VOL. 8, NO.

2, 2020 – Page 25-41

10.5278/ojs.jpblhe.v8i2.3554

A Scoping Review of the Relation Between Problem-based Learning and Professional

Identity Development in Medical Education

Nicolaj Johansson, Susanne B. Nøhr, Diana Stentoft *

ABSTRACT

There is a substantial amount of research pointing to the benefits of pedagogical

approaches such as problem-based learning (PBL) and the importance of developing
professional identity as a physician in medical education. The aim of this review is to
investigate the existing literature concerned with the relation between PBL and
professional identity development in undergraduate medical students. We performed a
scoping review of six electronic databases to map out how the relation between PBL and
professional identity development in undergraduate medical students is presented in the
existing literature. Eight peer-reviewed full text articles were retrieved as eligible for
review. The most important conclusion from our work is that even though the topic of
professional identity development in medical education has been studied quite
extensively, there is a lack of knowledge about how new types of pedagogical approaches
such as how a PBL curriculum influences medical students’ professional identity
development.

INTRODUCTION

Today medical educations around the world have to meet the demands from the fast-changing
societies and healthcare systems, and furthermore medical knowledge and the way of treating
complex diseases are rapidly expanding (Boyd & Fortin, 2010; Stenberg, Haaland-Øverby,
Fredriksen, Westermann & Kvisvik, 2016). To keep pace with such requirements and changes,

________________

* Nicolaj Johansson, Department of Health Science and Technology, Aalborg University, Denmark
Email: nijo@hst.aau.dk
Susanne B. Nøhr, Department of Clinical Medicine, Aalborg University, Denmark
Email: snoehr@dcm.aau.dk
Diana Stentoft, Department of Health Science and Technology, Aalborg University, Denmark
Email: stentoft@hst.aau.dk
N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

a high-quality education and practice that prepare medical graduates for the work as a physician
is essential (Boyd & Fortin, 2011).

Professional identity development is a substantial theme in the research field of medical

education, and is also acknowledged as a way of preparing graduate medical students for the
work as physicians (Cruess, Cruess, Boudreau, Snell & Steinert, 2014; Passi, Doug, Peile,
Thistlethwaite & Johnson, 2010). Similar research indicates that a strong sense of professional
identity enhances robustness and preparedness to the transition from medical student to
physician (Dolmans, De Grave, Wolfhagen & Van Der Vleuten, 2005; Lohfeld, Neville &
Norman, 2005; Sharpless et al.,2015; Tweed, Bagg, Child, Wilkinson & Weller, 2010).
Therefore, the importance of developing professional identity has been emphasised by
international guidelines in medical education by organisations as Royal College of physicians
and surgeons of Canada, Accreditation Council for Graduate Medical Education and
Tomorrows Doctor (Franco, Franco, Severo & Ferreira, 2015; Maudsley & Strivens, 2000) and
seems to have high priority on the medical educational agenda (Hefler & Ramnanan, 2017;
Passi, Doug, Peile, Thistlethwaite & Johnson, 2010; Sharpless et al., 2015). Besides medical
expert knowledge, medical students have to learn to think and act appropriately in their
professional positions, understanding workplace cultures, meet the expectations of patients,
relatives and other professionals, be effective in working with different stakeholders, and
discerning in making judgements about ethical issues (Alba & Barnacle, 2007; Cruess, Cruess,
Boudreau, Snell & Steinert, 2014; Sharpless et al., 2015). This leads us to the point that the
curriculum in medical education has an important and meaningful role to play in supporting
students’ professional identity development and is to be seen as a vital source in the
transformation to becoming a physician.

Parallel to the increasing interest of professional identity development in medical education,

research in PBL has been given much attention over the last decade (Barnett, 2009; Savery,
2006; Walke, Leary, Hmelo-Silver, Ertmer & Lafayette, 2015).

