Introduction

Professional identity formation (PIF) is essential for medical students as they grow and prepare to become future physicians. Well-developed PIF ensures that medical students not only acquire the necessary knowledge and skills, but also internalize the ethical values and professional behaviors essential for patient-centered care and lifelong learning as physicians [1,2]. Cruess et al. argued that PIF in medical education occurs through participation in communities of practice (CoPs), progressing from legitimate peripheral participation to full participation [3]. This process of being accepted into the medical community is referred to as “socialization,” during which personal identity integrates with professional identity through the development of a sense of professional solidarity. Factors influencing socialization include role models, mentors, and clinical/non-clinical experiences as core elements, along with the influence of the learning environment, healthcare systems, and other aspects [3].

Cruess et al. also highlighted the influence of the general public, stating,’ Patients, colleagues, families, other healthcare professionals, and the general public tend to see medical students and residents as members of the broader medical profession. This perception may profoundly influence self-recognition as they progress toward becoming professionals.” However, their report did not elaborate on the unique effects of dialogue with the general public.

Cruess et al.‘s study provides valuable insights into professional identity formation, but the influence of dialogue with the general public was not a primary focus of this study, which could be partly explained by the timing of the initiation of medical education, which varies by country. For example, in Germany, students begin a six-year medical program immediately after graduating from high school, whereas in the United States, students enter medical school after obtaining a bachelor’s degree [4]. In the U.S., medical education occurs after students interact with the general public. In contrast, in Germany and Japan, students often enter medical school directly after high school, meaning that the entire process of identity formation over six years is encompassed within the medical education curriculum. Given this context, dialogue with the general public may be even more critical in countries such as Germany and Japan, where medical education begins directly after high school.

Thus, PIF is traditionally understood as a process of socialization within professional communities, particularly through interactions with mentors, peers, and clinical experiences. While these internal factors have been extensively studied, PIF is also influenced by broader social interactions, including engagement with the general public. Recent studies suggest that broader social interactions, including engagement with the general public, also contribute significantly to PIF [5,6]. These reports showed that public engagement can provide opportunities to articulate professional roles, receive external validation, and reflect on their evolving identities. However, as mentioned earlier, most existing literature on PIF has focused on socialization within medical communities, leaving a gap in understanding how external interactions shape identity development. This study aims to address this gap by investigating how dialogue with the general public influences the PIF process among Japanese medical students.

To explore this, we conducted a qualitative study using semi-structured interviews with medical students who participated in an interactive public event at Kyoto University. During the event, titled “The Past and Future of Medical Education,” students introduced the public to the types of classes and training involved in medical education. By analyzing students’ reflections on this outreach activity, we examined how public engagement complements traditional forms of professional socialization. A thematic analysis was conducted using Steps for Coding and Theorization (SCAT).

Methods

Details of the dialog with general public event

Academic Day at Kyoto University is an initiative aimed at providing a platform for “dialogue,” enabling everyone to discover the joy and appeal of academic pursuits. Held annually, the event gathers more than 100 researchers in one place, offering them the opportunity to engage directly with the public and explain the university’s research and educational activities in an accessible manner. Additionally, it facilitates the incorporation of public feedback into universities’ research activities. From 2011 to 2023, the event was jointly planned and managed by the “Dialogue with Society on Science and Technology” working group, comprising members from the Kyoto University Research Administration Center (KURA), the Research Promotion Division, and Kyoto University faculty and staff. Since 2024, KURA has taken the lead in organizing the event, focusing on creating a space for dialogue that transcends boundaries within and outside the university. In 2024, the event was held twice: once in September and once in November. This study focused on the November event held at Kyoto University’s premises. During this event, the principal investigator, together with the students, ran a booth showcasing posters on the evolution of medical education and simulators or VR equipment used for participatory clinical training. The original content of the medical education-related posters used by the students for dialogue with the general public is presented in Fig 1, and their English translations are provided in Figs 2 and 3. The simulators and tools displayed, along with the interactions facilitated through them, are presented in Table 1. The event lasted for five hours, from 11:30 A.M. to 16:30 P.M. Throughout this period, the booth received a constant flow of visitors, and the students engaged in continuous dialogue with them, except during the designated break times.

