Under the radar: How participating in a student organization can shape medical students' professional identity

BACKGROUND: Medical students' professional identity formation (PIF) starts early in their academic journey and is shaped by diverse social influences. Research shows that while participation in student organizations cultivates essential skills, it may also reinforce homogeneity and prevent cultural change. However, the impact of student organizations on PIF remains under-researched. This study aimed to investigate how a particular student organization impacted the PIF of novice students.

METHODS: We conducted a qualitative study utilizing constructivist grounded theory and the rich pictures methodology. We interviewed 12 novices, six senior students, three alumni and seven teachers from a medical school in Indonesia. The interviews with students were facilitated by Rich Pictures. The transcripts and pictures were iteratively analysed.

RESULTS: Novice students (i.e. first-year medical students) participated in an orientation programme organized by a centralized student organization. Becoming a member of this organization facilitated access to extracurricular training and networking. During the onboarding to this organization, senior students imparted values professed by the student organization: hierarchy, camaraderie and confidentiality. However, the way the seniors put these values into practice deviated from their intended purpose, leading to a mismatch that the novices perceived as oppressive. After an initial phase of resistance, novices entered a negotiation process to decide whether to persist with the orientation programme, resulting in three distinct outcomes: internalizing the values and being accepted as a member, enduring the programme by role-playing or becoming an outsider. This negotiation was accompanied by intense emotional suffering and identity dissonance. This socialization process ended up reinforcing an often oppressive hierarchical culture, which prevented novices from becoming change agents.

CONCLUSION: Participating in this student organization significantly influences PIF, and developing survivorship bias may prevent students from enacting transformative change. Reforming this often oppressive system would require collaboration among faculty, teachers, student organizations and students.