Royal College of Surgeons in Ireland
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Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis

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journal contribution
posted on 2024-06-18, 14:56 authored by Áine RyanÁine Ryan, Catherine MoranCatherine Moran, David ByrneDavid Byrne, Anne HickeyAnne Hickey, Fiona BolandFiona Boland, Denis HarkinDenis Harkin, Shaista S Guraya, Abdelsalam Bensaaud, Frank DoyleFrank Doyle
Introduction: Professional identity formation (PIF) is an ongoing, self-reflective process involving habits of thinking, feeling and acting like a physician and is an integral component of medical education. While qualitative work has suggested that PIF is informed by professionalism, resilience, and leadership, there is a dearth of quantitative work in this area. Multiple methods build rigor and the present study aimed to quantitatively assess the relative psychometric contributions of professionalism, resilience, and leadership constructs to informing PIF, using a latent factor analysis approach.
Methods: We analyzed data from the PILLAR study, which is an online cross-sectional assessment of a pre-clinical cohort of medical students in the RCSI University of Medicine and Health Sciences, Dublin, using established and validated quantitative measures in each area of interest: PIF, professionalism, leadership and resilience. A total of 76 items, combining four validated scales, along with a selection of demographic questions, were used. The hypothesis that PIF is informed by, and correlates with, professionalism, resilience and leadership was examined by conducting a confirmatory factor analysis of a proposed three-factor higher-order model. Model estimation used Maximum Likelihood Method (MLM) with geomin rotation. The hypothesized (measurement) model was examined against an alternative (saturated) model, as well as a three-factor model.
Results: Latent variable analysis from 1,311 students demonstrated that a three-factor higher-order model best fit the data; suggesting PIF is informed by professionalism, resilience, and leadership, and that these constructs are statistically distinct and account for differential aspects of PIF. This higher-order model of PIF outperformed both the saturated model and the three-factor model. The analysis of which component may be the most or least influential was inconclusive, and the overall model was not influenced by year of training.
Discussion: Building upon existing conceptual contentions, our study is the first to quantitatively support the contribution of professionalism, resilience, and leadership to the development of professional identity, and to delineate the inter-relationships between PIF and these constructs. This information can be used by medical educators when designing curricula and educational strategies intended to enhance PIF. Future work should seek to assess the influence of these constructs longitudinally.



Bons Secours Health System


Data Availability Statement

The data analyzed in this study is subject to the following licenses/restrictions: The data that support the findings of this study are available from the corresponding author but restrictions apply to the availability of these data, which were used with permission for the current study, and so are not publicly available. Data is however available from the authors upon reasonable request and with permission of RCSI Research Ethics Committee. Requests to access these datasets should be directed to


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Published Citation

Ryan A. et al. Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis. Front Med. 2024;11

Publication Date

13 June 2024


  • Data Science Centre
  • Health Psychology
  • Medical Professionalism
  • School of Population Health

Research Area

  • Population Health and Health Services


Frontiers Media SA


  • Published Version (Version of Record)