Failure, remediation and the disruption of professional identity formation in undergraduate medical students (at two UK medical schools)

Abstract

The aim of this thesis is to understand how the narratives medical students create around their professional identities are impacted upon by academic failure and subsequent remediation at two UK medical schools. Whilst much has been written regarding pedagogically underpinned approaches to remediation, little has been published regarding how these interventions impact on the ways that students perceive themselves as future doctors, and the implications this has on their future studies. This thesis asks how failure and subsequent remediation impacts on professional identity formation, explores the different identities that students narrate they hold and considers how these findings can be used to inform a conceptual framework of remediation that supports professional identity formation. Through questionnaires, semi-structured interviews and a narrative approach to analysis, the experiences of participants are explored through the way they tell their stories, and how these stories provide an insight into their complex, evolving and intersectional identities. This thesis demonstrates that medical students narrate complex identities which are significantly impacted by failure and remediation, that the hidden curriculum of assessment and professional communities of practice are key to the ways that students hold these identities. The thesis also demonstrates that greater awareness and understanding of the agency of individual students is needed to ensure that those designing remediation interventions do so with professional identity formation in mind. Finally, this work makes recommendations regarding how remediation interventions can be constructed to support positive identity formation in the future, including a new focus on the longer-term implications of failure and remediation of the next generation of doctors, and the need to recognise that medical students are a heterogenous group, with a wide variety of lived experience. Support and remediation must therefore embrace, celebrate and respond to this, including a renewed focus on mental health and psychological wellbeing.