Minding the Form That Transforms: Using Kegan's Model of Adult Development to Understand Personal and Professional Identity Formation in Medicine

The formation of a physician's professional identity is a dynamic process shaped by and intertwined with the development of that person's larger adult identity. Constructive-developmentalist Robert Kegan's model of adult development describes four mental lenses used for meaning-making and the trajectory through which they transform over time. These lenses determine the way people take in and integrate complex influences into forming their adult identities. When people use a particular lens to construct meaning, Kegan describes them as being "subject" to that lens: The lens "has them," and they are unaware of the ways it shapes their world. Transformations occur when individuals are able to take a lens to which they were subject and regard it objectively. Kegan's lenses that are relevant to medical educators are called instrumental-focused on rules and rewards; socialized-attending to social norms and expectations; self-authoring-seeking to build internal values; and self-transforming-seeing gaps in one's closely held value systems and being open to those of others. When individuals have difficulty facing current challenges, they begin to grow a more complex lens. Subsequent lenses bring the ability to deal with more complexity but also bring their own challenges. Familiarity with Kegan's model can help educators provide more effective support to groups of learners as well as individuals, support learners' transformational growth through the challenging situations inherent in medical education, and supply a common language for many important areas of medical education, including competencies and entrustable professional activities, remediation, leadership development, and curriculum planning.