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Assistant professor of professional practice Adrian Reynolds discusses his article, “What is professional identity formation in medicine?” He explores how a student’s frustrated question, “Did I get dumber?” reveals the deep crisis of professional identity formation (PIF) in medical education. Adrian argues that the role of academic coaches and learning specialists is often misunderstood as remedial, when in fact their “hidden work” in teaching metacognition, self-regulated learning, and growth mindset is the true backbone of the curriculum. This discussion reframes PIF by focusing on the non-clinical specialists who guide students, navigating their own identity dissonance and role ambiguity in a hierarchical system. Learn why the curriculum “stands on the shoulders” of these educators and how they are central to transforming medical education.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Adrian Reynolds. He is an assistant professor of professional practice. Today’s KevinMD article is “What is professional identity formation in medicine?” Adrian, welcome to the show.

Adrian Reynolds: Thanks for having me, Kevin. It is such a pleasure to be here.

Kevin Pho: All right. Before we talk about your article, just briefly share your story and journey.

Adrian Reynolds: My journey into the academic coaching and medical education spaces is an interesting one. It has been fueled not just by scholarship and theory around coaching, teaching, and learning, but by my own personal experiences and struggles.

I take you all the way back, Kevin, to me as a high school student. I was a diligent, motivated, hardworking student. People who would come to the house would always remember me as someone who was always studying, always in the books. But guess what? They probably didn’t know I was filled with anxiety. Test-taking anxiety. I would show up late for exams, not because I was slacking off or anything, but because I was really sick the night before. I wasn’t studying properly. I wasn’t studying effectively. I was putting in tons of hours, but it wasn’t effective at all. I was a memorizer. I would try to memorize all my notes, and the moment I would go to take the test, if I forgot any line or any paragraph, everything would just fall apart. I just felt like my whole world was crumbling. The teachers back then, God bless them, did their best, but they weren’t trained on the science of learning, on teaching kids how to study effectively, how to learn to retain, or how to recall deep understanding of the material.

So that is really my background. That is why when I teach students and trainees how to approach their material, how to approach test questions, and so on (long-term retention, all of that), I do it from a place of: “I would never want you to go through the same kind of struggles that I went through years ago as a student.”

Kevin Pho: You wrote this KevinMD article specifically focusing on professional identity formation in medicine. For those who didn’t get a chance to read your article, tell us what it is about.

Adrian Reynolds: The article is really about drawing attention to the professional identity formation of learning specialists in medical education. In the literature on professional identification, which has been defined by Robert Merton in his 1957 piece, we think about the culture, the language, institutional hierarchies, and the knowledge base. When we take all that together and think about how it informs what it means to think and feel and act like a physician, we are talking about sort of the “soft skills” or the non-cognitive factors.

We see that in the literature, professional identity formation studies have primarily been centered around the identity formation of medical students and trainees. However, there is a piece that is missing, and that is the professional identity formation of non-clinician learning specialists. So people who are not coming from a background of the clinical sciences (who would probably have a background in counseling, curriculum development, and coaching broadly speaking): how do we enter and transition into the medical education space? Sitting at the table with physicians and physician-scientists and clinician educators, establishing our legitimacy and our credibility: these are important questions that have been totally under-explored or even just ignored in the literature on professional identity formation.

My goal here is to bring awareness and attention to the fact that there are people like us, like myself, whom we refer to as learning specialists. It is still an evolving, sort of new niched area in medical education, but there are people like us who are actually doing the work of informing the professional identification of medical students by virtue of teaching them how to learn in this new environment.

Kevin Pho: Give us an example of some roles of these non-clinician learning specialists when it comes to medical education. What are some examples of what that may look like?

Adrian Reynolds: A student came to me once, a medical student (I think the student was in their first year), and the student was clearly distraught, just totally frustrated, felt disappointed, defeated. The student asked me, I will never forget: “Dr. Reynolds, did I get dumber?”

So part of what we do is mindset work. We don’t just give test-taking tips and tricks; we work on shifting the mindset from one of “if I get less than an A, then I am not good enough.” So separating the student’s academic performance from their personal identity is part of the work of the learning specialist. In that session, when the student uttered those words, I didn’t jump straight into academic coaching strategies per se. Part of the coaching was: “Let’s talk about the mindset. Let’s talk about who you are as a person, and then let’s get into the strategies that you can use to turn things in your favor academically.”

