When the self "logs in" - a critical narrative review of digital identity in health professions education

Digital identity is no longer an add-on to professional life; it is a primary arena where the self is performed, negotiated, and sustained. Health professions education (HPE) depends on visibility; learners seeking mentors, academics signaling scholarship, clinicians building legibility on rating sites. Yet that same visibility is cross-pressured by codes of conduct, context collapse, and the ethics of self-disclosure. This critical narrative review treats digital identity as identity-as-work in public, persistent, searchable systems (the sum of traces others later encounter when platforms remix and rank them). Bringing symbolic interactionism (performance, audience, impression management) into conversation with a sociomaterial stance (platforms and artifacts co-produce action), and drawing a light Lacanian inflection where helpful, we read the corpus through four facets: authenticity, visibility, continuity (idem/ipse), and agency. Searches across Scopus, Embase, PubMed, PsycINFO, and Google Scholar returned 1,638 records; after 256 duplicates, 1,382 titles/abstracts were screened, 234 full texts assessed, and 45 sources included. Reflexive memos and iterative comparison guided an interpretive synthesis discussed with wider team. Two recurrent modes (tropes) surfaced. In a mediating mode, "digital neurotic self" curates authorship under constraint, running legibility tests (Is this true to my values? Which audience will see it? What trace will it leave?) and adjusting voice, timing, and placement. Practices include audience design (lists, close-friends, pseudonyms), contextual disclosure, dual-account compartmentalization, and portfolio stitching to maintain continuity while staying findable. In an instrumentalised mode, the 'digital psychotic self' is built for consumption and tuned to platform legibility; counters, templates, and recommendations, thin authored selfhood, nudge toward micro-celebrity, and drift from ipse (authored) to idem (community sameness). Across studies, homophily, metrics, and templated formats push toward uniformity; without active curation, narrative coherence frays into platform-tuned fragments. For HPE, we argue that digital identity is a dimension of professional identity formation. Educators should coach authorship and stewardship (audience design, narrative/portfolio stitching, sociolinguistic competence), teach platform literacy (how feeds rank/normalize; how ratings/altmetrics discipline presentation), and create counter-spaces that protect backstage rehearsal while enabling intentional visibility. Finally, help learners move beyond perpetual exploration toward value-anchored commitments, so visibility becomes a record of work rather than a performance for counters.