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Table 1. Simulators and tools in the event.

https://doi.org/10.1371/journal.pone.0324506.t001

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Fig 1. Original poster of the event (Japanese).

https://doi.org/10.1371/journal.pone.0324506.g001

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Fig 2. Upper half of the poster (Translated to English).

https://doi.org/10.1371/journal.pone.0324506.g002

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Fig 3. Lower half of the poster (Translated to English).

https://doi.org/10.1371/journal.pone.0324506.g003

Interviews and data collection

Interviews were conducted with students who participated in running the medical education booth during the Academic Day in Kyoto University 2024. Individual face-to-face interviews were conducted with each student. Before the interviews, participants were informed that their participation was entirely voluntary. They were explicitly informed of their right to refuse participation, withdraw at any time without providing a reason, or pause or terminate the interview midway. The interviews were conducted by the principal investigator, who was not involved in teaching the courses taken by the students or in their academic evaluations, ensuring that their progression had no influence on their decision. Before the interviews, it was explained that the study aimed to investigate the potential impact of their participation in the event as part of medical education research. Participants were encouraged to report any negative experiences, as doing so would enhance the quality of the study. These considerations aimed to ensure that respondents could answer questions without fear or anxiety, and to minimize biases arising from power dynamics during the interview process.

An interview guide was prepared and used to maintain a consistent structure throughout the interviews (Table 2). The guide was developed through discussions among all authors of the study. Each interview lasted 15–30 minutes and was conducted in a private room where there was no risk of being overheard by others. The seating arrangement was such that the interviewee was positioned closer to the door, allowing them to leave easily, if they desired. Audio recordings of the interviews were collected by the principal investigator, saved in the MP3 format, and transcribed by the first author.

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Table 2. Interview guide.

https://doi.org/10.1371/journal.pone.0324506.t002

Results

This study involved three participants. Each participant was interviewed once following their participation on Academic Day 2024. The average interview duration was 21 min. A thematic analysis using SCAT was conducted for each individual interview, and theoretical descriptions were categorized and examined based on their content. The following effects on students were identified:

The students reflected on their dialogue with the general public about medical education and demonstrated the following positive changes:

All students: “Rarely experiencing awareness or disclosure of their professional identity in everyday life.”

Third-year student (junior student in the earlier phase of their medical education):

“Reaffirming their professional identity through empathetic understanding of visitors.”

Fifth-year student (senior student in the advanced stage of clinical training):

“Disclosing their professional identity during dialogues with the general public, leading to the integration of professional identity and personal identity.”

These detected effects were based on the statements provided by the participants, as detailed below.

Discussion

PIF among medical students is often conceptualized as a process of socialization through participation in professional communities, as exemplified by the framework of Cruess et al. [3]. This process is influenced by various factors, but the impact of dialogue with the general public—individuals who do not belong to the professional medical community—has not been studied extensively. This study explored how Japanese medical students are influenced by interactions with the public as part of the PIF process. Based on these findings, we now discuss the theoretical implications of supporting professional identity development from a different perspective, particularly for students in the pre-stage of legitimate peripheral participation or those transitioning into legitimate peripheral participation. The results emphasize the significant role of public dialogue in fostering PIF and highlight key considerations and interpretations for student identity development. In this study, interviews were conducted with three medical students, which represents a very small sample size. Therefore, rather than aiming for generalizability, this study seeks to provide in-depth insights into the participants’ experiences. This study adopts a qualitative research approach grounded in the interpretivist paradigm, utilizing the SCAT method. Unlike grounded theory, which is rooted in the post-positivist, fact-oriented paradigm, SCAT is better suited to interpretivist, meaning-oriented qualitative research and supports studies with a single participant [15,16]. Consequently, the goal was not to achieve theoretical saturation, as in grounded theory, but rather to pursue specific and individual insights through a small number of research participants. This approach enables the extraction of generalizable and universal insights, despite the limited number of participants, reflecting the interdependent nature of human psychological, social, and cultural realities [7]. The aim of SCAT is not the reproducibility of results but rather the contribution of the derived theories to future practice and research in the respective field. To avoid misinterpretation and incorrect theorization when conducting deep analyses with a small number of participants, it is essential to utilize existing theoretical frameworks and construct innovative theories as extensions of these frameworks. This study focuses on PIF, with the theoretical framework proposed by Cruess et al. providing the foundational basis for the comprehensibility and relevance of this research.

Cruess et al. suggested that PIF in medical education can be classified using Kegan’s stages of identity development [3]. They identified medical students as primarily situated within stages 2–4 (Imperial, Interpersonal, and Institutional). In line with this framework, a study by Tagawa et al. on Japanese medical students found that elements of Kegan’s second stage were the most prominent on average [17], indicating that these students were in the process of socialization.

