustworthiness
was maintained with high ethical researcher standards (Merriam & Tisdell, 2016).
46
Chapter Four: Findings
This chapter introduces the study results, presenting the factors which doctor of physical
therapy students, during different stages of education, perceive as impacting their professional
identity development. It also explores the individual lived experiences during didactic education
that students perceived as significantly supporting or undermining professional identity
formation. The study used the social cognitive theory as a framework to analyze both the internal
and external factors and experiences recognized by students in three cohorts. Professional
identity formation is the internalization of values and attitudes, self-perception, envisioning
future professional self, and commitment within a professional role as part of a lifelong
developmental process (Cruess et al., 2014; Jensen & Jetten, 2016; Sarraf-Yazdi et al. 2021;
Wald, 2015).The literature review revealed factors that previous research in healthcare education
report impacting student professional identity development including: role modeling, feedback,
assessment, active engagement, and self-reflection. These influences were integrated in the
conceptual framework and guided survey development.
Study findings revealed that physical therapy students’ perceptions in this program are
consistently aligned with previous studies in other healthcare fields about factors impacting PIF.
No correlations between cohort and responses to survey questions were found. Qualitative
findings led to further depth and rich understanding of distinct student on-campus experiences
that supported or undermined student professional identity development and how those
experiences impacted students. The codebook with codes used during qualitative analysis is
found in Appendix C. The following sections include the research questions and corresponding
answers supported by evidence from analyzed quantitative and qualitative data. Results inform
program development to support physical therapy student professional identity formation.
47
Research Question 1: What Factors Do Physical Therapy Students at Various Educational
Levels Perceive as Impacting Their Professional Identity Development During Didactic
Education?
The first research question addresses what factors students perceive impact their
professional identity development during didactic education at various levels of education,
potentially impacting student response.
Sample Description
The sample represented included three different cohorts from within the program. A total
of 179 surveys were sent with a 43% completion rate. As shown on Table 1, the highest response
rate was from 2nd year students. This may have occurred as this cohort had one in-person
reminder from a third party to complete the survey while on campus. The smallest response rate
was from recent graduates (See Table 1). This potentially occurred as the new graduates stopped
using or were no longer checking their university email address after graduation.
Table 1
Survey Response Frequencies Per Cohort (N = 80)
Cohort n %
2nd year students 41 51
3rd year students 27 34
Recent graduates 12 15
48
Students’ Perceived All Survey Factors to Impact Professional Identity Development
Five Likert-type questions were asked about student perception of assumed influences on
PIF based on literature review and the conceptual framework of the study. Between 80–95% of
respondents agreed or strongly agreed that each factor identified; faculty behavior, faculty
feedback, peer behavior, self-reflection, and formal self-assessment, impacted their professional
identity development while on campus (See Table 2). Results revealed that faculty behavior and
feedback was the most highly rated by students to impact their professional identity
development. Table 2 demonstrates that although considered impactful, formal self-assessment
was rated the lowest for perceived impacting factors.
Table 2
Frequencies for Perceived Factors Impacting Student PIF While on Campus (N = 80)
Factor
Agree or strongly
agree
Neither agree or
disagree
Disagree or
strongly disagree
n % n % n %
Faculty behavior and interactions 76 95 4 5 0 0
Specific feedback from faculty 72 90 7 9 1 1
Peer behavior and interactions 68 85 9 11 3 4
Time for self-reflection 66 82 10 13 4 5
Formal self-assessment 64 80 13 16 3 4
49
Students were additionally questioned regarding the perceived importance of factors that
impact student professional identity development while on campus. Again, assumed factors were
included based on the conceptual framework from literature review. As shown in Table 3,
between 88% and 90% of the participants agreed or strongly agreed that conversations with
faculty, informal feedback from faculty, formal feedback from faculty, and observations of
faculty were equal in perceived importance to student PIF.
Table 3
Frequencies for Perceived Importance of Factors Impacting Student Professional Identity
Formation While on Campus (N = 77)
Source
Important/very
important
Neither important
or unimportant
Unimportant/very
unimportant
n % n % n %
Conversations with faculty 69 90 7 9 1 1
Informal faculty feedback 69 90 6 8 2 2
Formal faculty feedback 68 88 7 9 2 2
Observation of faculty 68 88 8 10 1 1
Conversations with peers 63 82 10 13 4 5
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No Significant Correlations Between Cohort and Question Responses
Students noted which cohort they belonged to during survey completion; 2nd year, 3rd
year, or recent graduating cohort. During data analysis, Spearman correlations were computed to
determine whether there were any relationships between cohort and student perceived factors
impacting PIF and perceived strength of professional identity. No significant correlations
between cohort and any other survey questions were found. For example, the correlation between
cohort and student perceived strength of professional identity was rs = –.08, p = .50, n/s. Cohort
was not a significant variable in any subsequent data analysis.
Qualitative Responses Reveal Faculty As the Primary Perceived Influence on Student PIF
An open-ended question at the end of the survey asked “What are/were the two most
important factors/influences facilitating your professional identity development while on
campus?” Participants inconsistently choose to answer some or all of the open-ended survey
questions. This inconsistency varied between each question. Initial descriptive coding of
responses revealed three primary categories of influence: others, programmatic elements, and
self. These three areas represent both the external and internal factors impacting student
professional development. (Figure 2) Within these three areas, the two most predominant
influences were faculty (with 48 coded references) and authentic learning experiences (with 11
coded references), both external influences on student professional identity development (See
Figure 2).
51
Figure 2
Most Important Student-Perceived Influences From Qualitative Responses
Others
Fifty-eight descriptive codes constituted the category of others as one of the significant
influences on student PIF. Forty-eight of those responses were linked to faculty. Students noted
the importance of faculty influence in a variety of capacities. The most frequent code relating to
faculty influence was faculty feedback with a frequency of 17 times. Students stated “feedback
during labs and practical” and “receiving constructive feedback and allowing time to practice to
see improvements” as impacting their professional identity development. One student stated
I feel that personal feedback from teachers is rare (I do not necessarily think that this is
fault of faculty, rather I need to seek out those conversations more). However, when I do
get that feedback, I feel it is very helpful and allows room for growth.
52
Time with faculty was a consistent theme seen in the qualitative student responses. Connection
with faculty and one-on-one conversations along with time outside of the classroom was a
subtheme repeatedly mentioned pertaining to faculty influence. Students noted “individual
meeting with faculty,” “opportunities to discuss with faculty,” “connections with faculty,” and
“conversations with professors.” Faculty influence went beyond feedback and students noted
role-modeling, observation, and behavior of faculty impacting them. “Role modeling from
professors,” “an honest example to follow,” and “observations of faculty” were noted in this
subtheme. Additionally, students perceived the impact of first hand experiences shared by faculty
as a powerful professional identity influence. One student stated “Hearing about faculty
experiences (especially when they made mistakes) and how they grew from them” was a
powerful influence. Another student stated “faculty sharing first-hand examples of their
experiences as PTs” significantly impacted professional identity.
Peers were mentioned eight times by students in the category of others as a primary
influencer of professional identity. “Encouragement from peers” and “time spent studying with
peers” was reported by students. Mentioned once in this category was friends and family,
however due to limited frequency both are considered outliers. Overall, the qualitative responses
revealed the faculty as the most important influence to student professional identity development
through their feedback, connection to students, one-on-one conversations, observation, role
modeling, and sharing of personal experiences.
Programmatic Elements
Programmatic elements were the second most frequently noted significant influence on
student perceived professional identity development. Program influence was disclosed by
students through a wide variety of codes revealing a pattern which was refined into two broader
53
categories: authentic experiences and didactic courses. The majority of responses pertaining to
program influences reflected educational experiences that were more authentic for simulating
student role in future patient care. Students expressed hands on lab experiences, lab practicals,
simulated patients, and real patients included in courses impacted their professional identity
development. Eleven codes reflected the importance of authentic learning experiences with
statements such as “Growth in labs/hands on experiences” and “working with patients/volunteers
who are not staff (this helped get out of the mindset of ‘comfort’ because these were people we
did not work with before and needed to establish rapport organically).” Five responses indicated
that didactic courses were a primary influence of professional identity. One specific course,
Whole Person Care, was mentioned three times. This course emphasizes the biopsychosocial-
spiritual model of healthcare and wholeness of both the provider and patient (Gang et al., 2022).
I was heavily influenced by our education on whole person care. I feel that whole person
care has been the most important topic for me, and has influenced how I desire and strive
to develop rapport and connect with my patients.
Outliers or unique responses which are part of programmatic elements that do not fit into the
axial coding subcategories of authentic learning and didactic courses should additionally be
noted (Gibbs, 2018). One student referenced the dress code as a primary influence on
professional identity and one mentioned leadership opportunities stating “being able to lead in
different aspects of the program” was a significant influence.
Self
Finally, thirteen responses pertained to self as a primary influencer of student
professional identity development. This aligns to the understanding that professional identity
includes internal factors which impact the identity development process (Erickson, 1980; Jarvis-
54
Selinger et al., 2012). This additionally aligns to the conceptual framework for this study
previously described (Figure 1). Within this primary theme, most responses were linked to self-
reflection and their own personal perceptions and effort. Verbatim statements supporting this
theme include the phrases “my own self values,” “personal effort,” and “my perception of my
own professional identity” as primary factors influencing PIF. Empathy, faith, and personal
experiences were all internal influences mentioned only once within the primary category of self
as an influencer.
By including open-ended questions at the end of the survey, qualitative responses
allowed for deeper nuanced understanding of factors that students perceive to impact their
professional identity while on campus. Beyond “faculty” the qualitative results indicate that time
beyond formal classroom interaction, particularly one on one, is a primary influencer of student
professional identity. Authentic learning experiences also emerged from qualitative data to
highlight how programming impacts student development. Ultimately, students perceived
external factors to be more influential than internal factors. Although not as predominant, self,
the only influence categorized as internal, is also recognized as impactful to lesser degree. These
emergent factors from qualitative data in three areas aligns closely to the social cognitive model
which asserts that interaction between person and environment impacts behavior (Bandura,
1986a).
Research Question 2: What Lived Experiences With Faculty and Peers During Didactic
Education Do Physical Therapy Students Understand to Influence Their Professional
Identity Development?
The second research question focused on the individual experiences that students
perceived as impacting their professional identity formation during the on campus portion of
55
their education. Coded data from open-ended survey questions contributed to answering this
research question.