Most researchers agree that PBL displays the following four characteristics: (a) a focus on
complex, real world problems that has no one right solution, (b) based on group work, (c)
students gain new information via self-directed learning and (d) teachers facilitate the learning
process (Boud & Feletti, 2013; Hmelo-Silver, 2004; Walke, Leary, Hmelo-Silver, Ertmer &
Lafayette, 2015). A PBL curriculum that involves these characteristics facilitates medical
students to learn in ways that mirror professional practice and to attain high-level competencies
and transferable skills, and therefore assists the demands of preparing the medical graduates for
clinical practice (Barrows, 1990; Murray & Savin-Baden, 2000).

The competencies that PBL a curriculum offers the graduate students as collaborative skills,
self-reflection, critical thinking, self-directed learning and solving real-life problems is the key
to assisting medical students in making a smooth transition to the clinical setting (Barrows &

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Tamblyn, 1980; Boud & Feletti, 2013; Tan, Van Der Molen & Schmidt, 2016). In addition to
these competencies, PBL also brings the medical students into real-life situations either with
real patients or cases that mirrors real life situations as a learning resource and the need for
cooperation and communication with other professionals, which enhance confidence,
motivation and satisfaction (Bleaklet & Bligh, 2008; Maudsley & Strivens, 2000).

Having noticed that PBL curriculum and professional identity development independently were
prevalent in the field of medical education research we set out to explore the scope of existing
literature which present the relation between PBL and professional identity development in a
medical education context.

To identify and uncover the volume of medical education research about the relation between
PBL and professional identity development we decided to conduct a scoping review and thus
the research question we seek to answer is as follows:

How is the relation between problem-based learning and professional identity

development represented in the field of medical education research?

Since it is not unreasonable to assume that PBL curricula reinforce a certain professional
identity development and mindset, which is unique to the PBL pedagogy, it is important to
explore the existing research to gain new knowledge about how PBL a curriculum affects the
professional identity development of medical students.

METHOD

This scoping review used the established scoping review framework delineated by Arksey and
O'Malley because it enabled researchers to identify and summarize known literature on a given
topic regardless of study design (Arksey & O’Malley, 2005; Levac, Colquhoun & O’Brien,
2010). Furthermore, Arksey and O’Malley drew four common reasons why a scoping review
might be conducted: (a) to examine the extent, range and nature of research activity, (b) to
determine the value of undertaking a full systematic review, (c) to summarize and disseminate
research findings, (d) to identify research gaps in the existing literature (Arksey & O’Malley,
2005; Levac, Colquhoun & O’Brien, 2010). All four of these reasons supported our aim for
conducting this scoping review as we sought to examine the volume, range and nature of papers
that investigates the relation between PBL and professional identity development in medical
education.

To guide the search strategy, we used the five key phases that one must go through when
conducting a scoping review as outlined by Arksey & O’Malley (2005) and Levac, Colquhoun
& O’Brien (2010): First starting point was to identify and formulate the research question to

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guide the search strategy. Second, to identify relevant studies, through scoping the literature as
comprehensively as possible. Third, to select the relevant studies which, involved inclusion and
exclusion criteria based on the research question. Fourth, the charting was used to extract data
from each of the included studies and a descriptive analytical method was used to extract
contextual or process-oriented information from each study. Finally, collating, summarizing,
and reporting the results which demanded consistency and clarity.

We have chosen to follow Arksey & O’Malley’s (2005) and Levac, Colquhoun & O’Brien
(2010) guidelines for scoping reviews. We consider this approach to be appropriate to the topic
of our study in accordance with what has been defined as the overall purpose of conducting
scoping reviews; a form of knowledge synthesis that addresses an exploratory research question
aimed at mapping key concepts, types of evidence and knowledge gaps in the literature.

Search strategy and selection criteria

Based on our research question, the following keywords were identified to manage the literature
search: medical education OR medical student OR medical students AND identity AND
problem based learning OR problem-based learning. These keywords in the mentioned order
together with relevant synonyms were combined to reflect the specific search string that was
used to search relevant databases:

((“medical education” OR “medical student” OR “Medical students”) AND

identity AND (“problem based learning” OR “problem-based learning”)).

We systematically searched the following six databases: PubMed, Scopus, ProQuest,

PsychINFO, EBSCOhost and Medline. In keeping with the intention of scoping reviews as
outlined by Arksey and O’Malley (2005) and Levac, Colquhoun & O’Brien (2010), these
databases were selected to give comprehensive coverage and concerned with medical education
or higher education, because research in medical education is not necessarily published in
medical education journals.

