This situation illustrates the tensions allied health professionals (AHPs) might experience in complex situations in their daily practice. At the heart, these kinds of tensions seem to be the result of the inability of professionals to reconcile the value of learned professional protocols and their personal set of values (Helmich et al., 2017). To understand these tensions, we explore the concept in which AHPs attempt to unite both elements: their professional identity.
Professional identity is currently a frequently researched phenomenon (Cruess et al., 2019; Hendrikx, 2018; Monrouxe, 2010; Rees et al., 2019). At the turn of the century, medical training focused purely on professionalism. In the last decade, Cruess et al. (2014) have been advocating to make professional identity development a focal point in medical training, since the educational objective of professionalism turned out to be too narrow (Cruess et al., 2014). In nursing, for example, professional identity development is often a struggle, especially when nursing professionals work in nonstandard workplaces such as retirement facilities (Thompson et al., 2018). Research about the professional identity of teachers, in turn, shows that the person behind the teacher educator matters for both the teacher educator him/herself and for their teachers-in-training (Vanassche & Kelchtermans, 2016). Van Lankveld (2017) has shown that the development of medical teachers’ professional identity is supported by the sharing of work experience stories in teacher communities and teacher-training courses. For students and teachers in medicine, nursing, and counselling/psychology, the clinical experience that they gather, the culture of their profession, and the norms and expectations that are central to their profession, are all important for professional identity formation – for both students and teachers, and also their wider environment (Volpe et al., 2019). In a scoping review of their own, however, Volpe et al. (2019) conclude that there seems to be a sociocultural bias within the reviewed studies: demographic data are collected but rarely included in qualitative results. Therefore, we conclude at this point that professional identity must be regarded as an important part of (inter)professional practice. In what follows, we look in more detail at what professional identity is, in order to learn more about the tensions AHPs experience in daily practice.
In spite of widespread research into professional identity (Burford et al., 2014; Feller & Berendonk, 2020; Fitzgerald, 2020; Goldie, 2012; Kwakman & Schilder, 2005; Monrouxe & Rees, 2017; Rees & Monrouxe, 2018; Ruijters, 2015), the multilayered and multidiscoursal nature of the subject makes it difficult to define professional identity in a straightforward way. According to Beijaard et al. (2004), Trede et al. (2012), and Fitzgerald (2020), a clear definition of professional identity is missing because of the multi-discoursal nature of the subject. Krueger (2008), upon considering some of the discussion-leading descriptions of professional identity, provides the following description of professional identity: “
The personal dimension is not only described, but there are also suggestions that the personal dimension sometimes creates friction between different professional values (Fitzgerald, 2020). Helmich et al. (2017) describe this as the struggle between sensemaking through a personal set of values and beliefs, and sensemaking through the instrumental information of protocols. Such value conflicts lead to feelings of ambiguity in the personal dimension of healthcare professionals. Feelings of ambiguity in the professional context can be highly emotional and are caused by reflection on oneself from different dimensions of professional identity, that each have their own norms and rules (Helmich et al., 2017; Jarvis & Trodd, 2008). Conflicts between values in the personal dimension and professional values, can have the effect that AHPs experience internal tensions at critical moments in their professional activity (Fitzgerald, 2020; Helmich et al., 2017; Jarvis & Trodd, 2008).
To understand the personal dimension, we will explore the concept in question. The personal dimension can be defined as a set of personal components that have a substantial impact on professional identity and frequently cause tensions in that role (Bushby et al., 2015; Fitzgerald, 2020; Lawson et al., 2017; McMahon et al., 2016; Nicholls & Gibson, 2010). Although much research has already been conducted on personal components, in-depth research into the personal dimension appears to be lacking, in spite of a clear need to deepen our understanding of this topic (Drolet & Sauvageau, 2016). In the literature on education and teacher identity, in which much more research focused on the personal dimension has been performed, Beijaard (2009) describes the personal dimension as composed of a set of specific personal, sociodemographic characteristics, the personal biography and learning history of the professional, and the beliefs s/he holds about the profession. According to Kelchtermans (2009), teachers develop an interpretative framework that arises from personal values and beliefs, which is shaped and reshaped in the course of their career through interaction with teacher colleagues and the impact of the social, cultural, and structural conditions in their working environment. Ruijters (2015) emphasizes the interaction between social identity and the personal dimension as well. In order to understand the individual professional, one should start from her/his specific personal, sociodemographic characteristics. For example, a professional's perfectionism is something partly hereditary, but is also largely influenced by the range of experiences gained in the context of personal identity development. Where Beijaard (2009) and Ruijters (2015) state that the personal dimension is constructed by the combination of a set of specific personal, sociodemographic characteristics with the professional's personal biography and learning history, other scholars have emphasized different components and describe the personal dimension as composed of the personal, sociodemographic characteristics and the reflected set of values, beliefs and associated standards that originate from the professional's background (Fatoki, 2014; Lucieer, 2020; Matthys & Thijssen, 2013). In research on teaching, scholars who emphasize the personal dimension are particularly interested in how past personal life experiences interact with teachers’ professional lives (Beijaard et al., 2000). Not every author uses the term personal dimension: some use the terminology ‘personal interpretation framework’ (Kelchtermans, 2009), while others frame the personal dimension in terms of Self Theory (Finn et al., 2010). Nevertheless, all these descriptions fit under what we understand as the ‘personal dimension’. Although a large portion of the literature we refer to here comes from education research, the theory formation on personal dimension in this literature cannot simply be extrapolated to the allied health domain – although it must be pointed out that the professionalization processes of teachers, teacher educators, and AHPs are similar. As a summary of the insights in the personal dimension outlined above, we will be using the following definition in this scoping review:
The personal dimension of the professional identity is composed of the set of specific personal, sociodemographic characteristics, the individual biography, personality-related subjects, and beliefs of the professional about profession-related subjects.
