The Emergence of Family Medicine Identity Among First-Year Residents: A Qualitative Study

BACKGROUND AND OBJECTIVES: As part of a national pilot, the Lehigh Valley Family Medicine Residency Program implemented curricular changes to emphasize family medicine identity. These changes included limiting first-year inpatient experiences, adding interval outpatient weeks, and increasing family physician mentorship. This study explores how postgraduate learners describe their professional identities within the context of their chosen specialty, as defined by Family Medicine for America's Health (FMAHealth). METHODS: This qualitative study approached family medicine identity formation from a social constructionist framework using evolved grounded theory. We performed a thematic analysis of focus groups conducted over 12 years with first-year residents (n=73). Then, utilizing a matrix analysis, articulations about professional identity were compared with structural components of the FMAHealth definition of the specialty. Three cohort groups (Preimplementation, Implementation, and Postimplementation) were defined to conduct a longitudinal comparison. RESULTS: Six unique biosketches synthesizing the analyses emerged. Expansion in ability to articulate professional identity was evident not only across, but also within cohort groups. The Preimplementation cohort entered and left their first year identifying as relationship-centered generalists desiring guidance from role models. The Implementation learners used more FMAHealth language to describe their practice, later recognizing the potential it held for patient care. Similarly, the Postimplementation cohort entered with a broader view of family medicine and exited wondering how to help advance its reach. CONCLUSIONS: Curricular changes placing interns within specialty-relevant learning settings coincide with thematic differences in articulations in professional identity. These findings suggest that experiential learning and role modeling contribute to professional identity formation among graduate medical learners.