Experiences Positively Impacting Student PIF Were Anchored in What Faculty Gave
An open-ended question asked students to “Describe an experience during your time on
campus, if any, that positively impacted your professional identity” followed by “How did that
impact you?” Data from the question about experiences on campus positively impacting
professional identity development were anchored in one overarching theme: what faculty gave.
Forty-four codes were applied to qualitative data and reduced to five domains of giving by
faculty; time, compassion, vulnerability, authentic learning experiences, and inspiration through
role modeling. Figure 3 represents these domains with corresponding subthemes.
56
Figure 3
Lived Experiences Positively Impacting PIF Anchored in What Faculty Gave
Faculty Gave Time
The strongest theme that emerged was the time that faculty offered students through one-
on-one conversations, connection, and providing feedback. Students reflected this gift of time
stating “Simply having honest conversation with faculty members,” “many one on one
conversations with faculty” and “I discussed this with a professor and they told me the strengths
they saw in me that they thought would allow me to thrive in that setting.” Another student
reported “Talking with [a professor] during any period of time, especially difficult ones, was
always a conversation that positively impacted me and, inspired me to be like her.” Students
highlighted time for faculty feedback as transformational stating “Positive feedback after lab
57
practicals of how I’m growing into becoming a great PT.” Twenty-three times codes were linked
to phrases where students perceived faculty giving of their time as meaningful.
Faculty Gave Compassion
Students perceived that faculty extended compassion and grace through encouragement,
and opportunities to learn from failure. Verbatim quotes include “Faculty understanding of
emergency situations outside of school” and “I realized that sometimes failures are to happen to
help you grow, to help you be a better professional, to learn to be successful in the future.” One
student described doing poorly on an exam stating,
One time I completely bombed a final exam when I nearly aced the midterm of this class.
I was really down on myself, but my professor emailed me and sent me a message of
encouragement, saying this was just an outlier exam, it doesn't define my ability to be a
great therapist.
Students perceived the gift of compassion from faculty as supportive and meaningful for
professional identity development.
Faculty Modeled Vulnerability
Beyond time and compassion, two students also recognized that faculty vulnerability
helped them see who they were or wanted to become. Faculty sharing their personal experiences
with patient care impacted student professional development. “Multiple times professors would
explain a situation or experience they have had that impacted them, which shed light on my own
views, impacting my own values and my professional identity.” Faculty proffered vulnerability
supporting student professional identity. In addition to vulnerability, faculty also created
authentic learning experiences.
Faculty Provided Authentic Learning Experiences
58
Beyond modeling vulnerability, authentic learning experiences given by faculty was one
of the most frequently noted positive influences on students and coded in data eleven times.
“Simulation labs really allowed me to gain great insight on how I was performing as a future
PT” and “SIM lab observations of other students” are verbatim quotes supporting the value of
faculty giving authentic learning experiences to students reinforcing professional identity
development. One student felt that the hands on research project helped highlight professional
identity development as well. Authentic learning experiences, whether through simulation, real
patients, or contributing to academic research were perceived by students to support professional
identity development.
Faculty Gave Inspiration Through Role Modeling
Students perceived that faculty provision of professional behavior to model was
impactful. The following excerpts reflect that impact on students; “I was able to see all of my
professors demonstrate kind acts as a physical therapist for example: helping a disabled family
move home, serving the less fortunate with free physical therapy services” and “I love seeing
patient models and how our professors interact with them. It brings to light their love for the field
and how I want to be able to communicate with patients and impact their journey.” Professional
and compassionate faculty behavior was a powerful guide for student professional behavior.
Overall, the qualitative results about lived experiences that impacted student professional identity
were primarily relational, categorized as external influences, and anchored in what faculty gave
including; time, compassion, vulnerability, authentic learning experiences, and inspiration
through role modeling.
Positive Experiences With Faculty Impacted Feeling, Thinking, and Planned Future
Behavior
59
It is crucial to understand the results of how these positive experiences impacted students.
To determine impact a follow-up question was asked. “How did that impact you?” Forty-two
excerpts were coded in response to this question and reduced to three primary domains of
impact; feeling, thinking, and future action. This is noted in Figure 4. Impact within these
domains align with Merton’s (1968) conceptualization of professional formation in healthcare as
“feeling, thinking, and acting.”
Figure 4
Impact of Lived Experiences Positively Impacting PIF
60
Impact on Thinking
The compassion, time, vulnerability, authentic learning experiences, and role-modeling
faculty provided impacted student thinking. Within the cognitive domain, student thinking was
impacted as they described positive interactions with faculty reminding them of the importance
of their role. Faculty interaction helped students define their values. One student noted that
“Development of beliefs and ethics” occurred as a result of interaction. Participants
acknowledged the faculty shared experiences “Provided an opportunity to see and learn from
others experiences and lessons learned on the job on how to best fulfill our roles as PT.”
Supporting the importance of faculty vulnerability, shared failures by faculty also provided
students to think of failure as an opportunity to grow. Excerpts like “It helped me to realize that
one hiccup will not determine my entire journey” reflect the impact of faculty interactions on
thinking with a growth mindset.
Impact on Feelings
The perceived impact on students from interaction with faculty went beyond the
cognitive domain to the affective domain. Participants reported impact on how they felt as a
student. The sub-theme of inspiration within the domain of feelings was noted in five statements
by students “It was very positive and made me feel optimistic and excited to be a therapist and
change my patients lives for the better.” One student recognized that the meaningful experience
shared with a professor was a source of current and future inspiration “The feedback gave me a
boost of determination when the program got difficult.” Student confidence was also impacted as
a result of positive interactions with faculty. “It allowed me to grow as a person, confidence, and
become more sure of myself.” Students felt acknowledged and recognized stating “it allows me
to feel recognized as a student/person with goals and aspirations.” Students felt reassurance and
61
encouragement stating “I always left the conversation feeling more encouraged” and “It is
reassuring for faculty to have some background information on why I may be struggling.”
Beyond inspiration and re-assurance, positive and authentic learning experiences with faculty
helped students begin to feel like they were physical therapists. “It made me start to trust my
training and embrace the challenges of real life situations when I could apply my knowledge in
other areas. It made me feel like a PT.” Positive feelings from interaction with faculty provided
confidence, encouragement, inspiration, and motivation.
Impact on Envisioning Future Self/Behavior
Eight responses from students indicated that supportive faculty interactions and learning
experiences championed envisioning future self as a physical therapist. “This impacted me a lot
by helping me see what makes a great physical therapist and how I can learn in school to be that
for my patients one day” and this “Helped me envision what my future profession would look
like and my future self.” Another student stated, “It helped me find my voice/identity as a
healthcare provider.”
Comprehensively, qualitative data from open ended questions support that faculty time,
compassion, vulnerability, role-modeling, and authentic learning experiences were powerful
lived experiences that changed student thinking, feelings, and envisioning of their future role and
behavior in support of professional identity development.
Academic and Faculty Experiences Were Primary Influences Negatively Impacting
Student PIF
Beyond the positive experiences, greater understanding of experiences that threaten
student professional identity development was accomplished by asking the open ended question
“Describe an experience during your time on campus, if any, that negatively impacted your
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professional identity” followed by “How did that impact you?” Multiple students stated they
could not recall a negative experience. Twenty-seven responses from students were coded and
found to be in three domains; faculty, academic experiences, and minimally self (Figure 5).
Experiences students perceived as negatively impacting their professional identity occurred with
similar frequency between faculty and academics.
Figure 5
Lived Experiences Negatively Impacting Professional Identity Formation
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Negative Experience: Faculty
Faculty interaction and observation was noted twelve times as a lived experienced
negatively impacting PIF. Most responses were related to how feedback was given. Students
stated “a professor I never had before seemed a little insensitive when providing feedback. It
made me question myself and if I was even fit to be a physical therapist.” An additional response
described feedback given and included that the professor “did so condescendingly.” Others
reported “I received feedback without being corrected or demonstrated the proper way or
different options I could have approached the situation” and “I left knowing everything I did
wrong but nothing I did correctly. It would be nice to hear both sides so I can see both my
strengths and my weaknesses.” Feedback that was considered callous or condescending
compromised students perception of their professional identity.
Negative Experience: Academics
Beyond faculty, individual negative academic experiences emerged as a theme that
equally threatened student professional identity development. Performing poorly on exams and
struggling academically were coded eight times. “Failing a lab practical after going in
confidently” and “Performing poorly on exams” are excerpts that represent this theme. Students
also noted that courses without practical application, inconsistency in grading, and leniency in
grading negatively impacted their PIF. “Passing a practical I believe I should not have passed”
and “Participation and learning certain material on campus that I believe didn’t effect or benefit
my field of work for the future” were both experiences that stood out as undermining student
professional identity. Low performance in academics created student uncertainty was seen as a
negative influence on student PIF in addition disappointment from isolated experiences with
coursework.
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Negative Experience: Self
Beyond the primary negative impacts of faculty and academics, two responses support
the theme of self as a domain of negative influences on PIF, and should be mentioned. A student
reported “The stress I was in the first few quarters made me question myself with everything”
and one student felt disconnected from the cohort being at a different stage of life. Self was a
very small component toward the experiences negatively impacting PIF but is worth noting as a
small internal influence.
In summary, students perceived that experiences negatively impacting their professional
identity were primarily interactions with faculty and poor academic experiences. These areas
both correlate to external influences. Beyond the actual experiences that occurred, it is important
to explore the impact of those experiences compromising student professional identity
development. The student-perceived impacts related to experiences negatively impacting PIF are
described below.
Negative Experiences Impacted Student Self-Efficacy
Twenty-four open-ended responses were coded as participants answered the question
“How did that impact you?” regarding the negative experiences on campus. Overall, the impact
primarily emerged to occur in feelings of reduced self-efficacy and to a much lesser degree
impact resulting in physical response or a perceived opportunity. Figure 6 represents areas of
impact with noted frequencies.
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Figure 6
Impact of Lived Experiences Negatively Impacting PIF
Feelings of Low Self-Efficacy
Students response revealed that lived experiences while on campus negatively impacting
their professional identity development led to worry and doubt. Responses such as “It made me
doubt and question my ability to be a PT” and “Made me question myself as a physical therapist”
were coded eleven times. Feelings of uncertainty, discouragement, and inadequacy occurred.
