Mental health and professional identity formation amongst medical students in Singapore: a qualitative study

Professional identity formation (PIF) is nurtured in medical school through the inculcation of the values, expectations and responsibilities of the profession-shaping belief systems that inform the professional identity and broader concepts of personhood. This developmental journey, however, places strain on mental health, with medical students facing higher rates of anxiety, depression and mental stress compared to non-medical peers. These experiences can impede effective PIF. Yet, studies that examine the intersection between PIF and mental health remain remiss, further compounded by the lack of research in localised, non-Western settings. To address these gaps, this study explores medical students' lived experiences with mental health challenges in Singapore, focusing on their impact on PIF.

Semi-structured interviews were conducted with 10 medical students on an oncology posting at the National Cancer Centre Singapore. Interviews were transcribed and analysed via deductive content analysis, guided by the Ring Theory of Personhood (RToP) that maps changes in belief systems across the Innate, Individual, Relational and Societal Rings.

Data analysis revealed three key domains: (1) stressors; (2) evolving self-concepts of personhood; and (3) adaptations. Medical students faced assessment-related, clinical, extracurricular and interpersonal stressors that introduced conflicts between emerging and existing belief systems. Personal adaptations to these conflicts were contingent upon the maturity of the internal compass and availability of personalised, enduring support systems. Students with a mature internal compass and rich peer, familial or collegial support engaged in healthy coping mechanisms that promoted adaptive growth in PIF. Conversely, an inexperienced internal compass and lack of support systems prompted maladaptive behaviour and placed further strain on the professional identity.

Beyond short-term well-being interventions to mitigate mental health challenges, this study highlights the importance of nurturing the internal compass through longitudinal, individualised and context-sensitive support that sustains students through their professional development. Future work can explore how such approaches may be effectively operationalised and evaluated in different cultures and clinical contexts.