Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. 91, No. 2 / February 2016 171 Commentary Editor’s Note: This is a Commentary on Cruess RL, Cruess SR, Steinert Y. Amending Miller’s pyramid to include professional identity formation. Acad Med. 2016;91:180–185. Medical education appears enraptured with the prospects and promises of professional identity formation (along with its sister concept professional identity development) as a vehicle of educational reform. Although scattered references to both terms began to surface in the 1990s (ISI Web of Science topic search “TS=professional identity formation OR TS=professional identity development”), key references to PIF* in the medical literature began to accumulate only in the past half decade. Evidence of this recent intonational cantata includes a June 2015 theme issue in Academic Medicine and a tightly interwoven trilogy of articles by Richard and Sylvia Cruess and colleagues, 1,2 the third of which appears in the current issue. 3 Alternative visions of profession as an object of identity formation emerged, however, in serendipitous visits to two underreferenced (within medical education) bodies of work on identity and formation: (1) issues of occupational preparation as framed within the organizational socialization literature, 4 and (2) issues of socialization and professional preparation from a military sciences perspective. 5 These alternative visions include whether PIF might be just another way to “on board” learners as managerial functionaries in the service of an increasingly formative (and formidable) biomedical–industrial complex, 6 or whether the construction/ formation of physicians-qua-professionals is about cultivating a future practice community whose collective moral vision, character, and potentially disruptive advocacy on behalf of patients may come to subvert the very structures and processes that initially gave rise to that identity. In triangulating these three literatures (medical, military, and occupational socialization), we forefront four issues: (1) the importance of exploring alternative framings of identity formation, (2) the importance of emphasizing the unique nature of professional work and what it means to be a professional in the context of identity formation, (3) the importance of identity as a collective versus individually focused undertaking, and (4) the importance of context and of explicitly addressing forces that may be countervailing to the object in question (PIF). We consider these issues all within the broader challenge of what it might mean to intentionally embrace identity and its formation as an educational objective. Occupational Socialization Our foray into alternative framings of socialization and occupational preparation began with a visit to the organizational socialization literature. 4 We anticipated a discourse similar to what was appearing within the medical PIF literature. We encountered something more orthogonal. While the general object-in-question (“occupational socialization”) sounded reassuringly familiar, the lexiconal framings of Abstract Professional identity formation in medical education is referenced increasingly as an object for educational reform. The authors introduce core concepts from two largely untapped literatures on identity and formation, contrasting framings on occupational preparation from within the organizational socialization literature with issues of socialization and professional acculturation from a military sciences perspective. The organizational sciences literature emphasizes socializing a workforce to “fit in,” raising questions about how organization values might clash with core professional values concerning patient primary and social justice. The military literature, in turn, advances the notions of professional identity as a collective property, and that a particular social other (the public) must participate in shaping the group’s identity as a profession. The authors extrapolate from these reviews that the training of physicians- as-professionals, and thus issues of socialization and identity formation, require intentionality and specificity around these contrasting issues. In turn, they argue that medical educators must attend to socializing trainees to a professional group identity while at the same time producing health care professionals who retain the capacity to resist the bureaucratic application of standardized solutions to contemporary problems. Educators must thus strive to identify the skills, knowledge, and attitudes necessary that will allow physicians-qua-professionals to function as a quasi-subversive work force and to disrupt the very system that helped to shape their identity, so that they may fulfill their mission to their patients. Acad Med. 2016;91:171–174. First published online October 29, 2015 doi: 10.1097/ACM.0000000000000961 Please see the end of this article for information about the authors. Correspondence should be addressed to Frederic W. Hafferty, Mayo Clinic, 200 First St. SW, Rochester, MN 55901; telephone: (507) 284-8343; e-mail: fredhafferty@mac.com. Alternative Framings, Countervailing Visions: Locating the “P” in Professional Identity Formation Frederic W. Hafferty, PhD, Barret Michalec, PhD, Maria Athina (Tina) Martimianakis, PhD, and Jon C. Tilburt, MD *We employ two different conventions when referencing the term “professional identity formation.” We use the acronym PIF when referring to the literature as a whole. Alternatively, we use an italicized P in PIF when advancing arguments that identity formation of professionals as a special subtype.