“This led to feelings of doubt and uncertainty that made me wonder if I was in the correct field
of study” and these moments “[Made] me discouraged for my education.” This “Made me feel
inadequate to be a PT.” Beyond questioning themselves, one student questioned the profession
stating “It called into question the expectations that should be required as a future member of the
doctoring profession.”
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Two students reported that the experiences that negatively impacted their professional identity
made them feel unintelligent or dumb. “It makes me feel like I am not smart enough to become a
good PT.”
Negative Experience Reframed as Opportunity
Conversely, one student reported the impact of the negative interaction provided an
opportunity for growth stating “It allowed me to see the bigger picture and focus on what’s really
important for my professional development.” Another student noted a specific experience with
demonstrated what behavior to avoid in the future stating, “It definitely was a turning point of
how I do not want to be as a future leader in this profession” and used the experience as learning
moment directing future behavior.
Although not a theme, an isolated response which should be noted is a physical response
as one student admitted “I developed an eating disorder to cope with it.” On the whole, the
impact of the lived-experiences negatively impacting student professional identify development
relate to reduced self-efficacy and a student questioning of their place in the field of physical
therapy.
Student Perceived Barriers to PIF Were Primarily Internal
Deeper comprehension of what students’ perceive as barriers to their PIF on campus is
critical for program student professional identity support effectiveness. The statement “Describe
any barriers that you have experienced with regards to your professional identity development”
revealed perceived barriers across a range of influences. Descriptive codes were categorized into
three primary themes. The breakdown of codes with associated themes is noted in Figure 7.
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Figure 7
Student-Perceived Barriers to Professional Identity Development
Barrier: Self
The most prominent influence with frequency was noted to be self with 11 descriptive
codes. Students felt their own confidence was a barrier expressing “My own self-confidence
hinders me a lot” and “Just trying to build the confidence with the choices that I make, as a
physical therapist, for my patient.” One student stated “I think I am my biggest barrier.”
Additionally, there were comments about mismatch of program and personal values, stress, and
navigating personal and professional balance threatening their professional development. A
student acknowledged, “There was an element of anxiety that came with it that made me feel like
I wasn’t going to actualize my lifelong dream.” Beyond self, students felt that COVID-19 was a
barrier as well.
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Barrier: COVID-19
Students perceived the COVID-19 pandemic deprived them of on-campus opportunities
which would have supported their professional identity. The verbatim statements “Not enough
1:1 time with professors and decreased lab and in person class time because of COVID-19” and
“First year of covid and online classes that limited interactions with faculty and peers”
demonstrate students felt programmatic changes required from COVID-19 reduced needed
interaction and time with faculty and peers for professional development. Additionally, reduced
hands-on lab learning experiences from COVID-19 was a barrier noted by students. “COVID
was a tough time overall but we eventually got through it. We missed some opportunities in lab
during that first quarter of quarantine which I believe would have definitely improved my
professional development and identity.” Students perceived that COVID-19, with required
program adjustments, decreased opportunities for time and interaction with faculty and peers
which negatively impacted PIF. This relates to the final barrier, faculty, described in the next
section.
Barrier: Faculty
Codes associated with faculty, primarily lack of time with faculty, were noted by students
as being a barrier to professional identity. A student described a barrier being “Less one on one
time with faculty than I would like” and in agreement another stated,
I think a barrier for me has not been having enough one-on-one time with my professors
to work through that. I know my professors can’t tell me who I am or who to be, but
having them to just discuss with and get feedback from would be helpful!
Although only mentioned once as a barrier, lack of representation within the faculty was seen as
barrier and must be acknowledged. “As a minority and a woman, I sometimes feel a rift because
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I barely see professors that look like me.” This barrier may have only been mentioned once by
participants due to limited underrepresentation within the cohort, however data on ethnicity and
culture was not gathered. Two individual additional threats can be interpreted as student
disappointment in faculty leading to undermining student PIF. These included disappointment
from “Leniency with grading and expectations” and a negative feedback interaction with a
faculty member. “I received feedback from a faculty member in simulation lab that consisted of
mockery of myself in front of my peers.” Comprehensively, three primary barrier themes of self,
COVID-19, and faculty emerged from qualitative responses.
Summary
Overall, results from quantitative data revealed that factors students perceived to impact
their professional identity were aligned with results from the literature review and previous
research in healthcare fields other than physical therapy. Most students agreed and strongly
agreed that faculty behavior/interaction, peer behavior/interaction, faculty observation, faculty
role-modeling, formal and informal faculty feedback, time for reflection, and formal assessment
were all factors impacting their professional identity development. No significant correlation
between cohort and any other survey question was found. Accordingly, no differences in student
perception were noted between 2nd year, 3rd year, and new graduate cohorts.
Qualitative findings provided a richer, nuanced explanation of the experiences student
noted to be impactful, either supporting or undermining, professional identity development.
Qualitative data revealed that interactions with faculty during didactic education were perceived
to be the primary influence on student professional identity development. Analysis and coding of
qualitative data disclosed that the time, compassion, vulnerability, authentic learning
experiences, and inspiration through role-modeling that faculty extended positively impacted
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physical therapy student professional identity. The impact from the positive faculty interactions
occurred in three domains, thinking (cognitive), feeling (affective), and the ability to envision
future self (future behavior). These domains align to the “feeling, thinking, and acting” that
Merton (1968) refers when describing the construct of professional identity development within
healthcare. Further qualitative data analysis revealed academic and faculty experiences were the
primary domains of negative experiences threatening student PIF. The result of these negative
experiences on campus, which students perceived to undermine student professional identity
development, primarily impacted student self-efficacy.
Finally, although faculty were the primary supporting factor for student PIF students also
perceived faculty to be barriers to professional identity development. The three areas where
students perceived barriers to PIF were faculty, themselves, and missed opportunities from
COVID-19.
The findings reveal student perceptions that can inform program changes supporting PIF
as an educational priority. Integration of professional identity into physical therapy curricula is
critical as a strong professional identity is correlated with well-being, job satisfaction, decreased
burnout, compassion, and successful transition to the clinic (Edwards & Dirette, 2010; Lawrence
et al., 2020; Scanlan & Hazelton, 2019; Wagner & Jackson, 2021). It is also correlated with
enhanced communication, improved moral reasoning, and accepting responsibility for the patient
which crucially impacts patient care (Kalet et al., 2021; Sawatsky et al., 2020). Because
professional identity directly impacts both healthcare provider and patient care it is vital to
integrate in physical therapy curricula and recommendations follow.
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Chapter Five: Discussion
The underutilization of professional identity formation as an educational priority in
physical therapy education is notable despite being an accreditation recommendation and
professional organization priority. Professional identity formation is defined as a lifelong
developmental process moving beyond behavior to the internalization of values, attitudes, ethics,
and commitment within a professional role (Cruess et al., 2014; Jensen & Jetten, 2016; Sarraf-
Yazdi et al. 2021; Wald, 2015). The purpose of this study was to determine what factors physical
therapy students perceive as impacting their professional identity formation during didactic
curriculum. Additionally, the purpose was to understand the specific lived experiences that
students perceive to support and undermine student PIF. The findings contribute to the paucity of
research in professional identity formation of doctor of physical therapy students to inform
program development in support of professional identity formation as an educational objective in
doctor of physical therapy curricula. Two research questions guided this study:
1. What factors do physical therapy students at various educational stages perceive as
impacting their professional identity development during didactic education?
2. What lived experiences with faculty and peers during didactic education do physical
therapy students understand to influence their professional identity development?
These research questions were answered with mixed methods data collection using closed and
open-ended survey questions. This chapter includes the discussion of the five primary findings,
recommendations for practice, limitations and delimitations, recommendations for future
research, and culminates with study conclusions.
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Findings
Study findings align with the conceptual framework created to guide this research study
represented in Figure 1. The conceptual framework centered primarily on the social cognitive
theory and to a lesser degree on identity development theory (Bandura, 1986a; Erickson, 1980).
The social cognitive theory describes the complex interaction of environmental factors,
individual experiences, and behavior impacting learning and this theory was applied to student
professional identity development (Bandura, 1982a). Inclusion of the identity development
theory acknowledges that the process of identity development is both a social and individual
endeavor (Erickson, 1980). The combined theories generated a lens to view internal influences,
external influences, and the socialization guiding identity construction to understand factors and
experiences students perceive to impact PIF. During literature review, five areas which impact
PIF in healthcare students emerged: (a) role modeling, (b) feedback, (c) assessment, (d) active
engagement, and (e) self-reflection. Quantitative results of this study revealed that doctor of
physical therapy students agreed with previous healthcare research agreeing or strongly agreeing
that all noted factors were impactful. These themes additionally emerged organically in
qualitative findings. There was no correlation between importance of perceived factors and
cohort. With focus on the defining experiences impacting PIF on campus, students perceived
faculty/faculty experiences to be both a powerful support and threat to PIF. Deeper
understanding of the impact of these experiences found them to affect student thinking, feelings,
and potential future behavior as well as influence self-efficacy. The findings address the problem
of practice by constructing a greater understanding of student needs, values, and beliefs as well
as the primary role of faculty in development of PIF during didactic curricula. The answered
research questions provide evidence impacting physical therapy program development and future
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educational objectives. The five findings, with connection to current research are explored
further in the following sections.
Finding 1: Factors Perceived by Doctor of Physical Therapy Students As Impacting PIF
Align With Previous Healthcare Education Research
Survey results indicated that between 80–95% of student respondents agreed or strongly
agreed that each of the factors; faculty behavior, faculty feedback, peer behavior, self-reflection,
and formal self-assessment, impacted their professional identity development while on campus.