We work with students who have failed exams, whether it is step exams for the trainees or preparing for board exams because they also have struggles academically, whether they are in a fellowship program or a resident, particularly when it comes to time management. A resident or trainee may say to me: “Hey, clinically, I am performing well. I am the star clinically; I am doing excellent patient care. However, when it comes to preparing for my board exams, studying, preparing for my ITEs, I struggle. I struggle with retention, I struggle with approaching the test questions.” As I said, time management is a big piece of that: managing the demands of medical school or being in a training program with finding the time to study. So when it comes to test-taking, just learning in general, time management, retention, and test-taking anxiety, these are the issues that we help coach learners through.

Kevin Pho: These medical students that you work with, presumably they are already at the cream of the academic crop because just to get through all the pre-medical requirements, the MCATs, and to be accepted to medical school, they are already the best of the best. So what is it about medical school specifically that challenges these already accomplished students?

Adrian Reynolds: Yes, they are already accomplished, but in an undergraduate setting, or many of them may have taken a gap year or pursued coursework at the master’s level. However, as we all know, medical school is just a whole different ballgame. Being able to retain all this volume of information in a short space of time is challenging. A student may have crammed their way through college, and it may have worked then. Now you are in medical school, and that is not going to work.

So how do we approach the material differently? There are challenges regarding time management, regarding goal setting, regarding metacognitive awareness (understanding really where the gaps are and how you self-test for that), and understanding how to set goals that are specific and achievable. Like I mentioned before, test-taking anxiety is a real issue for some students. Then you have issues like imposter syndrome that some students struggle with: “Yes, I made it this far, but am I supposed to be here?”

I could get even really more granular with you. One of the biggest problems that students and even trainees encounter is how they are approaching the study of the material. For example, let’s take a resident studying for boards in internal medicine. Their study system may look like this: “I spend a few days or a week studying GI, and then I move on to pulmonology.” It is sort of what we call block practice: one system, one subject at a time. Or even if they are on a specific rotation, they go one topic at a time, one subject at a time. However, I say to them: “Tell me how do patients present? Is it sort of one system at a time? One subject? How do you form your diagnosis? Is it just one thing at a time and then you move on?” And then they go: “Huh? So what you are saying is the way I approach the material should sort of mirror how I approach patients in real life?”

Kevin Pho: How common are these academic coaches and learning specialists in medical schools in general? It has been 30-plus years since I have been in medical school, and I don’t recall having these resources available to me as a student. So how common are these learning specialists?

Adrian Reynolds: I am glad you asked that question because I am a part of a stellar, growing, motivated group called the Medical Education Learning Specialists (MELS). I recently attended the annual conference in San Antonio, and there were close to 300 of us. So I would say, Kevin, unfortunately, the role of a medical education learning specialist is not as common as we would like to see. It has grown. I started out as a medical education learning specialist in 2016, and even then it was really new. I am the first at my institution, and many of the learning specialists I interact with are the first at their institution as well. It probably started to formalize around 2015 or so. It is not that people weren’t coaching before, but in terms of the professionalization of the enterprise of academic coaching as far as medical education learning specialists are concerned, it is still sort of in its infancy. And that is part of why I am on this podcast.

Kevin Pho: As you know, medicine is famously hierarchical. Things are really slow to change in medicine. So talk to us about some of the challenges that you face as a medical education learning specialist breaking into that hierarchical and traditional medical education mindset.

Adrian Reynolds: Well, I would say at my institution, I am very fortunate because my colleagues and faculty made room to really create and grow this position. They were already open to the notion of an academic coach, and it has really grown and evolved. But I think one of the challenges, just in speaking with my colleagues, has been really professionalizing the role: having people understand in a concrete way, what is it that we do? I often say to folks: “I am not the ‘fix-it’ person. Like, ‘OK, if students fail an exam, send them to Dr. Reynolds.'” Thankfully that has never been the case at my institution, but for other learning specialists, it is the case, and they are sort of spread thin, filling in with other sort of non-academic coaching tasks as they go along.

Onboarding has been a struggle. That sent a light bulb in my mind when I saw an email related to how learning specialists are being onboarded and trained. Training is lacking: consistent training for medical education learning specialists at their respective institutions, especially for them transitioning into a role that never existed prior to them being there. So that is a big piece. I can tell you that the onboarding is sort of a little disjointed across the board. We are working toward more professionalization and formalization of what we do through this group of medical education learning specialists.

Kevin Pho: In terms of a typical background of a medical educational learning specialist, just give us a spectrum of where they come from, where their training is, what kind of education they have, and what they have done before they have become medical education learning specialists. What kind of spectrum are we dealing with here?

