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Editorial
Questions of identity
  1. Rosie Allister, BSc (Hons), BVSc, MSc, MRCVS
  1. Veterinary Clinical Sciences, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian EH25 9RG, UK
  1. e-mail: rosie.allister{at}ed.ac.uk

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QUESTIONS of identity and being are central to philosophy, but they also have practical relevance in professional terms. Professional identity – how we perceive ourselves as professionals – has implications for our behaviour, the ethical principles we ascribe to, and the way we interact with the world. Developing professional identity is a crucial part of veterinary training.

Vets, like other professionals, are influenced by their occupational culture. Academic knowledge alone, without the ability to fit in and work with the norms and values held by others in the profession and observe expected standards of professional behaviour, would leave veterinary graduates ill-equipped for professional life. Yet although professional identity has received extensive attention in medical and other professional literature, it is almost absent from veterinary discourse.

As with many professions, as vets we have a social contract with our clients and society. Similarly to medicine, by the end of training, vets are expected to behave professionally and uphold a range of ethical principles (Monrouxe and Rees 2012). In medicine, professional identity formation has been described as the transformative process from lay person to physician (Holden and others 2012), and involves the development of core values, self-awareness and moral principles. Monrouxe (2010) suggests that the development of medical identity is as important as the acquisition of knowledge to medical training, stating that medical education is as much about learning to talk and act like a doctor as it is about learning the content of the medical curriculum. Weaver and others (2011) note that the development of medical identity is gradual, a process that enables a person to commit to professional goals and values that matter to them as a person, and which are also acceptable to the profession.

A number of theoretical perspectives, including social identity theory and self-categorisation theory, have been applied to understand and explore professional identity, and debate continues about these. It is generally agreed that socialisation has an important role in the development of professional identity (Hotho 2008). This is reflected in the professional training requirements of veterinary students, where the value of extramural studies and exposure to veterinary clinical practice goes beyond the acquisition of academic knowledge.

The importance of the development of professional identity can also be seen in the way veterinary education increasingly prioritises the teaching of professionalism, with ethics, communication skills, and the introduction of guidelines on professional behaviour using a veterinary fitness to practice model. Hotho (2008) observes that professional identity is one of the multiple social identities an individual holds, but socialisation into the professional community provides a sense of stability, belonging and values, and fulfils aspects of individuals' social identity needs.

Professional identity exists in, and needs to be able to adapt to, a professional world which is constantly changing. Notions of respect for, or superiority of, professions, which were previously taken for granted, have altered (Barnett 2008, Scanlon 2011b). Deprofessionalisation processes (Haug 1973), the loss by professional occupations of their unique qualities, such as monopoly over knowledge, public trust and autonomy, have been debated for some time. Some authors have suggested that professional decline has been overstated, and the rise in consumerism has been offset by increasing specialisation of professions, maintaining a knowledge gap between professionals and clients (Freidson 1986). However, others point to changes in technology and education, with the exclusivity of the professional knowledge-base being challenged by a better educated, more critical, client base with different expectations, and increased access to previously exclusive specialist information (Scanlon 2011a).

There are also challenges to notions of altruism in professional status, as the trend for accountability sees professions questioned and doubted, with lay people more likely to question myths of professional omnipotence (Scanlon 2011a). Changes in other professions are also affecting veterinary life. The rise of managerialism in the public sector, and the value placed on efficiency and performance targets, creates an ethic of performance which can be at odds with the ethic of service traditionally seen in the professions (Barnett 2008). Professionals including vets are subject to organisational and wider pressures, and have to reconcile their own values with the expectations that are placed upon them.

The study by Page Jones and Abbey (2015), summarised on p 433 of this issue of Veterinary Record, focuses on an aspect of professional identity – career identity – in a sample of vets and vet nurses. They describe the centrality of career to identity for many of the participants in their study, and the early age at which identification with the veterinary profession can develop.

Page Jones and Abbey highlight the business benefits of understanding career identity. For the participants in their study, their self-identification with the veterinary profession was stronger than their identification with a particular organisation. From this, the authors suggest that businesses could gain advantages from working to bring individual and organisational identity closer together. This idea is interesting, and warrants further attention; it has relevance to veterinary education, and there are potential individual, as well as organisation-level, impacts of increased identity congruence. Traditionally, professional identity and its formation was individualistic, with solo practitioners putting up a brass plate and waiting for clients (Beckett 2011), but with the increasing corporatisation of the veterinary profession, and trends towards employment rather than self-employment, individuals increasingly need to work within organisational values.

This research has wider implications. Page Jones and Abbey also highlight that membership of the veterinary profession influenced their participants' sense of self and contributed to self-worth and self-esteem. This is important. We know that, where self-esteem and self-worth are heavily reliant on work identity, individuals can become vulnerable when their professional identity is threatened, for example, by illness, complaints, mistakes, disciplinary proceedings, job dissatisfaction or loss, or adverse clinical outcomes. Such threats to identity can have catastrophic psychological effects for individuals who have invested heavily in their identity as professionals. Mellanby and Herrtage's (2004) study of the effect of mistakes made by recent graduates showed that, in many cases, mistakes had a considerable emotional impact on vets. Studies focusing on doctors suggest that complaints can be experienced as a challenge to professional competence and expertise (Allsop and Mulcahy 1998). Further insight into the role of professional identity in vets' experiences of complaints could help to improve responses and facilitate communication with clients. Analysis of the impact of complaints and disciplinary proceedings on vets is lacking, but a recent cross-sectional survey of the impact of complaints procedures on the welfare, health and clinical practice of 7926 doctors in the UK (Bourne and others 2015) found that doctors who had experienced a current or recent complaint were at increased risk of moderate/severe depression, anxiety and suicidal ideation.

We know that the veterinary profession has an elevated rate of suicide compared to the general population (Platt and others 2010), with subgroups identified as at risk of increased difficulties with psychological wellbeing (Platt and others 2012). As with medical identity (Mavor and others 2014), some of the norms associated with veterinary identity may undermine wellbeing. Better understanding of how vets' identity is formed and maintained, and the ways in which threats to professional identity affect individual level risk of psychological distress and ill health, could lead to the development of more effective support for vets in difficulty.

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