These factors were noted in the conceptual framework for the study design in Figure 1. Results
from physical therapy students in this study align with research in other healthcare education
fields positing that PIF is significantly influenced by educators through mentoring and role-
modeling and is one of the most critical factors in professional identity development (Ashby et
al., 2016; Foster & Roberts, 2016; Holden, 2012; Sarraf-Yasdi et al., 2021). Students agreed self-
reflection to be an important contributor as well to PIF which underpins previous research
reporting that curricular design with reflection opportunities impact student professional identity
development (Chandran et al., 2019; Maitra, 2021; Sarraf-Yazdi, 2021; Sonday, 2021; Wagner &
Jackson, 2021). Furthermore, students noted peers and opportunities for self-assessment were
also pivotal in supporting student PIF. This aligns to research asserting that a learning culture of
supportive peers and faculty, assessment, and feedback enhance professional identity growth
(Gaufberg et al., 2017; Noble et al., 2014; Sarraf-Yazdi, 2021). Overall, students in the three
surveyed cohorts agreed with previous healthcare education studies regarding factors impacting
their professional identity development while on campus. This is noteworthy as findings suggest
that existing frameworks of student PIF in other healthcare education fields are applicable to
physical therapy education as well. Successful interventions supporting PIF in healthcare fields
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include medical and pharmaceutical education with an explicit professional identity thread
woven through curricula reinforced by faculty development (Janke et al., 2021 Sarraf-Yazdi,
2021). Other promising practices supporting PIF in healthcare education include opportunities
for student self-reflection and prioritizing feedback (Garza et al., 2021; Johnson & Chauvin,
2016). These interventions can be modeled as existing promising practices within physical
therapy curricula. Findings fill the PIF knowledge gap in physical therapy education and
provides more relevance to previous research in other healthcare education fields for application
to physical therapy education.
Finding 2: Students Perceive Faculty As the Primary Influence on Student PIF With
Positive Experiences Centered Around What Faculty Give
The significance physical therapy students place on faculty as an impacting factor on PIF
was another important finding. Cognizance that students perceive faculty the most important and
greatest positive impact on their professional identity development provides insight into the
significance of faculty role in PIF and need for faculty development. This supports previous
research asserting that formation of identity occurs socially as students navigate roles and
responsibilities and that impact of faculty is particularly significant early in professional identity
development (Ashby et al., 2016; Grey et al., 2020; Hammond et al., 2016; Jarvis-Selinger et al.,
2012; Johnson & Chauvin; 2016). Concurring, a study of medical students found the most
frequently noted factor contributing to professional identity development was interpersonal
experiences during training, including mentors, faculty, role-models, or even cadavers (White et
al., 2011). The finding that physical therapy students perceive faculty as the most important
factor impacting PIF while on campus reflects back to the social cognitive theory that frames this
study emphasizing the social influence of learning (Bandura, 1986a).
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When asked to share meaningful experiences that shaped professional identity while on
campus students described experiences comprising the overarching theme of what faculty gave.
The subthemes of what students perceived faculty to give were in five domains; time,
compassion, vulnerability, authentic learning experiences, and inspiration through role modeling.
(Figure 3) Time was extended to students in multiple ways but was most frequently noted as
informal conversations. Students mentioned face-to-face conversations and interactions with
professors most often as a positive experience impacting who they were becoming
professionally. With a trend to more remote learning in higher education it is critical to
acknowledge the loss of these on-campus conversations and consider how this interaction
absence could impact student PIF. Study participants noted this loss expressing decreased
opportunities connecting with faculty during COVID-19 program adjustments as a barrier to PIF
as well. It is concerning to consider this student-expressed need as a component of PIF
juxtaposed with an increase in online learning. This concern is relevant with the admitted
challenge of the inability of online learning to fully establish a “social presence” as noted by Wut
& Xu (2021, p. 377). Program development and changes must include programming design
which meets the needs of learners for PIF with inclusion of opportunities for student faculty
connection.
Along with time given, students perceived faculty to give authentic learning experiences
augmenting PIF. The value of simulation and authentic leaning experiences is not surprising as it
aligns with medical student research by Vivekanada-Schmidt et al. (2015) ascertaining that
opportunities to meaningfully participate in more realistic care was critical for supporting
medical students professional identity development. Clinical simulation is a strategy to develop
student PIF and the defining nature of these experiences must be acknowledged by faculty
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(Wyatt et al. 2021). Currently students in the program receive three simulation experiences their
1st year, simulation lab one weekly for approximately 30 weeks in Year 2, and 2 practice weeks
of simulation with a comprehensive simulation exam in Year 3 during didactic curricula. These
authentic learning experiences within the environment were perceived by students as positive
internal impacts on their professional identity development.
It is pivotal to note that the defining experiences students recalled positively impacting
their professional identity development were external, as opposed to internal. Students agreed
that internal factors impacted PIF on closed ended survey questions however in open-ended
questions only external factors were noted. Professional identity formation is described as an
internal, developmental, transformative process requiring active student engagement (Poole &
Patterson, 2021; Saraf-Yazdi, 2021; Wald, 2015.) This process occurs both individually and
socially yet students perceptions of supporting factors were exclusively external. This may have
occurred secondary to how questions were worded. This finding may have additionally occurred
due to lack of explicit teaching regarding knowledge of student role, ownership, and engagement
in this process. Research asserts PIF curriculum should be deliberate, rather than hidden, to
ensure students recognize their role and empowered to self-evaluate (Cruess et al., 2014; Johnson
& Chauvin, 2018; Poole & Patterson, 2021). The program studied has not implemented explicit
education on student PIF engagement, therefore students may have only noted external, rather
than internal defining experiences.
As confirmed by the quantitative and qualitative results of this study, social learning,
observation of faculty, role-modeling, conversations, and feedback from faculty significantly
influence the transformative process of PIF in doctor of physical therapy education during
didactic curriculum (Ashby et al., 2016; Sarraf-Yazdi et al., 2021). Faculty were the core factor,
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whether through interaction, observation, or programming, that students perceived to support
their professional identity development. An unexpected finding was that no other experiences,
beyond faculty, such as peers or self-reflection, were mentioned in qualitative data that were
impactful despite acknowledgement of these factors being influential in quantitative survey
questions. This gives evidence to the pronounced role faculty have on student professional
identity development during didactic curricula and student focus on external factors impacting
this process. The impact of these positive experiences are a notable finding and explored further.
Finding 3: Lived Experiences Supporting Student PIF Impacted Student Thinking,
Feelings, and Potential Future Behavior
Although the predominant experiences impacting student PIF were provided by faculty
externally, the impact of these experiences was internal. The lived experiences, a consequence of
what faculty gave, positively impacted students in the cognitive, affective, and envisioned future
behavior domains. At the core definition, professional identity development moves beyond
behavior to thinking and feeling paralleling the domains emerging from qualitative data (Cruess
et al., 2014; Sarraf-Yazdi et al. 2021). This developmental process includes assimilation of
professional traits and virtues and envisioning of future professional self (Jensen & Jetten, 2016;
Sarrif-Yazdi et al., 2021; Wald, 2015). It is consequential that the defining experiences students
shared, supporting their professional identity development, revealed emergent themes in each of
these three areas.
Thinking
Student thinking and metacognition was impacted as a result from the time, authentic
learning experiences, vulnerability, and compassion that was given by faculty. Metacognition is
higher-level cognition implemented through self-reflection and is critical to professional and
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intellectual growth (Flavell, 1987). Students described experiences with faculty as opportunities
for self-reflection impacting their thoughts about failure, beliefs, ethics, and their role. Of
consequence, beliefs, ethics, and role are central themes defining the construct of PIF (Cruess et
al., 2014; Sarraf-Yazdi et al. 2021). Positive lived experiences with faculty on campus
effectively changed student thinking. Students self-reflected on beliefs, future behavior,
considered who they are as a student and who they want to be professionally in the future
impacting identity. These metacognitive experiences support professional identity formation
development (Cruess et al., 2015). Research supports the need for metacognitive thinking
opportunities beyond the cognitive base of professional identity formation embedded in curricula
(Cruess et al. 2019; Jensen et al., 2017). Metacognitive opportunities strengthen student PIF and
were a result of faculty-created positive interactions with students during didactic curriculum.
Feelings
Students described influential experiences pertaining to faculty that positively supported
their professional identity development impacting feelings. Their responses align with research
completed on medical students and the power of socialization in PIF and student treatment by
faculty impacting medical students to feel like a healthcare professional (Vivekanada-Schmidt et
al., 2015). Professional identity formation is a complex process of experiences and interpretation
of experiences both impact emotion and professional identity development (Vivekanada-Schmidt
et al., 2015). In both an analysis and commentary of emotions in medical education, emotion is
acknowledged as “an integral part of professional development” enriching and consequently
impacting student learning (McNaughton, 2013, p. 77; Monrad, 2022). Students noted that the
experiences with faculty led to feelings of safety and reassurance. This finding correlates with
studies in nursing and the importance of feeling safe as a critical component for student PIF
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(Vabo et al., 2022). Echoing the importance of positive emotions in healthcare education,
qualitative responses from medical students consistently found that emotionally positive
interpersonal experiences with others were the most defining experiences for professional
identity development (White et al., 2011).
There are emotional demands associated with illness and the provision of healthcare. The
culture of healthcare has previously devalued the role of emotion in healthcare providers’ growth
and well-being. However, there is a shift to support emotion in the context of learning and
provision of healthcare (Immoradino-Yang et al., 2019; Schwartz et al., 2021). Knowledge of
student emotion creates potential use of constructive emotion to augment student professional
identity development for clinic preparation. The constructive emotions revealed in this study,
such as student feelings of safety and reassurance from positive experiences with faculty,
reciprocally support PIF.
Future Behavior
Experiences with faculty on campus, positively impacting PIF, caused students to
envision their future self and behavior. Research indicates student future perspective taking and
future self-perceptions contribute to development of professional identity (Janke et al., 2021;
Yakov et al., 2021). This future oriented thinking and behavior provides motivation, regulation
and incentive towards goals strengthening professional identity development (Hamman et al.,
2013). Personal or individual factors such as perception of self-efficacy, future behavior, and
confidence to execute certain behaviors are important constructs in the social cognitive theory
and contribute to student engagement and motivation (Bandura, 1986a; Bandura, 1986b;
Bandura & Cervone, 1986). Calls exist within PIF literature for student active involvement in
guiding the development of future professional role highlighting the importance of future
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perspective taking in PIF (Cruess et al., 2014; Janke et al., 2021). Research reveals that faculty
who connect with students authentically improve student success and persistence during
education (Schreiner et al., 2011). Students noted the gift of vulnerability and compassion by
faculty as authentic connection, the result which was envisioning their future selves. This not
only contributes to strengthening professional identity development but to educational
persistence and motivation as well.