To encircle the specific topic of our scoping review, we employed a number of criteria for
inclusion as well as exclusion of studies derived from the research question. Studies were
included for further review if:

 Problem based learning/problem-based learning was mentioned in either the title,

abstract or keywords
 Identity was mentioned in either the title, abstract or keywords
 The study was conducted in the context of undergraduate medical education

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Figure 1. Volume of identified papers in six databases used in the scoping review concerned with PBL,
Medical education and professional identity.

In addition to the scoping review, a preliminary search was conducted to strengthen the
relevance of our scoping review. As shown in Figure 1, research in identity and medical
education is well represented with 208,230 identified papers and 10.466 papers were identified
relating to research in PBL and medical education. 2.618 papers were identified relating to PBL
and identity and only 8 papers met the inclusion criteria derived from the research question.

In order to limit our search, studies were excluded if they were not available in English. Books,
book chapters, conference abstracts and non-reviewed publications were also excluded. Having
performed the initial literature search using the specific search string outlined above, we
continued to sort the articles by employing the criteria for inclusion and exclusion in the
following three steps: First we identified and removed the duplicates from the first search, we
used the reference manager Mendeley. Second, the abstracts of the remaining articles were
sorted manually, in the sense that titles, abstracts and keywords were manually screened.

In this step, only the articles conducted in a medical education context with a primary focus on
undergraduate medical students’ and mentioning problem based learning/ problem-based
learning and identity in the title, abstract or keywords were included. Third, the full-text version
of the remaining articles was retrieved and included for in-depth analysis. To ensure the
eligibility of the selection of articles guided by the research question, the inclusion and
exclusion process, was assessed jointly by three researchers.

The search and identification process of the literature search is presented in Figure 2.

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N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

Figure 2. Search and identification flowchart.

The principal strength of this scoping review was the detailed search strategy designed to cover
all the research that studies relations between PBL and undergraduate medical students’
professional identity development.

RESULTS

The search was conducted on October 10, 2018 and included six databases PubMed (23),
Scopus (35), ProQuest (377), PsychINFO (21), EBSCOhost (17) and Medline (22), which
yielded in total 398 articles, which were potentially relevant, when duplicates were removed.
After further screening of the 398 titles, keywords and abstracts, in accordance with inclusion
and exclusion criteria, 8 full text articles were retrieved for detailed review, as shown in table
1 below. The very limited number of articles for review testifies Fig. 1 to the lack of studies
which explicitly examine the relation between professional identity development and PBL.

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Ref. Database Authors Year Title Journal

nr.
[1] Scopus Bell, K., 2009 When only the real Medical Education,
Boshuizen, H. P. thing will do: Junior 43(11), 1036–1043
A., Scherpbier, medical students’
A., & Dornan, T. learning from real
patients.
[2] MEDline Berkhout, J. J., 2018 Context matters Medical Education,
Helmich, E., when striving to 52(1), 34–44.
Teunissen, P. W., promote active and
van der Vleuten, lifelong learning in
C. P. M., & medical education.
Jaarsma, A. D. C.
[3] Scopus Evensen, D. H., 2001 A qualitative study Journal of
Glenn, J., & of six medical Educational
Salisbury- students in a Psychology, 93(4),
Glennon, J. D. problem-based 659–676.
curriculum: Toward
a situated model of
self-regulation.
[4] Scopus Badenhorst, E., & 2013 Negotiation of Teaching in Higher
Kapp, R. learning and identity Education, 18(5),
among first-year 465–476
medical students.
[5] PsycINFO Imafuku, R., 2014 Students’ Interdisciplinary
Kataoka, R., Experiences in Journal of Problem-
Mayahara, M., Interdisciplinary Based Learning,
Suzuki, H., & Problembased 8(2), 1–18.
Saiki, T. Learning: A
Discourse Analysis
of Group Interaction.
[6] EBSCOhost Imafuku, R., 2018 What did first-year Journal of
Kataoka, R., students experience Interprofessional
Ogura, H., during their Care, 32(3), 358–
Suzuki, H., interprofessional 366.
Enokida, M., & education? A
Osakabe, K. qualitative analysis
of e-portfolios.
[7] ERIC MacLeod, A. 2011 Caring, competence Advances in Health
and professional Sciences Education,
identities in medical 16(3), 375–394.
education.
[8] ProQuest Reddy, S., & 2016 The Guinea pigs of a Innovations in
McKenna, S. problem-based Education &
learning curriculum. Teaching
International, 53(1),
16–24.