The personal dimension of the professional identity is composed of the set of specific personal, sociodemographic characteristics, the individual biography, personality-related subjects, and beliefs of the professional about profession-related subjects.
In this study, we aim to improve the understanding of the role played by the personal dimension by considering the following research question: What is known about the personal dimension of professional identity of AHPs in the (allied) health literature?
To investigate how the personal dimension of AHPs is understood in (allied health) literature, a scoping literature study was conducted. Scoping reviews are used to clarify key concepts, key characteristics, definitions in literature, and to identify knowledge gaps (Munn et al., 2018). To select and analyze the literature, we used the five-stage methodological framework of Arksey and O’Malley (2005). These stages are: Stage 1: identifying the research question (in this article described in the introduction); Stage 2: identifying relevant studies; Stage 3: study selection; Stage 4: charting data; Stage 5: collating, summarizing, and reporting results. Stages 2–5 are shown in Figure 1.
Because of the allied health scope of the study, we conducted an electronic search in CINAHL, Medline, PubMed, PsycINFO, and ERIC. Keywords used were ‘professional identity’ in the abstract, and at least one name of a Dutch allied health profession or continuous use of the term ‘allied health’ in the text. In the Netherlands, allied health professions include dental hygiene, dietetics, occupational therapy, optometry, orthoptics, physiotherapy, podiatry, remedial therapy, skin therapy, and speech therapy. Unlike many other countries, nursing and social work are not allied health professions in the Netherlands and therefore were not included in the review. The PubMed search was conducted with the Medical Subject Heading (Mesh) term ‘social identification’, and at least one name of a Dutch allied health profession, or continuous use of the term ‘allied health’ in the text. This initial search resulted in 815 peer-reviewed articles published in the last 20 years, which were deduplicated for a total of 631 articles.
Screening of the articles was conducted based on title and abstract. Abstracts were selected when articles met the main inclusion criteria: ‘person-in-the-professional’ related matters in relation to professional identity, professional functioning, professional attitude, or professionalism, either as a main topic or subtopic. After a screening of the titles and abstracts, a total of 125 articles were included for full-text reviewing. All of these articles were read in full to determine eligibility and whether they fitted the inclusion criteria. Reasons for exclusion were: if the article merely brought up the term ‘professional identity’ (e.g., only mentioned it in a questionnaire), or merely elaborated about professional identity in relation to interprofessional education or collaboration, management, policies, or diagnosis – but did not link it with the personal dimension. As a result, 81 studies were included in the final analysis. The final 81 articles were analyzed and reviewed, and then summarized in outlines listing the title of the study, author(s), publication year, journal, database; methods, number of participants, discipline, type of population, main findings, and comments. These outline documents can be requested from the corresponding author, Eline Belgraver
These outline documents can be requested from the corresponding author, Eline Belgraver
First, the results were analyzed numerically according to the items in the outlines. Secondly, the results were analyzed thematically in order to map items related to the personal dimension. Development of themes was an iterative process. To start, the first author, EB, created a map of themes and subthemes that emerged from analysis of the data. Next, the first and second author, EB and RC, met on a weekly basis to discuss the emerging findings, refine mind maps, articulate themes and subthemes, integrate ideas, and to generate a thematic map of the findings. Finally, the four authors met quarterly to discuss the conceptual framework and evaluate the review process and the analysis.
The findings of the scoping review are described numerically and in terms of their content. Over the last 20 years, what became visible was a huge increase in the literature about the personal dimension (Cruess et al., 2019): 39 out of 81 articles were published in the last six years (see Table 2 in Appendix). The numerical part reveals a paradigm shift in the last two decades from professionalism to professional identity development in the healthcare literature (Cruess et al., 2019). The numerical findings also reveal the varying degrees of attention directed towards the personal dimension within the various professions.
The articles included in the scoping review were published over a period of 21 years (see Table 2 in Appendix). Not one of the articles studies the personal dimension in its entirety, and only one or a few aspects of the personal dimension are studied per article. The articles were published in 42 journals, which can be divided into multi-professional studies and uni-professional studies. Multi-professional studies that investigated the personal dimension were studies on interprofessional education (Clark, 2014; Conroy, 2019; Hertweck et al., 2012; Hind et al., 2003) and interprofessional care (Davis, 2006; Jakobsen et al., 2011; Kraft et al., 2014). Physiotherapy and occupational therapy are studied in a large number of these multi-professional studies. This can be explained by the fact that physiotherapists and occupational therapists often participate in interprofessional studies.