Because positive, on-campus experiences created by faculty supported PIF the
assumption could be made that with faculty development these authentic connections could be
facilitated more frequently, further strengthening professional identity development. Faculty
must be educated regarding the magnitude of seemingly inconsequential informal conversations
or experiences with students and potential to encourage envisioning the future self in support of
professional identity formation
Advances in the neurobiology of learning indicates that there is a social-emotional
component of learning that is not separate from cognitive learning (Immoradino-Yang et al.,
2019). This same research indicates that the construction of sense of self, or identity, self-
awareness and meaningful learning includes emotions (Immoradino-Yang et al., 2019). Results
from this study indicate that student-faculty relationships are critical in creating a learning space
supporting acquisition of values, generating motivation, and envisioning of future self during
didactic curricula. Paralleling previous research, findings reveal that these meaningful social
interactions with faculty, positively supporting student professional identity development,
impacted student thinking, feelings, and planned future behavior. These emergent themes,
change in thinking, feeling, and future behavior, distinctly correlate with Merton’s (1957)
defining goals of medical education to “think, act, and feel” like a physician and anchor the
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defining concepts of professional identity formation. With this in mind, facilitating positive
faculty interactions can advance student professional identity impacting the affective, cognitive,
and future behavior of students advancing PIF.
Finding 4: Lived Experiences Negatively Influencing PIF Impacted Student Self-Efficacy
Beyond positive experiences, students noted experiences which threatened professional
identity development. The experiences perceived to undermine PIF development occurred
primarily in two areas; academic lapses and faculty encounters. When students performed poorly
on lab practicals or exams, they questioned self and the ability to become a physical therapist.
Findings that academic challenges were detrimental to professional identity exposes potential
need for program emphasis on coaching with a growth mindset transforming challenges into
opportunities for growth. Emphasizing life-long learning, normalizing disclosure of failures, and
encouraging vulnerability may be indicated to prevent academic disappointments from
undermining students profession identity growth.
Beyond academic disappointments, poorly perceived faculty interactions were also noted
as potential undermining events to PIF as well. Ironically, positive faculty experiences were
included as the most influential positive impact on PIF. This was similarly described in medical
education by Sarraf-Yazdi et al. (2021) revealing socialization as a significant facilitator of PIF
but also a potential barrier. When experiences with faculty are disappointing, condescending, or
inconsistent these moments have the opposite effect causing students to question who they are
professionally impacting self-efficacy.
Themes from qualitative data revealed participants questioned personal self-efficacy after
experiences negatively impacting PIF occurred on campus. The self-efficacy theory originates
from Bandura’s (1986a) social cognitive theory advancing that individuals shape and produce
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events through human agency. Self-efficacy is the belief that an individual’s personal beliefs and
judgments about one’s own agency or capability to achieve a desired result, guides actions
(Bandura, 1997). These beliefs are very specific to context which influences the individual’s
confidence in their ability in a particular situation. Self-efficacy influences stakeholders’
motivation, choice, persistence, and effort of learning behavior (Ambrose, 2010; Clark & Estes,
2008). Factors which Bandura proposed that can strengthen self-efficacy, and therefore
motivation, include vicarious experience and verbal persuasion (Bandura, 1977). Vicarious
experience includes observation of others and attention to role modeling, while verbal persuasion
includes feedback. Faculty have a powerful impact on student perceived self-efficacy (Ferguson,
2021). Understanding the motivation-related influences on student professional identity
development directs attention to the value of faculty development to understand the social and
academic role in PIF and appreciate potential impact on student self-efficacy.
Finding 5: Self, COVID-19, and Poor Faculty Interactions During Didactic Curricula
Perceived As Barriers to PIF
The disclosure of self, COVID-19, and faculty as perceived barriers to doctor of physical
therapy student PIF further answers the second research question aimed to understand the lived
experience of students while on campus. Students included a few sentences describing perceived
barriers while on campus, however there was reduced opportunity for gathering rich descriptive
qualitative data as data originated from open-ended survey questions, rather than interviews, per
research protocol.
More students perceived themselves, as an internal influence, to be the primary barrier to
their own professional identity development with included subthemes of lack of confidence,
doubt, and anxiety. This may be related to research supporting that limited opportunities for self-
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assessment and reflection can compromise professional identity development. This aligns with
previous studies in healthcare education revealing that self- reflection and self-awareness are
components of PIF and opportunities for reflective practice strengthen student professional
identity development (Holden et al., 2012; Maitra et al., 2021;Yakov et al., 2021; Wilson, 2008).
Students require opportunities for self-reflection to strengthen professional identity because PIF
is an internal process (Noble et al., 2014, Sonday, 2021). In the program researched, there has
not been an intentional effort to provide rich self-reflective spaces potentially reducing PIF
growth.
Beyond self, students perceived COVID-19 to deprive them of potentially positive
experiences with faculty which could have supported their professional identity development. On
the other hand, poor interactions with faculty comprising of unmet expectations, disappointment,
or negative feedback experiences were perceived to threaten student professional identity
development. This aligns with previous research noted in the literature review from healthcare
education that negative role-modeling or inconsistent faculty role can undermine professional
development and erode values (Del Prato, 2013; Fitzgerald, 2020; Keshmiri et al., 2020
Martimianakis et al., 2015; Noble et al., 2014; Sarraf-Yazdi, 2021; Silveira et al., 2019). As
previously noted, faculty may not understand the process of student PIF, the magnitude of their
role in student professional identity development, importance of role-modeling, all which may
limit faculty engagement in this process (Sternszus et al., 2020; Noble, 2014). This lack of
understanding may be impacting the program studied in this research and points to the
importance of faculty development in this area.
Finally, although only mentioned once, it is crucial to note the single response to
perceived barriers included underrepresentation of female faculty of color. The single response is
84
potentially due to under-representation of minority students within the cohorts studied and a
limitation of sample. There is a positive correlation between faculty diversity and
underrepresented student success (Baker, 2013). Because professional identity is influenced by
personal experiences, it is constructed differently for minoritized individuals when compared to
other racial groups (Slay et al., 2011). Professional identity formation is shaped with the merging
of both personal and professional identities (Hammond et al., 2016; Schrewe & Martimianakis,
2022). Consequently, increased emphasis on the existing self, developed individually through
impact of power, ethics, and experiences, within professional identity development, is an
essential step toward inclusion and diminishing marginalization (Schrewe & Martimianakis,
2022). In a review of literature, Wyatt et al. (2021) note that ethnicity and race have been absent
or not part of PIF analysis in healthcare education and advocate inclusion of alternate
frameworks to examine professional identity development in under-represented students.
Echoing this concern, a meta synthesis of PIF literature in medicine revealed the majority of
studies do not consider race, ethnicity, gender, and sociocultural data in findings interpretation
creating bias and impacting underrepresented student populations in healthcare education
negatively (Volpe et al., 2019).
This gap exists despite findings that participant background significantly contributes to
professional identity development and that PIF requires the convergence of the personal and
developing professional self (Sarraf-Yazdi et al., 2021; Volpe et al. 2019). Previous research and
the current study finding mirrors the representation concerns within the APTA, the leading
physical therapy organization within the United States, and the organization’s resulting
commitment to support “efforts to increase diversity, equity, and inclusion” (APTA, 2019,
para.1). Those students who identify with under-represented populations within physical therapy
85
education are impacted by different cultural experiences potentially impacting sense of
belonging and professional identity development requiring further exploration (Schrewe &
Martimianakis, 2022). Acknowledging and examining the cultural and social influences which
define learners development and identity is necessary to champion professional identity
development which advances inclusivity (Schrewe & Martimianakis, 2022).
The need for future research for greater understanding of the lived experiences of
minoritized individuals and impact on professional identity development to support greater
diversity is clear. This merited research will provide the valuable understanding needed to enable
programs and educators to meet the different needs and challenges of underrepresented students
to encourage successful PIF.
In summary, student response about barriers to PIF during didactic curriculum can be
interpreted by asking the question “What are students saying they need?” when they describe
barriers. The answer to this question reveals the following needs to support PIF: a.) quality, one-
on-one, face-to-face, interactions and time with faculty as an external and environmental
influence on PIF and b.) self-confidence in the adaptive, non-linear, internal process of PIF at the
individual and collective level as an internal influence supported by self-reflection (Jarvis-
Selinger et al., 2012). These barriers, revealing student needs, align with previously mentioned
factors in the conceptual framework, including active engagement/self-reflection as internal
influences and role modeling of faculty as an external influence on student PIF (Figure 1).
Ultimately, the relationships with faculty and behavior of faculty influenced students’
internalization of values and roles within the physical therapy profession. Socialization with
faculty during didactic curriculum was perceived by students as a key driver in PIF. Supportive
experiences were meaningful and impacted student thinking, feelings, and envisioned future self.
86
Contrarily, academic disappointments and poor interactions with faculty threatened PIF and
diminished student self-efficacy. However, students perceive themselves to be the greatest
barrier to their own professional development. The resonating student voice gives meaning to
lived experiences and provides an anchor point for program recommendations to weave support
in didactic curricula for the PIF of future physical therapists. The following section details
program recommendations to create a culture and learning environment supporting student PIF
based on these findings.
Recommendations for Practice
The following section centers on recommendations for the physical therapy program
evaluated based on quantitative and qualitative study findings of student perceptions. The
recommendations align with this study’s conceptual framework of the social cognitive theory
represented in Figure 1. The findings drive the call to action which includes implementation of
program recommendations organized within the social cognitive theory. The three program
recommendations include a formalized curricular thread with feedback and assessment
(environment), faculty development to support PIF knowledge and role modeling (environment),
and student opportunities self-reflection (person) (Bandura, 1986; Schunk & Usher, 2019).
Figure 8 represents the recommendations aligning to the conceptual framework and social
cognitive theory reciprocally impacting behavior, environment, and person.
87
Figure 8
Recommendations Aligned With Social Cognitive Theory Supporting Student PIF
Recommendation 1: Faculty Development
Understanding physical therapy student perspective about factors impacting professional
identity development was the impetus for this study. Findings revealed that student perceive
faculty to be the primary influence in PIF. Faculty development is necessary to ensure
foundational knowledge, unified understanding of PIF definition, factors impacting student
development, and faculty primary role in the process. Researchers agree that a cognitive base for
faculty and a clear understanding of the PIF process is critical to facilitate student PIF and
faculty engagement (Cruess et al., 2019; Moseley et al., 2021). Faculty uncertainty regarding PIF
is noted in literature, consequently, emphasis on faculty knowledge and goal alignment is
necessary for PIF incorporation in curricula (Garza et al., 2021; Janke et al., 2021).