Adrian Reynolds: That is a great question. Some of them have taught in the K-12 setting. They have had university teaching experience. Others are from a counseling background or academic advising background outside of medical education. Others hold advanced or graduate degrees in psychology and might have worked as a counselor. So it is a broad spectrum across the educational landscape.

For me, for example, my training (my doctorate) is in foreign, second, and multilingual language teacher education. Basically, what that means is understanding how languages are acquired or learned and teaching people like future teachers how to teach languages. Interestingly for me, the transition into medical education and academic coaching worked out really well given my background because now I am teaching trainees and students how to learn the language of medicine. All the theories, the concepts, and the strategies that I have mastered in terms of language teacher education and language education, I have been able to transfer into this space. So it has been one exciting journey.

Kevin Pho: That leads me to my next question. Outside of academics, how do you contribute to medical students’ professional identity formation?

Adrian Reynolds: We get emails from students who are not even our students at our institution reaching out for advice. We might be at a conference, at a poster session, and we meet students who have questions about how to retain material, how to prepare for exams, how to calm their anxieties around that, and how to manage their time. So we are always sort of “on call,” if you will, because almost everyone we meet isn’t really aware that such a role even exists, and they find it really interesting.

Personally for me, one of the ways in which I contribute is through my own podcast, Faith Meets Academia, in helping folks who have an interest see the connection between their spirituality, their faith, and what they are doing academically. As an ordained minister, I have for sure always seen the marriage between what I do professionally as an academic coach involved in the learning sciences and my own spiritual growth, and I see them as mutually informing.

Kevin Pho: For medical students who may be listening to you, when should they consider perhaps seeking the services of a medical education learning specialist?

Adrian Reynolds: Well, that is an interesting question. I came up with this notion of “preventive academic coaching,” sort of like preventive medicine. I don’t wait until you fail something to see a learning specialist. So for me, at the University of Miami, from day one my philosophy has always been creating a culture around the science of learning, creating a culture of learning how to learn in medical school. In the first few weeks of medical school, our students have four to five mandatory hours of study skill development around the science of learning so that we are not waiting until they fail something or are really struggling before they come to meet with us.

However, what I could offer is this: If you find that you are putting in the hours and putting in the effort, and it is not translating into higher scores, improved clinical reasoning, or improved retention of the material, you absolutely need to have a conversation with a learning specialist. If you feel like you aren’t managing your time well and you feel like every single thing on your to-do list is highly important, you absolutely need to meet with a learning specialist. If you feel like you are losing focus often (when you study, your mind is just wandering), you need to meet with a learning specialist. They could in turn refer you to other services if there is sort of a new or diverse challenge there to be addressed, such as meeting with disability services or so on.

There are a few tips that I could offer in terms of where medical students or trainees make mistakes. You definitely want to “play like you practice, practice like you play” in sports. On these standardized exams, the way our learners are assessed is usually mixed. It is not section by section, subject by subject. It is mixed. So when you are studying, you want to study in what we call an “interleaved” fashion. You want to study similar subjects and topics together so that when you are presented with a patient case, you are able to think sort of in a more synthetic way. You are able to think adaptively and transfer knowledge across systems and subjects as opposed to just one thing at a time. So that is called interleaving. If I could name just a few quick strategies, I would say interleaving, retrieval practice, and spaced repetition. Those I sort of refer to as the “big three” when it comes to effective evidence-based studying.

Kevin Pho: We are talking to Adrian Reynolds. He is an assistant professor of professional practice. Today’s KevinMD article is “What is professional identity formation in medicine?” Adrian, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Adrian Reynolds: In terms of take-home messages, I would say for any clinician out there listening: The challenges that trainees and students come upon in terms of their academic or clinical performance might not necessarily have to do with competence per se. It may have more to do with how they are approaching the material, how they self-regulate, how they manage their time, how they set goals, and so on. So that really is to be considered.

It is important to make space for academic coaches, particularly non-clinician academic coaches, to have a seat at the table because we bring a very different sort of perspective and viewpoint to the mix. When we meet with students, we can genuinely say: “We are not judging you per se on the content itself because we are not the content experts. But through coaching, we can help you develop a higher sense of metacognitive awareness so that you can go into any test situation or any clinical encounter with confidence and a clearer understanding of what is expected of you.” So if you don’t have a learning strategist, an academic learning specialist coach on your team, you probably need one, whether you are in GME or UME.

Kevin Pho: Adrian, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Adrian Reynolds: Thank you. It was a pleasure. Thanks for having me.