The development of medical students' professional identities in rural settings: A scoping review.

Background: Major documented disparities exist in health equity between individuals living in rural and metropolitan areas. Recruiting and retaining doctors in rural areas remains a considerable challenge. Students' exposure to rural experiences facilitates their development of professional identities aligned to this specific community of practice. Although previous studies have explored medical students' identity development in rural settings, a comprehensive picture of the development of medical students' professional identities in rural settings is yet to be established. Our study aims to address this, and as such, a scoping review was conducted to map the existing literature in this area.

Methods: Our review follows the Joanna Briggs Institute methodology, with reporting being guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We searched MEDLINE, Embase, Web of Science and PsycINFO databases. We use inductive thematic analysis to synthesise the evidence with reference to the review questions. We present our results based on our developed framework.

Results: We identified 1085 publications with 20 fully meeting the inclusion criteria. The majority of included studies were published in the last 9 years, originating from Australia, South Africa and the United States. These are based on voluntary rural medical placements, with the commonest placement duration being 12 months. Included publications predominantly use qualitative methodologies, most commonly individual and/or group interviews. Only two of the included studies use an approach informed by established theories of identity development. We used inductive thematic analysis of the included studies, identifying three related themes: Acting Up, Rural Community and Feeling of Fit. Fewer than half of the included studies referenced students' future intention to practice rurally, and no paper specifically examined an association between students' professional identity and intention to practice rurally.

Discussion: It is a core remit of medical education to include professional identity as a key outcome. In a rural context, understanding the role that professional identity plays in medical students' future career choices may be key to understanding workforce maldistribution. Existing medical student identities research tends to lack theoretical grounding and alignment; subsequently failing to comprise a homogenous body of literature essential for facilitating our comprehensive understanding of professional identity, which is necessary for advancements within this field.