88
Clark and Estes (2008) suggest that the amount of support provided for advancing
knowledge through training reflects the importance of an issue. A learning organization and
culture is reflected by effort to increase knowledge through training. In describing learning
organizations Senge (1990) states “superior performance depends on superior learning” and
describes collective learning as essential to this goal (p. 7). A culture shift toward valuing PIF
with intentional and explicit faculty and student support is critical and called for in the literature
(Cruess et al., 2014, Gaufberg et al., 2017; Janke et al., 2021; Wald, 2015). A culture model shift
toward a learning organization with appropriate training and transfer of knowledge to
stakeholders has potential to impact curricular design meeting healthcare educational reform
recommendations. Faculty must have the conceptual knowledge of this complex, transformative,
and lifelong process of PIF and their critical role in this process to effectively engage in
supporting student development. Faculty professional development will ensure faculty have
required knowledge and role alignment within the program for intentional support of student PIF.
Research has shown that training is necessary and effective in an academic setting and will
consist of synchronous and asynchronous content and highlight evidenced-based research about
student professional identity development (Hauser et al., 2010). The vital role of faculty in
healthcare higher education will be included. Strengthened faculty collective self-efficacy will
impact faculty job satisfaction, motivation, and reflect perceptions of faculty as a whole to
influence student outcomes (Fives & Buehl, 2016; Klassen et al., 2010; Henson, 2002).
Comprehensively, faculty development as a recommendation is an environmental factor which
mutually impacts student and behavior within the social cognitive theory (Figure 8).
Recommendation 2: Explicit Curricular Thread
89
The second recommendation includes the implementation an explicit professional
identity thread in curricula with faculty feedback and formal assessment. To ensure strong
student professional identity development and meet healthcare educational reform
recommendations physical therapy programs must be intentional. This aligns with previous
research indicating that explicit curricular opportunities for a unified faculty-student approach to
teaching, assessing and monitoring student PIF is imperative for effective support of student PIF
(Sarrif-Yazdi, 2021; Wald, 2015; Wilkins et al, 2020). Furthermore, research reveals novice
students require a structured procedural framework for facilitating PIF (Fragkos, 2016,
McCarthy et al., 2021). A perspective report by Poole and Patterson (2021) asserted the
importance of explicit “curricular renewal” and initiatives to support the transformational
process of PIF in healthcare education (p. S46). These initiatives should be explicit, deliberate,
and longitudinal throughout healthcare educational program (Chandran et al., 2019; Poole &
Patterson, 2021) The combination of explicit curricular thread with feedback and formal
assessment will provide the necessary framework to encourage student PIF.
Based on study findings, development of a professional identity curricular thread in
physical therapy education can be grounded in effective frameworks already implemented in
other fields of healthcare education (Cruess et al., 2019; Garza et al., 2021a; Garza et al., 2021b;
Janke et al., 2021; Kalet et al., 2017; Sarraf-Yazdi, 2021). Use of existing effective frameworks
and mapping to previous successful interventions will reduce the workload required potentially
incentivizing program to embed this curricular change.
Two effective components of PIF educational initiatives include feedback and formal
assessment to supporting student development (Garza et al., 2015; Noble et al., 2014; Sarraf-
Yazdi, 2021; Wald, 2015). Results from both quantitative and qualitive data in this study indicate
90
the significant value students place on faculty feedback. Findings indicated that effectiveness of
feedback was found to significantly support or undermine student professional identity
development. Faculty feedback and recognition is considered an essential need for student
professional identity formation (Goldie, 2012; Hensen & Jetten, 2018). Findings from this study
correlate with previous research asserting that faculty feedback impacts students self-efficacy in
the process of PIF (Noble et al., 2014; Sarraf-Yazdi, 2021). To enhance a culture of effective
feedback in healthcare education, both faculty development and student training is recommended
(Alfehaid et al., 2019). Faculty will be made aware of the critical importance of effective
feedback during the previously recommended faculty development and training. Additionally,
students must be taught that feedback is not passive and actively seek and use feedback to
maximize the benefits (Boud & Molloy, 2013). This can be accomplished through the
presentation of cognitive knowledge of PIF included in the curricular thread early in the
program.
Beyond feedback, formal assessment of student professional identity development is
critical. Schein (2017) purports what is measured by organizations transmits they cultural value
within the organization. In other words, what is important is indicated by what is measured. In
addition to opportunities for self-reflection, it is essential for students and faculty to recognize
student professional identity as a dynamic developmental process. Recommendations that
support inclusion of professional identity in curricula recommend formal student assessment
enabling students to track progress and growth (Garza et al., 2015; Wald, 2015). Recognition of
areas of strength and/or needed development will give students a baseline to reflect upon. The
Macleod Clark Professional Identity Scale (MCPIS) is recommended as a professional identity
measure with adequate psychometric evidence and good methodological quality when compared
91
to other measures (Matthews et al., 2019). It is also considered appropriate for a variety of
healthcare fields as an appropriate professional identity measure (Matthews et al., 2019). The
MCPIS can be used to assess student PIF throughout the program and track progress of
development in an established PIF student profile. The recommendation of formal assessment,
using the MCPIS, is a strategy to strengthen student professional identity development during
didactic curricula contributing to opportunities for the necessary self-reflection and growth,
increasing student self-efficacy.
To operationalize this recommendation, the curricular thread should be shared in faculty
development and curriculum review leading to increased awareness, value, and intentionality in
supporting student professional identity formation for success in clinical education and transition
into professional role. The explicit inclusion of a curricular PIF thread with feedback and
assessment will potentially minimize the impact of the occasional negative academic experiences
undermining student self-efficacy. This recommendation aligns with the study conceptual
framework as an environmental support from the social cognitive theory as noted in Figure 1. In
summary, incorporating the recommendation of an explicit curricular thread and space for
student formal assessment of PIF with faculty feedback will make values explicit and transmit
the cultural value of PIF within the program reciprocally impacting student and behavior.
Recommendation 3: Opportunities for Student Reflection
A final program recommendation includes creating opportunities for student self-
reflection during didactic curricula to strengthen self-efficacy. This recommendation is
visualized in Figure 8 and included as an internal influence on professional identity development.
The recommendation aligns with findings revealing that campus experiences, whether with
faculty or academic lapses, perceived as negatively impacting student PIF undermined student
92
self-efficacy. Conversely, research in medical education has shown that reflection powerfully
influences self-understanding strengthening self-efficacy (Sandars, 2009). Therefore, reflection
is essential for professional identity development within healthcare education to maximize self-
efficacy (Sandars; 2009). The recommendation aligns with previous research indicating
intentional educational design with opportunities for self -reflection and awareness support
student professional identity development (Chandran et al., 2019; Maitra, 2021; Noble et al.,
2019; Sarraf-Yazdi, 2021; Sonday, 2021; Wagner & Jackson, 2021; Wilkens, 2020). Students
must understand that PIF is an internal and active process requiring their participation in
engagement (Cruess et al., 2014; Wald, 2015).
Importantly, opportunities for reflection have been found to mirror experiential learning
opportunities for supporting the transformative process of student PIF (Garza et al., 2021b).
Research in occupational therapy revealed students felt that clinical education was a strong
primary impactor in professional identity formation (Ashby et al., 2016). This is critical as
clinical education and authentic learning experiences are paramount to student professional
identity development but are limited particularly early in curricula. When clinical opportunities
are scarce early in physical therapy curricula, reflection can provide a satisfactory alternate for
these learning experiences prior to clinical education in support of PIF.
Intentionally designing curriculum with self-reflection space and self-awareness
opportunities embedded throughout the program, particularly early in didactic coursework,
supports professional identity development and self-efficacy. Incorporation of reflection early in
curricula will develop clinicians with lifelong reflective practice skills as a lifelong learner. This
recommendation aligns with the study conceptual framework as personal support from the social
cognitive theory reciprocally impacting behavior and environment as noted in Figure 8.
93
Implementation of self-reflection opportunities will be accomplished after faculty development
and through curriculum review to determine location for specific space for student reflection
prompts and opportunities during didactic curriculum. Students will be instructed on Gibbs
cyclical model of reflection early within the program and will use this framework to reflect on
specific simulation experiences (Gibbs, 1988). Reflective writing assignments will be submitted
to individual student professional identity portfolio for faculty and student tracking.
The findings and ensuing recommendations reveal how PIF can become an educational
priority embedded into physical therapy curricula with reciprocal impact on behavior,
environment, and individual (Figure 8). Integration of professional identity into physical therapy
curricula is critical to support improved patient care and healthcare provider well-being. Because
professional identity strength is positively correlated to strong clinical communication skills,
particularly in patient education, it directly impacts clinical performance and patient care (Kalet
et al., 2021). In addition to communication, students with stronger professional identity
demonstrate improved moral reasoning and responsibility for patient care (Kalet et al., 2021;
Sawatsky et al., 2020). Beyond patient care, professional identity is also correlated to healthcare
provider well-being, higher job satisfaction, decreased burnout and stress, and enhanced
compassion and empathy (Edwards & Dirette, 2010; Lawrence et al., 2020; Scanlan & Hazelton,
2019; Wagner & Jackson, 2021). Professional identity directly impacts both healthcare provider
and patient care and is therefore critical to include in physical therapy curricula.
Implementation of professional identity formation as an educational priority is imperative
to meet the previously published healthcare education reform recommendations (APTA; Irby et
al., 2010; Jensen et al, 2017). Threading professional identity throughout physical therapy
curricula meets the action item advanced by The National Study of Excellence and Innovation in
94
Physical Therapist Education in 2017 deemed critical for excellence in physical therapy
education (Jensen et al., 2017). Implementation also meets the recommendation by the American
Physical Therapy Association for professional formation as a primary focus of education
(American Physical Therapy Association, n.d.).
In addition to enhancing future healthcare provider well-being, improved patient care,
and meeting healthcare education recommendations, implementing these recommendations will
likely boost student satisfaction. Findings indicated that students valued factors supporting their
professional identity development and desired more professional identity growth opportunities.
Improved student satisfaction impacts program application rates and reputation. Accordingly, it
could be used as a marketing strategy and a compelling motivation for physical therapy programs
to effectuate PIF in curricula.
In summary, three recommendations, viewed through the social cognitive lens, to support
physical therapy student professional identity development include a) faculty development b) an
explicit curricular thread with corresponding faculty feedback and formal student self-assessment
and c) opportunities for student self-reflection. The recommendations, based physical therapy
student perception of factors facilitating or threatening student PIF, strengthen the conversation
of faculty and program role in student professional identity development, meet healthcare
education recommendations, support provider well-being impacting future patient care, and
improves student satisfaction.
