An "integration" of professional identity formation among rural physicians experiencing an interplay between their...

The present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private-professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by 'Big Questions' concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the 'discourse of integration' are necessary steps to overcome the limitation of the current understanding of professional identity formation.