Competence, mattering and belonging: An evidence-based and practical approach to understanding and fostering medical student professional identity formation

Introduction: Understanding professional identity formation (PIF) in medical education is essential for preparing future physicians to navigate their profession and integrate communities’ of practice (CoP) values, norms, and expertise to meet patients’ needs. Despite robust PIF literature, gaps persist due to greater focus on internal psychological processes than social-contextual influences. Empirically describing PIF within medical training’s cultural context will enhance understanding and inform learning environment interventions. Methods: We employed a constructivist qualitative approach to examine social-contextual factors influencing students’ PIF. In one-on-one interviews, 52 graduating students from 4 geographically diverse U.S. medical schools described their PIF from pre-medical school through graduation. We used an iterative, multi-stage, constant-comparison approach to data analysis, employing reflexive methods throughout. Results: Social-contextual cues defining PIF were identified in three domains: competence, mattering, belonging. As students received cues, their professional identity evolved. They described a gradual integration of personal and professional values, with growing confidence and a shifting position within the physician CoP. Conclusions: This study provides a conceptual framework that describes how CoP members’ interactions with medical students positively influence and at times undermine students’ sense of competence, belonging, and mattering. Understanding these cues can help educators create a supportive environment that enhances students’ PIF.