Occupational therapy is the profession with the most personal dimension-related studies; half of the studies are related to occupational therapy (see Table 1). This can be partly explained by the ongoing search for ‘the’ professional identity of occupational therapists, and the implications that a weak sense of professional identity has been the case for these professionals, which is a frequently recurring theme in occupational therapy literature (Ashby et al., 2016; Burley et al., 2018; Clouston & Whitcombe, 2008; Devery et al., 2018; Furness et al., 2019; Goh et al., 2019).
Distribution of allied health professions in this scoping review.
|Health care (non-specified)||8||9%|
Furthermore, occupational therapy is holistic and more socially oriented (Burley et al., 2018; Drolet & Désormeaux-Moreau, 2016), whereas other allied health professions are more biomedically oriented and influenced by the medical model (Clouston & Whitcombe, 2008; Nicholls & Gibson, 2010; Whitcombe, 2013). This biomedical and biomechanical orientation can give rise to tensions for dieticians and physical therapists who are required to become more client-centered (McMahon et al., 2016; Nicholls & Gibson, 2010). In dietetics and dental hygiene research, some attention is given to the personal dimension, while in remedial therapy, orthoptics, optometry, and skin therapy the personal dimension is barely studied. This small quantity of personal dimension-related studies in some professions can be explained through a variety of reasons, ranging from organizational to occupational content factors. Remedial therapy and skin therapy are not practiced worldwide. Orthoptics is practiced worldwide but is a small profession. Optometry is practiced worldwide (WCO, World Council of Optometry, 2015), but in the optometric world barely any attention seems to be given to this subject. Optometry is an instrumentally and biomedically oriented profession (Long & Rosen, 2017), a profession taught through ’the official regulations and guidelines regarding optometry standards of practice‘ (Spafford et al., 2004, p. 802). In conclusion, the findings for allied health professions reveal a substantial growth in attention given to subjects related to the personal dimension. In uni-professional research, the degree of attention given to these subjects varies, ranging from barely any studies in optometry and orthoptics; some uni-professional studies in speech therapy, dental hygiene, and dietetics; and a large quantity of studies in occupational therapy, with physiotherapy ending up in the middle range.
In the allied health professions studied in this scoping review, a variety of scientific approaches are employed, as illustrated in Table 1. In the articles studied for the review, the personal dimension figured mainly as a topic for a subsection. Most studies were qualitative studies, only 11 studies were quantitative studies. 25 out of 81 studies were multi-professional studies. Half of the quantitative survey studies are multi-professional studies (Cooper, Spencer-Dawe & McLean, 2005; Gendron et al., 2016; Hertweck et al., 2012; Hind et al., 2003; Jakobsen et al., 2011; Stull & Blue, 2016). In our review, many qualitative studies mentioned study limitations, such as small numbers of participants or regionally executed studies. Some studies (Drolet & Sauvageau, 2016; Guajardo et al., 2015; Helmich & de Carvalho-Filho, 2018; Khalili et al., 2014) specifically combine the findings and views of different authors and study them from a polyvocal and cross-cultural perspective.
Concluding the numerical side of the review, we can observe a large variation in the attention given to components of the personal dimension within a variety of allied health professions. The reviewed studies vary in sample size and research methods. Only seven out of 81 studies were review studies, which underlines the need for our scoping review.
Viewed from diverse allied health discourses and cultures, the personal dimension appears to reveal itself as a multi-layered and multi-discoursal concept. Many components of the personal dimension can be unraveled from the multi-discoursal terms used to name single components. In order to do justice in our model to the fact that these components are not strictly demarcated, we introduce here the concept of four interrelated aspects of the personal dimension. The first aspect encompasses specific characteristics of the professional dimension and forms the foundation of the personal dimension. The second and third aspects consist of life experiences and specific character traits. Finally, the fourth aspect, the worldview of the professional, is formed by the interaction of the first three aspects (Figure 2).
The professional's sociodemographic characteristics are factual properties of a single aspect within the personal dimension. These include characteristics like
Information on the characteristic of age is frequently recorded, but not otherwise used as data in the studies included in our review. Given that age and time spent in the profession (seniority) are connected, and both are highly personal, some of the studies reviewed can be examined through the lens of the personal dimension. In their study about teaming, Gendron et al. (2016) state that age paired with time spent in the profession (seniority) is significantly associated with professional identity, and that teamwork adds both personal and professional value to occupational activity. Unfortunately, they do not further elaborate on their statement that the personal, sociodemographic characteristics of age and professional experience are correlated with professional identity. Black et al. (2010) and Holland et al. (2013) do offer an explanation for this correlation. They state that age is related to professional seniority, and that being older is often associated with having increased professional experience, an asset that strengthens a professional's confidence. Moreover, being older is associated with experiencing other themes in ethical dilemmas (Kenny et al., 2009). Unfortunately, the studies reviewed that include experience as a factor do not take the characteristic of age into account, while in the research sample composed of students there is sometimes a large age difference (Atkins & Gingras, 2009). On the other hand, the professional identity of students and experienced professionals, and how both groups perceive their professional role, is frequently a topic of comparison in studies (Champine et al., 2018). This leads to the conclusion that researchers are not in a position to identify which part of the results are related to professional experience, and which part may also be related to age and corresponding life experience. Based on what is stated in the studies reviewed, more senior and experienced professionals tend to have more confidence in themselves and others. Confidence is related to resilience, which is part of the third aspect of the personal dimension.