In this study, the students also described having limited opportunities to recognize or express their professional self, which aligns with previous findings suggesting that medical students are in Kegan’s stages 2–3 of socialization.

Cruess et al. further argued that the integration of personal identity and professional identity occurs through participation in CoPs. This study observed a similar phenomenon but only among fifth-year students with clinical training experience. This finding supports the significance of participation in CoPs, highlighting its role in fostering the integration of individual and professional identities.

As mentioned earlier, this study is based on the theoretical framework proposed by Cruess et al. How do these findings align with alternative perspectives on PIF? Varpio et al. analyzed and reported on 43 studies that investigated medical education interventions aimed at influencing PIF [18]. According to their findings, the majority of these studies focused on undergraduate medical education, with the most common approach being reflective writing and the use of narrative reflections. They noted that an individualistic approach predominated in interventions targeting PIF. In their report, they stated that “this study demonstrates that individualist perspectives reliant on reflective writing elide the impact of social contexts of PIF.” These findings suggest a prevailing individualistic bias in PIF approaches within undergraduate medical education. Given this tendency, public engagement may serve as a valuable complementary approach, mitigating the limitations of solely individualistic methods in fostering PIF.

Furthermore, this study demonstrated the potential of dialogue with the general public to facilitate reflection on and articulation of participation in such CoPs, thereby supporting the integration of the aforementioned identities. Despite these findings, several aspects require further investigation. In this study, outreach events supported by the university were utilized as opportunities for dialogue with the public. As mentioned in the Results section, discussions about professional identity are difficult to hold in everyday life. Therefore, simply exposing the students to the general public is insufficient. It is essential to create an environment in which students can comfortably talk about the medical education they receive and healthcare in general. In addition, the general public who visited the booths at this event did so with the intention of learning about the current state of medical education directly from the medical students. This, in turn, allowed students to speak candidly about their efforts and learning experience. During the interviews, a fifth-year student remarked, “In conversations with patients during clinical training, I rarely had the opportunity to talk about my identity as a medical student, as I was focused on discussing medical knowledge, patient conditions, and treatments.” It is important to note that this benefit stemmed from engaging with the general public, an interaction distinct from their usual exchanges with family and acquaintances or with patients during clinical training.

As previously mentioned in the introduction, medical education differs by country. When applying the findings of this study, attention must be paid to the differences between systems and cultures. As medical education in Japan begins immediately after high school graduation, unlike in the United States, these findings may be particularly applicable to medical students in countries that have similar systems to Japan, such as Germany.

Cross-cultural comparisons of PIF suggest that different societal and educational structures shape how individuals in the medical field perceive and develop their professional identities. For instance, Wahid et al. highlights the significant role of social recognition in shaping the PIF of medical educators in non-Western settings, indicating that societal validation plays a crucial role in professional identity development [19]. Similarly, studies on medical students have shown that in Germany, the emphasis on structured mentorship programs fosters PIF through hierarchical professional relationships, whereas in the U.S., early clinical exposure plays a crucial role in shaping students’ professional identities. Our findings suggest that in Japan, public engagement can serve as a unique factor in PIF, offering students an alternative means of professional identity reinforcement outside of the clinical setting.

In addition, this study could not sufficiently examine the peer interactions that occurred when senior and junior students collaborated to manage an event. Senior students expressed that they felt they could “speak naturally based on their own experiences” engaging in dialogue with the general public. Junior students, on the other hand, reflected on their dual role as both learners and educators, describing their experience of “explaining to the general public what they had learned from the senior students.” This aspect presents an intriguing topic for further investigation, which will be valuable in future research.

Conclusion

This study explored how Japanese medical students are influenced by the process of PIF through dialogue with the general public. The findings revealed that medical students who participated in the event where they explained their experiences as direct recipients of education to the general public had a positive impact on their PIF development. In other words, interaction with the general public, distinct from the professional group they currently belonged to or would be part of in the future, was found to counterintuitively heighten students’ awareness of their own professional identity. This study suggests that dialogue with the general public, traditionally been undervalued in comparison to interactions within professional groups, can contribute to the socialization process by fostering the reevaluation of professional identity and its integration with personal identity.

Supporting information

Acknowledgments

We thank all the students who participated in the interviews and all the faculty members who facilitated the Academic Day.