Who am I? Narratives as a window to transformative moments in critical care

Critical care clinicians practice a liminal medicine at the border between life and death, witnessing suffering and tragedy which cannot fail to impact the clinicians themselves. Clinicians’ professional identity is predicated upon their iterative efforts to articulate and
contextualize these experiences, while a failure to do so may lead to burnout. This journey
of self-discovery is illuminated by clinician narratives which capture key moments in building
their professional identity. We analyzed a collection of narratives by critical care clinicians to
determine which experiences most profoundly impacted their professional identity formation. After surveying 30 critical care journals, we identified one journal that published 84 clinician narratives since 2013; these constituted our data source. A clinician educator, an art
historian, and an anthropologist analyzed these pieces using a narrative analysis technique
identifying major themes and subthemes. Once the research team agreed on a thematic
structure, a clinician-ethicist and a trainee read all the pieces for analytic validation. The
main theme that emerged across all these pieces was the experience of existing at the heart
of the dynamic tension between life and death. We identified three further sub-themes: the
experience of bridging the existential divide between dissimilar worlds and contexts, fulfilling
divergent roles, and the concurrent experience of feeling dissonant emotions. Our study
constitutes a novel exploration of transformative clinical experiences within Critical Care,
introducing a methodology that equips medical educators in Critical Care and beyond to better understand and support clinicians in their professional identity formation. As clinician
burnout soars amidst increasing stressors on our healthcare systems, a healthy professional identity formation is an invaluable asset for personal growth and moral resilience. Our
study paves the way for post-graduate and continuing education interventions that foster
mindful personal growth within the medical subspecialties.