Professional identity formation, professionalism, leadership and resilience: a longitudinal assessment of professional identity formation in medical students

Background: Professional Identity Formation (PIF) is integral to medical education, underpinning how students internalize the values, attitudes, and behaviours expected of physicians. Despite growing interest in PIF, most existing studies rely on qualitative designs, limiting the understanding of its cumulative progression over time. Aim: This study aimed to quantitatively assess PIF including professionalism, leadership, and resilience in two cohorts of medical students using a longitudinal design. Methods: Data were drawn from the PIF, Professionalism, Leadership, and Resilience (PILLAR) study, conducted between 2019-2024, a longitudinal assessment of medical students at RCSI University of Medicine and Health Sciences. A total of 146 students (95 Direct Entry undergraduate Medicine (DEM) students and 51 Graduate Entry Medicine (GEM) students) were followed from entry to final year. Repeated assessments were conducted over five years for DEM and four years for GEM, using 76 items from four validated scales measuring PIF, professionalism, leadership, and resilience. A hierarchical mixed-effects model was applied to examine developmental changes. Results: Validated PIF scores, reflecting the transition from student to qualified doctor, demonstrated a significant and progressive increase across training stages up to the final year in both DEM (β = 2.61; 95% CI [2.33, 2.89], p < 0.001) and GEM (β = 2.39; 95% CI [2.00, 2.78], p < 0.001) programs. No consistent changes were seen in professionalism, leadership or resilience in DEM or GEM. Conclusion: These findings demonstrate that PIF develops cumulatively throughout medical school, reflecting students’ evolving professional identity and underscoring the importance of longitudinal quantitative assessments in medical education.