Information on the second personal characteristic,
The third characteristic,
The fourth characteristic,
To conclude, although these four characteristics – gender, age, nationality, and ethnicity – are rarely studied as main topics, they do influence the personal dimension of professionals to a greater or lesser extent. Gender, nationality, and ethnicity play a role in the background of all types of professionals, but their impact is greater for minority groups in allied health (Abreu, 2006; Gheller & Lordly, 2015; Neiterman & Bourgeault, 2015). Being part of a minority group affects the personal dimension of professionals and those professionals encounter barriers in study and work that challenge their confidence (Gheller & Lordly, 2015). It must be noted that this impact on minorities is not only relevant for the minority group itself. In multidisciplinary teams, it is important an individual professional will be able to understand that his perspective is one perspective and other professionals may look at a client, practice, or institution from a very different viewpoint (Jarvis & Trodd, 2008). Having an eye for the effect of personal characteristics can create awareness, and reduce tensions between the personal dimension on the one hand and professional beliefs that stem from the professional identity on the other (Jarvis & Trodd, 2008).
To denote the impact of professionals’ personal histories on the personal dimension, various terms are used. Hooper (2007) uses the term
All personal life experiences of being confronted with ethical doubt cause professionals to grow and to reflect on their professional values. Consequently, these personal experiences shape the professional practice of AHPs. Because of the demonstrated effects of personal dimension factors on healthcare practice and the limited research that has been done on these factors, Kenny et al. (2009) call for further investigation of the ’relationship between healthcare practitioners’ personal and professional identity‘ (Kenny et al., 2009, p. 434).
The third aspect of the personal dimension consists of personal traits. In the selected articles, many terms are used to identify traits related to the personal dimension. Some authors use categories like
Ashby et al. (2013) explore factors that influence the resilience of occupational therapists and establish that challenges requiring resilience often relate to (professional) values and identity. They distinguish between professional and personal resilience. Personal resilience can be supported through professional supervision when time is allowed for reflective practice and professional reasoning with a colleague with a shared philosophy. In the case of students, professional supervision is provided by clinical teachers, which supports the growth of personal resilience and professional robustness (Ashby et al., 2013). Clinical teachers should ’aim to build resilience in students that protects them from the corrupting influence of negative role models in the health system‘ (Rowe, 2015, p. 5), but need to take into account that they, too, have a personal dimension and will therefore experience dilemmas, notably due to their dual or triple identities as clinician-educator or clinician-educator-scientist (Kluijtmans et al., 2017; Matthews et al., 2020; Ong et al., 2019; Rees et al., 2019). Newly graduated AHPs feel more insecure and less confident about their decisions. This is supported by Holland et al. (2012) and O’Leary & Cantillon (2020), who describe professional confidence as a maturing, dynamic personal belief held by professionals or students. Feeling less confident has consequences for personal resilience. Professionals sometimes get overwhelmed by the emotional aspects of their job and by the workload they are confronted with (Jarvis & Trodd, 2008; Lau et al., 2016). Such feelings are related to their personal life experiences. Performing professional activities that are meaningful and hold personal value reduces the likelihood of burnout, increases job satisfaction, and generates a stronger sense of professional identity (Jakobsen et al., 2011; Scanlan & Hazelton, 2019). Resilience-related personal traits can be developed through (inter) professional socialization, which is often accompanied by the virtue of solidarity, which will be explained in the next paragraph.
Caring, justice, solidarity, courage, veracity (honesty), and integrity are virtues that are mentioned in various contexts in the articles reviewed. None of these articles have virtues as their main subject, but they are described as traits that influence professional practice.
The virtue of caring was often the reason for becoming an AHP: these professionals want to help and understand people (Drolet & Sauvageau, 2016). In practice, being caring causes tensions for professionals when working in the border area of caring and therapy, especially for students and young professionals. AHPs whose role it is to give therapy are sometimes regarded as caretakers. This brings with it the dilemma between wanting to help people but also needing to maintain professional and personal boundaries (Binyamin, 2018). Men in female-dominated health professions do effectively experience additional role strain because of the social prejudice that men are less caring than women, which can lead to feelings of inadequacy in caring (Gheller & Lordly, 2015).
