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Introduction: Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training., Method: We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles., Results: We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance., Discussion: This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

We all want our writing to have impact but realizing that goal is difficult. Prompting specific responses from readers takes savvy and the know-how to wield grammatical tools. This Writer's Craft addresses the skill of varying emphasis in academic writing through five grammatical tools: italics, bold, dashes, parentheses, and scare quotes. It describes each of these tools, and illustrates when and how to use them effectively. In the writer's craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how'syourwriting?, Competing Interests: The author has no competing interests to declare., (Copyright: © 2024 The Author(s).)

Introduction: Validity is frequently conceptualized in health professions education (HPE) assessment as an argument that supports the interpretation and uses of data. However, previous work has shown that many validity scholars believe argument and argumentation are relatively lacking in HPE. To better understand HPE's discourse around argument and argumentation with regard to assessment validity, the authors explored the discourses present in published HPE manuscripts., Methods: The authors used a bricolage of critical discourse analysis approaches to understand how the language in influential peer reviewed manuscripts has shaped HPE's understanding of validity arguments and argumentation. The authors used multiple search strategies to develop a final corpus of 39 manuscripts that were seen as influential in how validity arguments are conceptualized within HPE. An analytic framework drawing on prior research on Argumentation Theory was used to code manuscripts before developing themes relevant to the research question., Results: The authors found that the elaboration of argument and argumentation within HPE's validity discourse is scant, with few components of Argumentation Theory (such as intended audience) existing within the discourse. The validity as an argument discourse was legitimized via authorization (reference to authority), rationalization (reference to institutionalized action), and mythopoesis (narrative building). This legitimation has cemented the validity as an argument discourse in HPE despite minimal exploration of what argument and argumentation are., Discussion: This study corroborates previous work showing the dearth of argument and argumentation present within HPE's validity discourse. An opportunity exists to use Argumentation Theory in HPE to better develop validation practices that support use of argument., Competing Interests: Erik Driessen is the Editor-in-Chief for Perspectives on Medical Education. He was removed from all editorial processes relating to the handling of this submission., (Copyright: © 2024 The Author(s).)