Table 1. Articles included for full text review (in-dept analysis).

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During the analysis of the 8 included articles, three main themes appeared relevant to discuss
in relation to the research question. Firstly; the methodology used in the articles, secondly; how
professional identity is conceptualized and finally how the relation between PBL and
professional identity in medical education is visible. Themes that in one way or another can be
regarded as a framework for the later discussion of the consequences or impact that a PBL
curriculum has on undergraduate medical students´ professional identity development.

Nature of research
Of the 8 articles (see Table 2) for full text review, 7 contained empirical content utilizing
qualitative approaches to data collection such as interviews, observations, self-reported
statements and learning portfolio interviews, to investigate the relation between PBL and
professional identity development in a medical education context [1,3-8]. The observations in
the articles [4,5,7] were all conducted during PBL group sessions, group meetings or tutorials
and the interviews in these articles were performed after or during the observation period. The
articles using retrospective data as interviews [1,4,7,8], e-portfolios [6] and self-reported
statements [1] were analyzing or interpreting the learner’s own experiences with PBL. The last
article [2] was identified as conceptual, since it is contained conceptual principles about current
knowledge on enhancing active learning in PBL, and furthermore introduced some theoretical
frameworks that may foster the understanding of the relation between active and self-regulated
learning and professional identity development.

Table 2. Learning context, research participants and type of research.

Conceptualization of professional identity

Professional identity in the included articles often refers to what a physician is, described as a
representation of a position or a self, achieved in stages over time during which the
characteristics, values, and norms of the profession are internalized through social interaction,
agency, learning, reflection, acting, and feeling like a physician [1-8]. The authors of the 8

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papers argue that professional identity is an adaptive developmental process that occurs both at
the individual level of the medical student and as a result of socialization into a clinical role and
professional community. Contained within these analytical descriptions from the articles, some
principles of professional identity are brought forward: Professional identity development is a
dynamic and developmental process that occurs in all medical students; professional identity is
the result of social interaction and active participation in clinical practice; and professional
identity develops from a series of identity transformations that occur primarily during periods
of transition [1-8]. Each of the included articles contributes to various ways of examining the
concept professional identity and thereby emphasises the challenge of doing research on
professional identity development.

Relation between PBL and professional identity development in medical education

Below in table 3 the identified themes are listed to give an overview of the PBL concepts that
are identified in the articles as influencing the professional identity development.

Table 3. PBL Themes that are represented in the included articles.

The results indicates that professional community, real patient learning, cultural environment,
social interaction, agency and communication are important PBL competencies that affect
professional identity development. Of the 8 articles 6 recommend PBL as pedagogical approach
to enhance professional identity development in undergraduate medical students’ [1-3,5-7].
Thus 2 of the 8 articles problematized PBL in regards to the need for active participation,
communication skills, opportunities for learners and learners as equal participants in the group
sessions to generate learning [4,8]. These articles claim that PBL is best suited for capable
students [4,8].

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The three identified themes 1) nature of research, 2) conceptualization of professional identity

and 3) relation between PBL and professional identity development in medical education
deliver different perspectives on the connection between PBL and professional identity
development, which will be discussed below.

DISCUSSION

Educational focus on professional identity development serves the need of preparing the
medical graduates for the work as physician (Cruess, 2006; Hafferty, Michalec, Martimianakis,
& Tilburt, 2016). Competencies as critical thinking, self-reflection, self-directed learning,
communication and problem-solving skills have been emphasized as important goals of medical
education, which also affect the developmental process through which medical students’ form
his or her professional identity (Niemi, 1997). However, little is known about how PBL
curricula affect the professional identity development and the learning context and environment
through which the personal experiences of the undergraduate medical students are elaborated.
Thus, to our knowledge, this is the first scoping review conducted with the aim to explore and
identify the existing literature concerned with the relation between PBL and professional
identity development in a medical education context.