Justice or fairness is a virtue that frequently causes dilemmas in allied healthcare. AHPs with a strong sense of justice face dilemmas when healthcare systems prioritize patient care differently than they do as professionals (Binyamin, 2018). Quality of care is another subject of dilemmas. In their human and professional hearts, AHPs want to do everything in their ability for a patient, but in economically managed healthcare systems, patients have limited rights to healthcare (Kenny et al., 2009). Particularly in occupational therapy, this is a common dilemma causing frustration for professionals. In Drolet and Sauvageau's study about occupational therapists in Quebec (2016), 81% of the participants spontaneously mentioned social justice and advocacy as values that were important to them. These values are linked with a core service provided by occupational therapists, helping patients to recover the occupations that are important to them (occupational justice). As a result, the confrontation with economic restrictions that prevent the recovery of these occupations leads to feelings of injustice among these AHPs. Moreover, since this is a field-specific service, dilemmas arise for occupational therapists in regard to interprofessional practice when their profession is not valued as important by other professions (Bushby et al., 2015; Dige, 2009; Hess-April et al., 2017; Wimpenny & Lewis, 2015).
In the stereotypical view of (allied) health professionals,
The connection between courage and professionalism is elaborated by Zmetana (2013). She states that professionals have the conviction and the courage to do what is right and make the right choices, which goes beyond the capacity of merely knowing right from wrong. This fits with the findings of Rowe (2015) who refers to moral courage as ’a continuous commitment to and reflection upon personal values and moral behaviors that influence ethical decision making‘ (Rowe, 2015, p. 4). He states that a lack of moral courage and agency is frequently observed in health care professionals, which has a negative impact on their professional practice (Rowe, 2015). Moral courage, veracity (honesty), and integrity are connecting virtues between the personal traits in the third aspect and the core values in the fourth aspect of the personal dimension. This latter aspect is the worldview of the AHP, which is discussed in the next paragraph.
To conclude, the third aspect of the personal dimension, being personal traits, consists of two (sub)aspects: resilience-related personal traits and virtues. Character traits like resilience, self-assurance, and confidence, combined with the performing of professional activities that are meaningful and hold high personal value, reduce the likelihood of burnout and support professionals in meeting challenges. The development of positive traits and of character strengths, increases personal resilience. Virtues like caring, justice, and solidarity are positive personal traits that play an important role in human-centered care, but which can cause dilemmas when the quality of care desired by the professional cannot be realized due to cost-effective health care. In such situations, moral courage is required to balance the pressure between economy and good care.
The fourth aspect of the personal dimension, the worldview of the AHP, can be seen as the filter through which the professional views his or her professional practice. This filter is formed by the first three aspects of the personal dimension and consists of
In their study, Burford et al. (2014) see personal beliefs as part of the personal moral and ethical codes, or core beliefs, of individuals. These core beliefs are identified as underpinning the professionalism of individuals. In testing their theoretical findings with the participants of their study – students and educators of three health professions – Burford et al. observe that the participants saw professionalism as part of the identity of the professional that cannot be parceled off from the latter. In all the reviewed articles in which core beliefs are defined, core beliefs are seen as belonging to the personal dimension. The authors connect core beliefs with family upbringing and confirm that these are sometimes the underlying motivation for becoming a healthcare professional. One example of a core belief that is frequently mentioned in healthcare is consistency of approach; the belief that every patient has the same rights to good care, irrespective of origin or social status, and the right to be seen as a person, not as a patient (Burford et al., 2014).
This worldview filter, as outlined above, is formed by the first three aspects of the personal dimension. For instance, there is a relationship between the core values in the fourth aspect and the virtues in the third aspect. Two of the virtues, which are also values, that are important in the personal dimension are veracity (honesty)
These examples of the effects of worldview demonstrate that characteristics like nationality, ethnicity, and gender do influence the worldview of AHPs and, moreover, can cause moral dilemmas in allied healthcare. Life experiences, personal traits, and virtues do shape the core values and core beliefs of professionals, and the personal norms connected with these. Professionals are not always aware of their own worldview. The experience of an ambiguous situation, or talking about ethical dilemmas in peer-support groups or in response to new research findings, can create awareness of how the personal dimension interferes in clinical practice (Guendouzi & Williams, 2010). Hammond et al. (2016) argue that when professionals frequently participate in moral and ethical reasoning in peer-support groups, they develop a stronger sense of their personal dimension, which supports their individual agency.
In the scoping review presented in this article, in which we included 81 studies, we explored the research question,
The first aspect encompasses
In the case presented in the introduction, the optometry student is young and inexperienced. He was raised to always tell the truth and studies optometry to care for people's eyes. His education focuses on skills, knowledge, protocols, and law. The client is a young man of his optometrist's age, whom he expects to behave and think in the same way as himself. Because of his lack of experience, he is still insecure, lacking the resilience and moral courage to deal with the angry client. His mentor is an experienced optometrist who knows from experience that clients do not always tell the whole truth when they know that something important, like a driver's license, is at stake. His help, in taking the decision to record to real visual acuity, is an example of the supervision students need to gain confidence and resilience. This dilemma situation was a disconcerting life experience for the student, which brought about an adjustment in his worldview that served him in dealing with similar dilemmas in his later career.
