{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T01:08:09Z","timestamp":1788397689965,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["asmepublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Education"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The transition from medical student to practicing physician affects the complex processes of professional identity formation and professionalism, which have a lasting effect on the physician's career development. This study explored two different transitional processes of medical students in Taiwan, the associated rituals during this transitional period (the \u2018liminal phase\u2019) and their effect on the formation of professional identity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Using snowball sampling, we recruited 13 medical students from two training systems: six from the traditional postgraduate year programme and seven from the accelerated postgraduate year (A\u2010PGY) programme. Semi\u2010structured interviews were thematically analysed to identify significant themes that encapsulated trainees' experiences. A consistent and mutually confirmed discussion ensured the identification of robust recurring themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A comparative analysis of the two training modalities provided critical insights into the relative impact of the training dynamics. The A\u2010PGY cohort, subjected to an altered \u2018incorporation\u2019 ritual, encountered an influx of unexpected symbolic social power, complicating their transformation within the liminal phase. Without a defined internship like in the PGY system, A\u2010PGY trainees exhibited confusion and inconsistencies in professional identity formation marked by conflicting internal and external perceptions. This ambiguity affected their clinical training, social integration and overall development of professionalism. The absence of a structured, sequential liminal phase increased conflict and diminished motivation, culminating in an incomplete self\u2010crafting journey for A\u2010PGY trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the impact of the well\u2010sequenced implementation of rituals in liminality on professional identity formation. A good transition training programme for medical students should compass sequential rituals in the liminal phase, including clear starting and ending points, supervision by seniors, guided reflection and plenty of opportunities for observation and imitation in context. Optimal training and pivotal elements in a medical training system warrant delicate design and further research when developing and changing the structure of the training programme.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/medu.15483","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T20:48:31Z","timestamp":1722545311000},"page":"173-181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of liminality and rituals on professional identity formation in physician training"],"prefix":"10.1111","volume":"59","author":[{"given":"Jian\u2010Hua","family":"Hong","sequence":"first","affiliation":[{"name":"Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Lin","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology National Taiwan University Hospital Yun\u2010Lin Branch  Yun\u2010Lin Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1962-8389","authenticated-orcid":false,"given":"Daniel Fu\u2010Chang","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department &amp; Graduate Institute of Medical Education and Bioethics National Taiwan University College of Medicine  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En\u2010Chi","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology National Taiwan University Hospital  Taipei 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