Moreover, this study answers the call to analyze qualitative data within programs to
provide essential feedback about development of student professional identity (Garza et al.,
2021). Implementation of these recommendations effectuate a research-supported framework to
support student professional identity development bridging theory to practice within physical
95
therapy curricula. Findings from this study will inform program initiatives, educational goals,
and curricular change, impacting behavioral change at individual faculty and student level
crucially impacting patient care.
Limitations and Delimitations
There are several intentional delimitations included in this study. The research is limited
to specific internal and external influences and interactions impacting student professional
identity formation. Influence of student personal attributes, such as family support, previous
lived experiences, and personality characteristics which may contribute to student PIF are not
included and considered a delimitation. Another intentional delimitation was small sample
purposely limited to one specific physical therapy program. This limits generalizability and can
be categorized as a delimitation as well. Finally, interviews as a data collection method were not
included secondary to concern with faculty-student power relationships and need for anonymity.
Observation was also not included as significant interactions may not occur in a defined
classroom or lab setting. The delimitations of data collection methods, focus on influences
during didactic education, and purposeful sampling are intentionally constructed study
boundaries for feasibility and research question relevancy.
Limitations of this study include elements outside of researcher control and are potential
weaknesses, some which were anticipated and must be noted. First, a limited number of students
completed the survey, potentially due to lack of incentivization. Additionally, student perception
of professional identity formation can be subjective and may interfere with determining specific
outcomes. Instrument validity is a primary limitation as the survey did not have established
psychometric properties impacting internal validity. Because of the anonymity required to
protect student participants, the survey was robust including 37 closed and open-ended questions.
96
This potentially impacted motivation resulting in study attrition with seven participants not
completing the entire survey decreasing sample size additionally impacted internal validity.
Furthermore, there was potential for selection bias in that only those students who were
interested in professional identity participated in the survey. Not all participants completed the
qualitative questions which may also be a result of selection bias and/or survey fatigue. This
potentially influenced data and conclusions. An additional threat to internal validity was the
impact of the COVID-19 pandemic as it influenced student qualitative response as a barrier to
student professional identity. This barrier may not emerged in qualitative data as a barrier if the
study was completed at different time.
Finally, the sample of participants, although representative of the cohorts, included
limited underrepresented Black students, per enrollment data, which is an additional study
limitation. Other ethnicities including Asian, Hispanic, and Asian Islander are strongly
represented in the program per enrollment data. This indicates a bias sample which may cause
skewed data. Discrepancies in representation indicate unique structural barriers many
underrepresented groups navigate. Responses from a limited number of black students may have
failed to identify important factors or connections within the data set due to underrepresentation.
This should be addressed in future studies with inclusion of more black student perceptions
within multiple programs to minimize marginalization and improve accuracy of results.
Recommendations for Future Research
Three areas for further research are recommended based on the findings, questions which
arose during data analysis, and limitations of this study. The three areas for further research
include exploring the perceptions of under-represented minority physical therapy students and
their professional identity formation journey, use of validated assessment tool to quantify
97
strength of physical therapy student professional identity pre- and post- curricular interventions,
and research across multiple physical therapy programs to improve transferability of findings.
These recommendations originate from this study and further research in the areas described will
further inform effective pedagogical approaches to program development strengthening doctor of
physical therapy student PIF.
The first recommendation for future research includes researching the perceptions of
under-represented minority physical therapy students and factors impacting their professional
identity development. This study revealed lack of representation was a barrier to professional
identity development by one student. This was likely coded once because of limited number
students representing this specific minority within the program. Although representation was not
a research focus, this area is critical to explore to ensure effective understanding and potential
differences in under-represented student professional identity development. Wyatt et al. (2021)
proposes centering under-represented minorities in PIF research. Focusing research on under-
represented students to understand their lived experiences will inform program development to
meet the needs of this critical student population.
Secondly, additional research is needed about measurement of professional identity in
physical therapy education. Research within other healthcare fields demonstrate that
opportunities for students’ to track their own professional identity progress supports growth and
development (Cruess et al., 2019; Garza et al., 2021b). Strength of professional identity could be
assessed through the McCleod Clark Professional Identity Scale which is recommended for
students in healthcare education (Matthews et al., 2019). Comparison of student scores pre- and
post- PIF initiatives could help determine effectiveness of intervention as programs implement
explicit constructs to support student professional identity development. Confirmation of
98
effective strategies would further inform program development for supporting student physical
therapy student professional identity development. Finally, because this research was completed
on participants of one physical therapy program, it would be beneficial to research multiple
physical therapy programs for improved transferability of findings.
In summary, the recommended future research will provide further evidence-based
strategies to effectively inform PIF interventions addressing the problem of underutilization of
professional identity formation as an educational objective in physical therapy education.
Conclusion
This study examined factors doctor of physical therapy students perceive to impact their
professional identity development while on campus. It also attempted to further understand the
lived experiences students recognized as defining or threatening PIF during didactic coursework.
The answers to the research questions are important because of the limited research in physical
therapy education pertaining to student professional identity formation. Understanding student
salient factors and lived experiences impacting PIF inform program development to support
learner needs and contribute to importance of faculty role in the transformative process of PIF in
physical therapy students. Furthermore, findings provide impetus for physical therapy program
development to meet healthcare education and APTA recommendations regarding inclusion of
professional formation in curricula.
Beyond supporting healthcare education reform recommendations, findings promote
professional identity formation as an important educational priority in physical therapy education
to nurture clinicians who are compassionate, resilient, possess professional well-being, and
successfully transition to the clinic. Ultimately, findings and emergent recommendations support
99
physical therapy student professional identity to critically impact compassionate and effective
patient care.
This study bridges the gap from theory to practice in physical therapy education with
pertinent program recommendations anchored in student perceptions. Comprehending physical
therapy student perceptions and experiences endorses faculty development, informs program
initiatives, and illuminates learning opportunities. Inclusion of professional identity formation as
an educational priority will critically shape student professional identity and fundamentally
improve patient care.
100
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Appendix A: Informed Consent
University of Southern California
Rossier School of Education – Organizational Change and Leadership 3470 Trousdale Pkwy,
Los Angeles, CA 90089
As a current/recent physical therapy student of Loma Linda University you are invited to
participate in an anonymous survey. Your responses will help the Loma Linda University
Physical Therapy Program. Thank you so much for considering participating. The informed
consent is below followed by the link at the bottom of the page.
Rossier School of Education – Organizational Change and Leadership 3470 Trousdale Pkwy,
Los Angeles, CA 90089
INFORMED CONSENT FOR NON-MEDICAL RESEARCH
You are invited to participate in a research study conducted by Gina Gang (Principal
Investigator) and Dr. Heather Davis (Faculty Advisor) at the University of Southern California,
because you are/were a full time doctor of physical therapy student at Loma Linda University.
Your participation is voluntary. You should read the information below before deciding whether
to participate.
PURPOSE OF THE STUDY
The purpose this study is to explore physical therapy students’ perceptions of factors and
educational experiences impacting their professional identity formation development.
POTENTIAL RISKS AND DISCOMFORTS
There are no anticipated risks or discomforts associated with this survey.
POTENTIAL BENEFITS TO SOCIETY
The anticipated benefits to society relate to a greater understanding of student needs to support
professional identity during didactic physical therapy education and improve effectiveness of
student transition from classroom to clinic.
PAYMENT/COMPENSATION FOR PARTICIPATION
There is no compensation for participation.
CONFIDENTIALITY
The survey is anonymous and your records for this study confidential. The members of the
research team and the University of Southern California’s Human Subjects Protection Program
(HSPP) may access the data. The HSPP reviews and monitors research studies to protect the
rights and welfare of research subjects. No identifiable information will be collected in this
study.
PARTICIPATION AND WITHDRAWAL
Your participation is voluntary. Your refusal to participate will involve no penalty or loss of
benefits to which you are otherwise entitled. You may withdraw your consent at any time and
discontinue participation without penalty. You are not waiving any legal claims, rights or
remedies because of your participation in this research study.
INVESTIGATOR’S CONTACT INFORMATION
Principal Investigator, Gina Gang: email at ggang@usc.edu or phone at (909) 557-5000 Faculty
Advisor, Dr. Heather Davis: email at davishm@usc.eduor (310) 425-4144
118
RIGHTS OF RESEARCH PARTICIPANT – IRB CONTACT INFORMATION
If you have questions, concerns, or complaints about your rights as a research participant or the
research in general and are unable to contact the research team, or if you want to talk to someone
independent of the research team, please contact the University Park Institutional Review Board
(UPIRB), 3720 South Flower Street #301, Los Angeles, CA 90089-0702, (213) 821-5272 or
upirb@usc.edu
Thank you for clicking on the following link as a consent to participate in the anonymous survey:
https://usc.qualtrics.com/jfe/form/SV_803MPMvtaalmyKq
119
Appendix B: Student Survey
I am a student at USC conducting a study designed to understand student physical
therapy professional identity formation while on campus. Data will contribute to further
understanding of student professional identity development. The survey will take approximately
20 minutes. First let’s define what we mean by professional identity formation for the purpose of
this study. Professional identity formation is the internal adoption of the values, attitudes, beliefs,
and morals of a profession. Professional Identity in physical therapy entails taking on the
behaviors of a professional therapist, yet goes beyond the mere “doing” of physical therapy, to
actually “being” a physical therapist. It includes the ability to see one’s self as a physical
therapist.
Table B1
Table of Survey Questions With Associated Responses and Research Questions
Question Response options RQ Concept
Rate the degree to which you agree
with the following statement: I am
responsible for my own professional
identity formation.
Strongly disagree,
disagree, agree, strongly
agree
RQ1 Active
engagement
(person)
Rate the degree to which you agree with
the following statement: Faculty
behavior and interactions
impact/impacted my professional
identity development while on campus.
Strongly disagree,
disagree, agree,
strongly agree
RQ1 Active
engagement
(person)
Rate the degree to which you agree with
the following statement: Peer behavior
and interactions impact/impacted my
professional identity development
while on campus.
Strongly disagree,
disagree, agree,
strongly agree
RQ1 Role-modeling
(behavior)
Rate the degree to which you agree with
the following statement: Specific
feedback from faculty
Strongly disagree,
disagree, agree,
strongly agree
RQ1 Feedback
(environment)
120
Question Response options RQ Concept
impacts/impacted my professional
identity development while on campus.