Compared to general literature on the personal dimension, allied health literature shows similarities but also gaps. While in the educational literature, Beijaard (2009) describes the personal dimension as composed of a set of specific personal, sociodemographic characteristics, the personal biography and learning history, and the beliefs a professional has about the profession, the allied health literature does not define the personal dimension. Lieff et al. (2012) underline the need to be mindful of factors related to the personal dimension in the development and implementation of healthcare curricula. Professional identity research shows that teachers develop a personal interpretative framework that arises from personal values and beliefs, which is shaped and re-shaped in the course of their career through interaction with teacher colleagues and the impact of the social, cultural, and structural conditions in their working environment (Kelchtermans, 2009; Vanassche & Kelchtermans, 2016).
To conclude: in all the literature on allied health professional identity that we studied for our scoping review, not one of the articles studies the personal dimension in its entirety. Many articles researched or identified various (sub)aspects of the personal dimension, but this was never the core focus of the study. Only seven review studies were available for inclusion in our scoping review, compared to a large amount of small-sample qualitative studies. These qualitative studies were valuable but came with limitations for the generalizability of their findings, which was identified as the primary limitation of these studies by the authors. Many aspects of the personal dimension are mentioned in the articles reviewed, but these are not elaborated on. This is particularly the case for different personal, sociodemographic characteristics like gender, nationality, and ethnicity. In further research on the personal dimension, it would be interesting to combine several small studies.
Not all allied health professions are included in research about the personal dimension. In occupational therapy, aspects of the personal dimension are frequently studied, in optometry the personal dimension is barely studied. This demonstrates the need for further research into the personal dimension in all allied health professions. Lindquist et al. (2006) also call for further research into how professional identities are formed and how the understanding of other professions is shaped. The lens through which the personal dimension is studied in this review will be checked in empirical research on four Dutch allied health professions, but perspectives from other disciplines or collaborations with other countries are also recommended.
Being aware of the cultural (ethnic) background of habits and having an eye for the effect of personal, sociodemographic characteristics can create awareness for professionals to provide appropriate responses in a practice visited by clients with a variety of cultural backgrounds (Mårtensson & Archenholtz, 2017), and to know how to cope with dilemmas with this kind of background especially in interprofessional teams (Davis, 2006; Hertweck et al., 2012).
All personal life experiences of being confronted with ethical doubt cause professionals to grow and to reflect on their professional values and reduce tensions between the personal dimension on the one hand and professional beliefs that stem from the professional identity on the other.
Professionals are not always aware of their own worldview. The experience of an ambiguous situation, or talking about ethical dilemmas in (interprofessional) peer-support groups or in response to new research findings, can create awareness of how the personal dimension interferes in clinical practice (Guendouzi & Williams, 2010).
The strengths of our scoping review are the systematic nature of our study, the quantity and range of the included articles, and the scoping review's potential contribution to future research, practice, and education.
A limitation is that the review is conducted on the basis of Dutch allied health professions, which includes some allied health professions that are not widely practiced internationally, but also omits some professions, such as nursing, which belong to allied health in other parts of the world such. It would be interesting to study the differences between the personal dimension as elaborated in the allied health professions of this scoping review and the personal dimension as elaborated in nursing.
Another limitation is that the search did not include a sociological database. Including a sociological database could have provided some relevant studies from a different perspective. Although there was a substantial overlap in the studied databases because many journals are included in both (allied) health and psychology databases.
This scoping review serves as an initiative to generate more attention for the personal dimension of professional identity.
Distribution of allied health professions in this scoping review.
|Health care (non-specified)||8||9%|
Included articles in scoping review.