As presented in the results section the volume of research examining the relation between PBL
and professional identity development is very limited despite the importance of professional
identity development in medical education. In order to reduce the identified research gap, the
purpose of this discussion is to inspire and contribute for further research, by discussing
different theoretical approaches to professional identity development and alternative research
methodologies to explore the relation between PBL and professional identity development in
medical education.

New methodological approaches can apply important knowledge to medical education

As our results show, none of the included articles used ethnographic material to explore the
relation between PBL and professional identity development in medical education. Thus,
various social researchers have previously suggested that professional identity is primarily
acquired through active participation in a professional practice, by observing how others behave
and how they embody the values and behaviors of the profession (O’Brien & Irby, 2013). This
argument suggests that social research in medical education can profitably take advantage of
ethnography or methodological triangulation to better understand the complexities of the
medical students’ professional identity development in relation to PBL. Conducting
ethnographic studies or methodological triangulation the researcher will gain a thorough insight
into the process in which the medical students develop their professional identity. To produce
knowledge that can explain this dynamic and complex development process, Leung (2002)
suggest that one has to employ methods such as participant observation and unstructured

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interviewing and put emphasis on the influence of the curriculum. Moreover, the formal, as
well as the informal PBL curriculum, contains important knowledge to the research field of
professional identity development. To go beneath the surface of the existing research and
produce new knowledge, ethnography or method triangulation will allow us to untangle this
research field and give a deeper understanding of how a PBL curriculum transforms the students
(Leung, 2002). While other types of qualitative methods such as interview, self-reported
statements and portfolios may be used to investigate students’ perceptions, they cannot uncover
the influence of prior socialization or learning on their perceptions.

Professional identity development in medical education

As the results shows in this scoping review the individual level is more or less absent. Thus,
these new theoretical lenses could put forward new and interesting perspectives on the relation
between PBL and professional identity development and thereby contribute to a unique
approach to the delivery of undergraduate medical PBL curriculum.

The reviewed articles affiliate with a certain perspective that points out the need of the
undergraduate medical students’ to engage in a professional community to develop a
professional identity. The theoretical perspective, can be closely tied to the concepts of
community of practice (CoP) presented by Lave and Wenger. They suggest that social
interaction between individuals enhance learning, and that CoPs emerge when those who wish
to share a set of common approaches and shared knowledge and standards that create the basis
for action, communication, problem solving, performance, and accountability (Wenger, 2001).
CoP as a concept and PBL is often seen as a particularly helpful relation because they appear
to reflect the reality of both medical education and practice (Dolmans & Schmidt, 1996; Lave
& Wenger, 1998). A perspective that seems to capture the description of the practice of medical
education that is presented in the included articles [1-3,5-8] and the idea that becoming a
member of a community of practice is one of the major ways in which students begin to form
their professional identities, often through as a dynamic process of legitimate peripheral
participation (Lave & Wenger, 1998). It should be kept in mind that CoPs illustrate only one
way of expressing the development of professional identity. Therefore, the research field
demands attention towards the role of the individual and new theoretical approaches in a varied
manner to explore and support the PBL curriculum improvement.

Social identity theory can subject the positions available to the medical students to a critical
examination and support the preferred theoretical lens on CoP and turn the research focus
towards the importance of the environment and context in which the PBL is practiced.

Tajfel & Turner (2004) and Jenkins (2014) propose that social identity theory refer to the way
in which we understand ourselves to be a member of a group, along with an emotional
connection to our group membership(s). As such, group membership is a very central aspect
within all our identities. In the context of real patient learning, case work, group work and the

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learning environment in which the medical students work and learn contributes to their social
identity in different ways: through their developing sense of self as a member of the group of
students or physicians, and as a member of the department in which they work. Furthermore,
the engagement within the work as a physician and the level to which they are included, also
contribute to their professional identity (Turner, 1987). Another theoretical perspective
presented by Jarvis-Selinger, Pratt & Regehr (2012) claims that professional identity
development is an adaptive process occurring at two levels: the individual level of
psychological development, which occurs primarily within the individual; and the collective
level, whereby the individual learns through interaction in the social context (Jarvis-Selinger,
Pratt & Regehr, 2012). Students’ learn and make meaning of their environment through the
mental structures or schemata they develop. As students learn and develop, these schemata
become increasingly complex and form the basis for self-reflection, self-directed learning,
problem-solving and communication skills (Dolmans & Schmidt, 1996; Tajfel & Turner, 2004).