Rate the degree to which you agree with
the following statement: Time for my
own self-reflection impacts/impacted
my professional identity development
while on campus.
Strongly disagree,
disagree, agree,
strongly agree
RQ1 Self-reflection
(person)
Rate the degree to which you agree with
the following statement: Formal self-
assessment of my professional identity
development would impact my
professional identity formation.
Strongly disagree,
disagree, agree,
strongly agree
RQ1 Assessment
(environment)
On the scale, rate where responsibility
lies, between yourself and faculty, for
your professional identity formation
while on campus.
(myself) 1–5 (faculty)
scale
– Active
engagement
(person)—
beliefs
On the scale, rate where impact lies,
between peers and faculty, for your
professional identity formation while
on campus.
(peers) 1–5 (faculty)
scale
– Role-modeling
(behavior)
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: Role modeling by
faculty.
None, low, moderate,
high
RQ2 Role-modeling
(behavior)
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: Role modeling by
peers.
None, low, moderate,
high
RQ2 Role-modeling
(behavior)
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: Feedback from
faculty.
None, low, moderate,
high
RQ2 Feedback
(environment)
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: Opportunities for
self-reflection (thinking about specific
experiences areas of strength and
needed growth including an action plan
for the future).
None, low, moderate,
high
RQ2 Self-reflection
(person)
121
Question Response options RQ Concept
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: My choice as a
student to intentionally engage in
activities that may help me grow in my
professional identity development.
None, low, moderate,
high
RQ2 Active
engagement
(person)
Rate the value of the following as it
relates to strengthening your
professional identity development
while on campus: Opportunities for
formally assessing and tracking your
professional identity development.
None, low, moderate,
high
RQ2 Assessment
(environment)
Rate your level of satisfaction with:
Opportunities provided during the
program for self-reflection regarding,
growth, change, and development.
Dissatisfied, somewhat
satisfied, satisfied, very
satisfied
RQ2 Self-reflection
(person)
Rate your level of satisfaction with:
Opportunities provided during the
program for tracking and assessing
your professional identity
development.
Dissatisfied, somewhat
satisfied, satisfied, very
satisfied
RQ2 Assessment
(environment)
Rate your level of satisfaction with:
Individual feedback provided during
the program impacting your
professional identity development.
Dissatisfied, somewhat
satisfied, satisfied, very
satisfied
RQ2 Environment
(feedback)
Rate your level of satisfaction with: The
program’s emphasis on supporting
student professional identity
development.
Dissatisfied, somewhat
satisfied, satisfied, very
satisfied
RQ2 Environment
How often, if any, during your time on
campus, have you had conversations
with faculty that significantly impacted
how you see yourself now and in the
future professionally?
Never, once a year, 2–3
times a year,4–5 times
a year, 6–7 times a
year, 8–10 times a year
RQ2 Role modeling
(feedback)
How often, if any, during your time on
campus have your observations of
faculty impacted how you see yourself
now and in the future professionally?
Never, once a year, 2–3
times a year,4–5 times
a year, 6–7 times a
year, 8–10 times a year
RQ2 Role-modeling
How often, if any, during your time on
campus have educators provided you
time/ opportunity for self-reflection
regarding your professional
development?
Never, once a year, 2–3
times a year,4–5 times
a year, 6–7 times a
year, 8–10 times a year
RQ2 Reflection
122
Question Response options RQ Concept
How important are/were your
conversations with faculty on campus
with respect to your professional
identity development?
Very unimportant,
unimportant, important,
very important
RQ1 Role modeling
(behavior)
How important do you feel it is for you
to develop your professional identity as
part of your education?
Very unimportant,
unimportant, important,
very important
RQ1 Active
engagement
(person)
How important are/were your
conversations with peers on campus
with respect to your professional
identity development?
Very unimportant,
unimportant, important,
very important
RQ1 Role-modeling
(behavior)
How important is/was formal feedback
from faculty on campus with respect to
your professional identity
development?
Very unimportant,
unimportant, important,
very important
RQ1 Feedback
(environment)
How important is/was informal feedback
from faculty on campus with respect to
your professional identity
development?
Very unimportant,
unimportant, important,
very important
RQ1 Feedback
(environment)
How important are/was your
observations of faculty on campus with
respect to your own professional
identity development?
Very unimportant,
unimportant, important,
very important
RQ1 Role modeling
(behavior)
How much do/did you think about
developing your professional identity
during your education?
Never, rarely,
sometimes, often
– Perceived PI/
frequency
How strong do/did you perceive your
professional identity is/was during
your educational time on campus?
(embracing the values, behavior,
attitudes of a physical therapist and
seeing yourself in that role)
Very weak, weak,
strong, very strong
– Perceived
professional
identity/
quality
Note. Dashes indicate open-ended responses or question did not refer directly to a research
question.
123
Table B2
Qualitative Research Questions From Survey
Question Response options RQ Concept
What are/were the two most important
factors/influences facilitating your
professional identity development while
on campus?
– RQ1 Facilitators
What are two things the program could
do/change to improve support of
students in professional identity
development?
– RQ1 Opportunity
for
improvement
Describe an experience during your time
on campus, if any, that negatively
impacted your professional identity. (It
may have caused doubt and uncertainty
leading to question who you were
becoming professionally.) How did that
impact you?
– RQ2 Barriers
Describe any barriers that you have
experienced with regards to your
professional identity development.
– RQ2 Barriers
Describe recommendations, if any, you
have for the program to improve
supporting student professional identity
formation.
– RQ2 Highlights
culture
Is there anything else you would like to
share regarding the development of
your professional identity during your
time on campus?
– – –
Please indicate what graduating cohort
you belong to:
Graduating class of
2024, Graduating class
of 2023, Graduating
class of 2022,
Graduating class of 2021
– Demographics
Note. Dashes indicate where responses were open-ended or question did not refer directly to a
research question.
124
Appendix C: Codebook for Qualitative Analysis
Table C1
Codebook for Two Most Important Student-Perceived Influences on PIF
Parent code Level 1 child code Level 2 child code
People Faculty
Seen/heard/observed
time/feedback
Peers
Family
Friends
Program elements Authentic learning experiences
Didactic courses
Dress code
Leadership opportunities
Practice
Self Self-reflection
Personal perception/effort
Empathy
Faith
Personal experience
125
Table C2
Codebook for Experiences Positively Impacting Student PIF
Parent code Level 1 child code
Time Conversations
Feedback
Connection
Time to answer questions
Compassion Encouragement
Chance to learn from failure
Vulnerability Sharing vulnerable experiences
Authentic learning
experiences
Simulation lab
Interaction with real patients
Lab experiences
Hands on research
Inspiration Role-modeling
126
Table C3
Codebook for Impact of Experiences Positively Impacting Student PIF
Parent code Level 1 child code
Thinking (cognitive) Importance of role
Learning from faculty experiences
Failure as growth opportunity
Thinking about beliefs/ethics
Multiple perspectives
Feeling (affective) Valued
Reassured/Safe
Inspired
Confidence
Felt like a physical therapist
Recognized
Envisioning future role
(behavior)
Found voice
Reflected on future
Goal setting for future
Saw future self
127
Table C4
Codebook for Experiences Negatively Impacting PIF
Parent code Level 1 child code
Faculty Perceived indifference of faculty
Uncertain expectations
Opposing thoughts between faculty
Student should have failed and did not
Poor experience with faculty feedback
Academics Courses were not practical
Inconsistency with grading/content
Not enough time for content/lab
Too many exams together
Performing poorly on exam
Struggling academically
Self Disconnect from cohort
Stress and questioning self
128
Table C5
Codebook for Impact of Negative Experiences
Parent code Level 1 child code
Low self-efficacy Worry/doubt
Questions expectations
Inadequacy
Frustration
Felt dumb
Discouraged
Reframed as opportunity Opportunity for growth
Informed of what behavior to avoid in future
Table C6
Codebook for Student: Perceived Barriers to PIF
Parent code Level 1 child code
Faculty Lack of one-on-one time
Negative interactions
Lack of representation
Lenient grading/Expectations
Self Lack of self-confidence
Anxiety/Stress
Fear/Doubt
Language barrier
Mismatch between self and university values
Myself
Difficulty balancing professional/personal roles
COVID-19 Missed opportunities
Abstract (if available)
Abstract
This study applies the social cognitive theory to understand doctor of physical therapy student perceptions of professional identity formation (PIF). The purpose of this study was to determine what factors students, in various educational stages, perceived to influence their professional identity development during didactic curricula. Also, this study sought to understand the lived experiences students perceived as supportive or threatening to individual PIF while on campus. Using a survey with closed and open-ended questions, data from eighty participants, representing three cohorts were analyzed using a mixed methods approach. Quantitative findings from this study indicate that factors students perceived impactful align with previous research in other healthcare education sectors and included faculty as the greatest impact. There was no correlation between factors perceived important and cohort. Emergent themes from open-ended questions about lived experiences revealed that what faculty gave; time, compassion, vulnerability, authentic learning experiences, and inspiration to be the most significant positive impact on PIF. Experiences negatively impacting PIF were primarily external, with limited faculty encounters and program features impeding PIF. The impact of experiences supporting PIF impacted student thinking, feelings, and future behavior while experiences threatening PIF created reduced self-efficacy. When questioned about the greatest barrier to PIF, students perceive themselves to be the greatest barrier. This study contributes to the paucity of research in professional identity formation of doctor of physical therapy students and informs program development to support professional identity formation as an educational objective in doctor of physical therapy curricula.
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Asset Metadata
Creator
Gang, Gina Rachelle'
(author)
Core Title
Educators, experiences, and environment: exploring Doctor of Physical Therapy student perceived influences on professional identity formation
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Organizational Change and Leadership (On Line)
Degree Conferral Date
2023-05
Publication Date
02/14/2023
Defense Date
12/08/2022
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
OAI-PMH Harvest,physical therapy education,physical therapy students,professional identity formation
Format
theses
(aat)
Language
English
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Electronically uploaded by the author
(provenance)
Advisor
Davis, Heather (
committee chair
), Hirabayashi, Kimberly (
committee member
), Malloy, Courtney (
committee member
)
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ggang@llu.edu,ggang@usc.edu
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Gang, Gina Rachelle'
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Tags
physical therapy education
physical therapy students
professional identity formation