|2001–2005||Hughes, J.||Br J OT||literature study||OT|
|Hind, M. et al||J Interprof Care||survey study||medicine, nursing, pharmacy, PT, diet|
|Ikiugu, M.N.; Rosso, H.M.||OT intern||survey course evaluation analysis||OT|
|Spafford, M.M. et al.||Optom Vis Sci||field observations interviews||Opt|
|Cooper, H.; Spencer-Dawe, E.; Mclean, E.||J Interprof Care||survey study interviews||medicine, nursing, PT, OT|
|Kathard, H.||Adv Sp-Lang Path||literature study||SLP|
|2006–2010||Abreu, B.C.||Am J OT||work journey literature study||OT|
|Lindquist, I. et al.||Med Teach||Interviews||PT|
|Plack, M.M.||J PT Educ||interviews||PT|
|Clouston, T.J.; Whitcombe, S.W.||Br J OT||discussion paper||OT|
|Hooper, B.||Am J OT||interviews, observations, narratives||OT|
|Jarvis, J.; Trodd, L.||Child Lang Teach Ther||discussion paper||SLT Teachers|
|Atkins, J.; Gingras, J.||Can J Diet Pract Res||interviews||Diet|
|Dige, M.||Sc J OT||literature study||OT|
|Kenny, B.J. et al.||Int J Lang Comm Dis||interviews||SLT|
|Black, L.L. et al.||Phys Ther||interviews, reflective journals||PT|
|Edwards, H.; Dirette, D.||OT Health Care||survey study||OT|
|Guendouzi, J.; Williams, M.J.||Commun Med||interviews||SLT|
|Nicholls, D.A.; Gibson, B.E.||PT Th Pract||literature study||PT|
|2011-2015||Jakobsen, F.; Hansen, T.B.; Eika, B.||J Interprof Care||survey study||OT, PT, nursing|
|Hertweck, M.L. et al.||J PA Educ||survey study||psychology, OT, PT, PA|
|Holland, K.E.; Middleton, L.; Uys, L.||SA J OT||literature review and focus groups||OT|
|Holland, K.E.; Middleton, L.; Uys, L.||Sc J OT||literature study||OT|
|Trede, F.; Macklin, R.; Bridges, D.||Stud Higher Educ||interviews written reflections||PT|
|Ashby, S.E. et al.||Aus J OT||interviews||OT|
|Awlor, S.L.||Can J Dent Hyg||history||DH|
|Hayward, L.M. et al.||Phys Ther||interviews, reflective journals, observation||PT|
|Holland, K.E.; Middleton, L.; Uys, L.||OT intern||interviews||OT|
|Zmetana, K.||Can J Dent Hyg||literature study||DH|
|Burford, B. et al.||Med Educ||focus groups||paramedic, OT, podiatry|
|Clark, P.G.||J Interprof Care||narrative analysis of literature||health and social care|
|Khalili, H.; Hall, J.; DeLuca, S.||J Interprof Care||literature study||health professionals|
|Kraft, M.; Blomberg, K.; Hedman, A-M.R.||Intern J Older People Nurs||interviews||OT, PT, nursing|
|2011–2015||O’Flynn, S.; Kelly, M.A.; Bennett, D.||Med Educ||literature study||health care practitioners|
|Bushby, K. et al.||Br J OT||literature review||OT|
|Guajardo, A.; Kronenberg, F.; Ramugondo, E.L.||SA J OT||literature study||OT|
|Martinez, J.; Leland, N.||OTJR||case study||OT|
|Neiterman, E.; Bourgeault, I.L.||Soc Sci Med||interviews||int educ health care prof (IEHPs)|
|Rowe, M.||SA J PT||nominal group technique (NGT)||PT, physician, surgeon, nursing|
|Turner, A.; Knight, J.||Br J OT||literature review||OT|
|Wimpenny, K.; Lewis, L.||SA J OT||Case study Interviews||OT|
|2016–2021||Ashby, S.E.; Adler, J.; Herbert, L.||Aus J OT||survey study||OT|
|Drolet, M-J.; Désormeaux-Moreau, M.||Sc J OT||interviews||OT|
|Drolet, M-J.; Sauvageau, A.||Sc J OT||interviews, literature study||OT|
|Drolet, M-J.; Sauvageau, A.||Sc J OT||interviews, literature study||OT|
|Gendron, T.L. et al.||Clin Gerontologist||survey study||Clin/Couns Psych, Geront, nursing, pharm, PT, OT, SW & management, administration|
|Hammond R; Cross, V.; Moore, A.||Physiotherapy||group discussions||PT|
|Lau, B. et al.||Phys Ther||systematic review||PT|
|McMahon, A.T. et al.||J Human Nutr & Diet||literature search interviews||Diet|
|Stull, C.L.; Blue, C.M.||J Interprof Care||survey study||OT, DH, DT, dentistry, clin lab sci, medicine, nursing, pharmacy, public health, vet med|
|Hess-April, L. et al.||SA J OT||interviews||OT|
|Kluijtmans, M. et al.||Med Educ||interviews||PT-sci, nurse-sci|
|Lahav, O.; Yalon-Chamovitz, S.||Am J OT||survey study||OT|
|Lawson, L. et al.||Am J Fam Ther||interviews||nursing, medicine, PT students|
|Long, D.D.; Rosen, I.||Health Soc Work||reflection on work practices||Opt. SW|
|Mårtensson, L.; Archenholtz B.||Sc J OT||focus groups||OT|
|McEntee-Atalianis, L.; Litosseliti, L.||Narr Inq||small story analysis||SLT|
|Ranz, R.; Nuttman-Shwartz, O.||Eur J Soc Work||25 Facebook posts (narratives)||SW|
|Binyamin, G.||Adv Health Sci Educ||cases, personal reflections||OT|
|Burley, S. et al.||Aus OT J||ethn study: obs, interviews, review progress notes||OT|
|Champine, J.M. et al.||Int J Dent Hyg||survey study||DH|
|Devery, H.; Scanlan, J.N.; Ross, J.||Aus OT J||surveys interviews||OT|
|Gheller, B.J.F.; Joy, P.; Lordly, D.||Can J Diet Pract Res||interviews||Diet|
|Helmich, E.; de Carvalho-Filho, M.A.||Med Educ||commentary to content analysis||medicine|