PBL as a catalysis for developing professional identity in medical education

PBL is often a debated medical education pedagogy and has been widely recognized as a
progressive student-centered active learning approach and currently underpins the philosophy
of the entire medical education curriculum (Barrows, 1990; O’Brien & Irby, 2013; Quirk,
2006). Even though there is no universal definition of what constitutes PBL and a conceptual
uncertainty lingers in the literature both in terms of its underlying philosophy and in how it is
executed. Thus, PBL advocating an experience-based learning environment that encourages
collaboration to identify what to learn and how to solve a problem and they apply their new
knowledge to the problem and reflect on what they learned of the strategies used (Barrows,
1996; Hmelo-Silver, 2004; O’Brien & Irby, 2013; Schmidt & Rikers, 2007).

Medical education appears enraptured with the intention of developing professional identity in
medical students to prepare them and make them “fit in” to the work life (Hafferty, Michalec,
Martimianakis, & Tilburt, 2016). PBL as defined by Barrows (1996) intend to prepare the
students in the transition from medical school to working life by putting the students in real life
learning environments. Cruess & Cruess (2014) argue that students should be supported in the
transition to becoming a physician and that medical schools ought to devote more attention to
the development of professional identity. In this respect, we would like to add on this
perspective of Cruess & Cruess (2014), even though training in professional identity
development at medical school most certainly will help medical students adjust in their career.
We believe that an extended focus on the relation between PBL and professional identity
development is needed during the transitions in the whole education program. With a
perspective on medical education as a site of occupational socialisation and a site where the
PBL curriculum sets the agenda for learning, then Hafferty (2016) argue that socialisation
theory could contribute to an insight into identities that medical students assume. Furthermore,
Hafferty addresses socialisation theory as a theory we can draw upon in exploring topics such

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as behaviour, attitudes, self-image, self-reflection, occupational culture, values, norms and

emotions (2016).

The development of professional identity in undergraduate PBL medical education serves an

important purpose (Barrows, 1990; Murray & Savin-Baden, 2000) and to our knowledge, this
is the first scoping review conducted to summarise the existing research currently available on
this topic and to that end we encourage to further research to bridge the knowledge gap
identified.

CONCLUDING REMARKS

In this paper, we have presented a scoping review of a sample of the research literature about
the relation between PBL and professional identify development. More specifically, we have
tried to answer the following question: How is the relation between problem-based learning and
professional identity development represented in the field of medical education research? As it
turned out, there was not much evidence in the sample of included articles on PBL we reviewed
that could be used to clarify the specific relation between PBL and professional identity
development in medical education. We found that none of the 8 included articles explicitly
conceptualized professional identity or PBL, but used the concepts as common terms. However,
we could identify a pattern of the use of professional community, that could be used to provide
an adequate unifying picture of what affects professional identity development in medical
students.

The most important conclusion that can be drawn based on the findings we have been able to
produce, is that even though the topic of professional identity development in medical education
has been studied quite extensively, there is a lack of knowledge about how new types of
pedagogical approaches such as a PBL curriculum influences medical students’ professional
identity development. Thus, it is impossible to draw any final conclusions on how PBL affect
the professional identity development in medical students and therefore more and varied
research is needed.

References
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological
framework. International Journal of Social Research Methodology, 8(1), 19–32.

Badenhorst, E., & Kapp, R. (2013). Negotiation of learning and identity among first-year
medical students. Teaching in Higher Education, 18(5), 465–476.

Barnett, R. (2009). Knowing and becoming in the higher education curriculum. Studies in
Higher Education, 34(4), 429–440.

37
N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

Barrows, H. (1990). Inquiry: The pedagogical importance of a skill central to clinical

practice. Medical Education, 24(1), 3–5.

