Beyond the Medical Curriculum… Exploring the Impact of Student Extra-Curricular Activities on Professional Identity Formation.

Professional identity formation (PIF) of medical students is a critical component and foundational mission of medical education, as it is interconnected with students' striving for competence and effectiveness as future physicians. Activities that culminate in meaningful interactions and experiences positively influence students' PIF. In this study, we explored how medical students involved in extra-curricular activities (ECAs) experience ECAs' impact on their PIF. Using constructivist grounded theory, we completed 16 semi-structured interviews with Year 3 and Year 4 medical students at a medical school in Singapore from November to December 2023. Participants were purposively and theoretically sampled. We analyzed deidentified transcripts through open, axial, and selected coding. We constructed themes and identified relationships between themes that we refined through discussion and constant comparison with newly collected data. We constructed three main themes: (1) Participants' decision to pursue both medicine and ECAs was driven by their aspiration to live life fully and meaningfully, generating alignment between their personal and future professional identities. (2) Participants' participation in ECAs yielded positive affordances and gains in medical competence development, thereby strengthening their PIF. These experienced benefits from ECA participation for both their professional and self-identities reinforced participants' perseverance in both endeavors. (3) Pursuing ECAs, even when viewed as not a norm when medical training intensified, was an expression of self-advocacy for some participants to live out their passions and preserve important elements of their prior self-identities as they learned to accept a new professional identity as a doctor-to-be. The study results highlighted that participants' PIF evolved as they simultaneously lived and learned in two spaces - one within medicine and one outside of medicine, where they learned to advocate for other unique and non-negotiable aspects of their self-identities and fully live out their other passions. Medical educators must acknowledge that ECA participation has a self-autonomous nature and strong potential to foster students' holistic development as they become doctors. To maximize ECAs' benefits for students' PIF, medical educators could provide timely guided reflective practice to consolidate students' learning from their participation in ECAs. Finally, medical educators must consider personalizing their support for students as they navigate their unique PIF journeys.