|Hendriks, T. et al.||Int J Soc Psychiatry||interviews||Health care prof|
|James, K. et al.||Br J OT||interviews||OT|
|2016–2021||Conroy, C.||IJAHSP||narrative literature review||nursing, OT, SW, biomed sci, medicine students|
|Furness, L.; Tynan, A.; Ostini, J.||Aust J Rural Health||focus groups||PT, OT, Diet, ST, SW, Psych, Pod|
|Goh, N.C.K. et al.||Aust OT J||interviews||OT|
|Ong S.Y. et al.||BMJ Open||interviews, focus groups||OT
|O’Shea, J.; McGrath, S.||Br J OT||interviews||OT|
|Rees, C.E; Kent, F.; Crampton, P.E.S.||Med Educ||interviews (group and individual)||medicine, midwifery, nursing, OT, param and PT|
|Scanlan, J.N.; Hazelton, T.||Aust OT J||survey study||OT|
|Volpe, R.L. et al.||Med Educ||scoping review||medicine, nursing, couns/psych|
|Feller, K.; Berendonk, C.||Med Educ||focus groups||physicians, AHPs|
|Fitzgerald, A.||Nurs Forum||concept analysis||nursing, medicine, SW, OT, pharm|
|Matthews, R.; Smith-Han, K.; Nicholson, H.||Adv Health Sci Educ||narrative inquiry||PT, medicine students, diet, psychology|
|O’Leary, N.; Cantillon, P.||Adv Health Sci Educ||interviews||SLT|
|Lecours, A.; Baril, N.; Drolet, M-J.||Can J OT||concept analysis||OT|
|Sonday, A.||SA J OT||interviews focus groups||OT, PT|Interprofessional collaboration – a health science term from the perspective of linguistics / Interprofessionalität – ein gesundheitswissenschaftlicher Begriff aus dem Blickwinkel der Linguistik Impact of an online spiritual care course on perceived competency in spiritual care of students in social and health care professions / Wirksamkeit eines Online-Spiritual Care-Seminars auf die wahrgenommene Spiritual Care-Kompetenz bei Studierenden in Sozial- und Gesundheitsberufen Implementation of telerehabilitation in Austrian outpatient physiotherapy – A qualitative study / Implementierung von Telerehabilitation in der ambulanten Physiotherapie in Österreich – Eine qualitative Studie Nurse educator education in six European countries: a descriptive study / Ausbildung von Pflegepädagog/-innen in sechs europäischen Ländern – eine deskriptive Studie Extension and Validation of the Self-care Index to Predict Transfer to a Post-acute Care Institution in Internal Medicine Patients / Erweiterung und Validierung des Selbstpflegeindexes bei internistischen Patienten mit dem Ziel eine Verlegung in eine post-akute Nachsorgeinstitution vorauszusagen The personal dimension of allied health professional identity: A scoping review in health sciences literature / Die persönliche Dimension der beruflichen Identität von Gesundheitsfachkräften: ein Scoping-Review in der gesundheitswissenschaftlichen Literatur Testing the iMTA Productivity Costs Questionnaire (iPCQ) for the use with chronic disease patients in Switzerland / Prüfung des iMTA Productivity Costs Questionnaire (iPCQ) für den Einsatz bei Patienten/-innen mit chronischen Krankheiten in der Schweiz Socialisation into interprofessional teams: A mixed-methods study among early health professional learners who engaged in a teams and teamwork module / Sozialisierung in interprofessionellen Teams: Eine Mixed-Methods-Studie zum Effekt eines Team- und Teamwork-Moduls bei Auszubildenden im Gesundheitswesen Measures to reduce stress in the workplace – results from focus group interviews with health professionals / Maßnahmen zur Reduktion von Stress am Arbeitsplatz – Resultate aus Fokusgruppeninterviews mit Gesundheitsfachpersonen Evaluation of the Interprofessional Education Day 2019 / Evaluation des Interprofessional Education Day 2019 Evaluation of an APN service in acute inpatient care of patients with a malignant brain tumor: a qualitative study in a Swiss university hospital / Evaluation eines APN-Angebots in der akut-stationären Versorgung von Patienten und Patientinnen mit malignem Hirntumor: eine qualitative Studie in einem Schweizer Universitätsspital Current practice of physiotherapists in outpatient stroke rehabilitation: a cross-sectional survey in Austria / Arbeitsweise von Physiotherapeut*innen in der ambulanten Schlaganfallrehabilitation: eine Querschnittsumfrage in Österreich Opportunities and challenges for home care services in implementing the Buurtzorg model in Switzerland: results of an exploratory case study / Chancen und Herausforderungen für häusliche Pflegedienste bei der Umsetzung des Buurtzorg-Modells in der Schweiz: Ergebnisse einer explorativen Fallstudie Systematically promoting job-specific digital competencies in the health professions: A teaching concept / Berufsspezifische digitale Kompetenzen in den Gesundheitsfachberufen systematisch fördern: Ein Lehrkonzept