Barrows, H. (1996). Problem‐based learning in medicine and beyond: A brief overview. New
Directions for Teaching and Learning, 68(1), 3–12.

Barrows, H., & Tamblyn, R. (1980). Problem-based learning: An approach to medical

education. New York, NY: Springer.

Bell, K., Boshuizen, H., Scherpbier, A., & Dornan, T. (2009). When only the real thing will
do: Junior medical students’ learning from real patients. Medical Education, 43(11),
1036–1043.

Berkhout, J., Helmich, E., Teunissen, P., Vleuten, C., & Jaarsma, A. (2018). Context matters
when striving to promote active and lifelong learning in medical education. Medical
Education, 52(1), 34–44.

Bleakley, A., & Bligh, J. (2008). Students learning from patients: Let’s get real in medical
education. Advances in Health Sciences Education, 13(1), 89–107.

Boud, D., & Feletti, G. (1997). The challenge of problem-based learning (2nd ed.). London:
Kogan Page.

Boyd, C., & Fortin, M. (2010). Future of multimorbidity research: How should understanding
of multimorbidity inform health system design? Public Health Reviews, 32(2), 1–18.

Cruess, S., & Cruess, R. (2004). Professionalism and medicine’s social contract with society.
Virtual Mentor, 6(4), 185–188.

Cruess, R., Cruess, S., Boudreau, D., Snell, D., & Steinert, D. (2014). Reframing medical
education to support professional identity formation. Academic Medicine, 89(11), 1446–
1451.

Dall’Alba, G., & Barnacle, R. (2007). An ontological turn for higher education. Studies in
Higher Education, 32(6), 679–691.

Dolmans, D., De Grave, W., Wolfhagen, I., & Van Der Vleuten, C. (2005). Problem‐based
learning: Future challenges for educational practice and research. Medical Education,
39(7), 732–741.

Dolmans, D., & Schmidt, H. (1996). The advantages of problem-based

curricula. Postgraduate Medical Journal, 72(851), 535–538.

Evensen, D., Salisbury-Glennon, J., & Glenn, J. (2001). A qualitative study of six medical
students in a problem-based curriculum: Toward a situated model of self-
regulation. Journal of Educational Psychology, 93(4), 659–676.

Franco, R., Franco, C., Severo, M., & Ferreira, M. (2015). General competences on medical
professionalism: Is it possible? Medical Teacher, 37(10), 976–977.

38
N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

Hafferty, F. (2016). Socialization, professionalism, and professional identity formation. In R.

Cruess, S. Cruess, & Y. Steinert (Eds.), Teaching medical professionalism: Supporting
the development of a professional identity (pp. 54–67). Cambridge: Cambridge
University Press.

Hafferty, F., Michalec, B., Martimianakis, M., & Tilburt, J. (2016). Alternative Framings,
Countervailing Visions: Locating the “P” in Professional Identity Formation. Academic
Medicine, 91(2), 171–174.

Hefler, J., & Ramnanan, C. (2017). Can CanMEDS competencies be developed in medical
school anatomy laboratories? A literature review. International Journal of Medical
Education, 8(1), 231–238.

Hmelo-Silver, C. (2004). Problem-based learning: What and how do students learn?

Educational Psychology Review, 16(1), 235–266.

Imafuku, R., Kataoka, R., Mayahara, M., Suzuki, H., & Saiki, T. (2014). Students’
experiences in interdisciplinary problem-based learning: A discourse analysis of group
interaction. Interdisciplinary Journal of Problem-Based Learning, 8(2), 1–18.

Imafuku, R., Kataoka, R., Ogura, H., Suzuki, H., Enokida, M., & Osakabe, K. (2018). What
did first-year students experience during their interprofessional education? A qualitative
analysis of e-portfolios. Journal of Interprofessional Care, 32(3), 358–366.

Jarvis-Selinger, D., Pratt, D., & Regehr, D. (2012). Competency is not enough: Integrating
identity formation into the medical education discourse. Academic Medicine, 87(9),
1185–1190.

Jenkins, R. (2014). Social identity (4th ed.). London: Routledge.

Lave, J., & Wenger, E. (1998). Situated learning: Legitimate peripheral participation.
Cambridge: Cambridge University Press.

Leung, W. (2002). Why is evidence from ethnographic and discourse research needed in
medical education: The case of problem-based learning. Medical Teacher, 24(2), 169–
172.

Levac, D., Colquhoun, H., & O’Brien, K. (2010). Scoping studies: Advancing the
methodology. Implementation Science, 5(1), 1–9.

Lohfeld, L., Neville, A., & Norman, G. (2005). PBL in undergraduate medical education: A
qualitative study of the views of Canadian residents. Advances in Health Sciences
Education, 10(3), 189–214.

MacLeod, A. (2011). Caring, competence and professional identities in medical

education. Advances in Health Sciences Education, 16(3), 375–394.

Maudsley, G., & Strivens, J. (2000). Promoting professional knowledge, experiential learning
and critical thinking for medical students. Medical Education, 34(7), 535–544.

39
N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

Murray, I., & Savin-Baden, M. (2000). Staff development in problem-based

learning. Teaching in Higher Education, 5(1), 107–126.

Niemi, P. (1997). Medical students’ professional identity: Self‐reflection during the

preclinical years. Medical Education, 31(6), 408–415.

O’Brien, B., & Irby, D. (2013). Enacting the Carnegie Foundation call for reform of medical
school and residency. Teaching and Learning in Medicine, 25(1), 1–8.

Passi, V., Doug, M., Peile, E., Thistlethwaite, J., & Johnson, N. (2010). Developing medical
professionalism in future doctors: A systematic review. International Journal of
Medical Education, 1, 19–29.

Quirk, M. (2006). Intuition and metacognition in medical education keys to developing

expertise. New York, NY: Springer.

Reddy, S., & Mckenna, S. (2016). The Guinea pigs of a problem-based learning
curriculum. Innovations in Education and Teaching International, 53(1), 16–24.

Savery, J. (2006). Overview of problem-based learning: Definitions and

distinctions. Interdisciplinary Journal of Problem-Based Learning, 1(1), 9–20.

Schmidt, H., & Rikers, R. (2007). How expertise develops in medicine: Knowledge
encapsulation and illness script formation. Medical Education, 41(12), 1133–1139.

Sharpless, S., Baldwin, S., Cook, S., Kofman, S., Morley-Fletcher, S., Slotkin, S., & Wald, S.
(2015). The becoming: Students’ reflections on the process of professional identity
formation in medical education. Academic Medicine, 90(6), 713–717.

Stenberg, U., Haaland-Øverby, M., Fredriksen, K., Westermann, K., & Kvisvik, T. (2016). A
scoping review of the literature on benefits and challenges of participating in patient
education programs aimed at promoting self-management for people living with chronic
illness. Patient Education and Counseling, 99(11), 1759–1771.

Tajfel, H., & Turner J. (2004). The social identity theory of intergroup behavior. In J. Jost &
J. Sidanius (Eds.), Political psychology: Key readings (pp. 276–293). New York, NY:
Psychology Press.

Tan, C., Van Der Molen, H., & Schmidt, H. (2016). To what extent does problem-based
learning contribute to students’ professional identity development? Teaching and
Teacher Education, 54(1), 54–64.

Turner, J. (1987). Rediscovering the social group: A self-categorization theory. Oxford: Basil
Blackwell.

Tweed, M., Bagg, W., Child, S., Wilkinson, T., Weller, J., & Tweed, M. (2010). How the
trainee intern year can ease the transition from undergraduate education to postgraduate
practice. The New Zealand Medical Journal, 123(1318), 81–91.

40
N. Johansson, S. B. Nøhr, D. Stentoft JPBLHE: VOL. 8, NO. 2, 2020

Walker, A., Leary, H., Hmelo-Silver, C., & Ertmer, P. (2015). Essential readings in problem-
based learning: Exploring and extending the legacy of Howard S. Barrows (pp. 5–15).
West Lafayette, IN: Purdue University Press.

Wenger, E. (2001). Communities of practice: Learning, meaning, and identity. Cambridge:

Cambridge University Press.

41