medicine.

Preface

Professional practice for podiatric practitioners is not a new phenomenon; it has dominated the focus of educational discussion and debate on how best the scope and parameters of podiatric medicine can be developed for the majority of two decades. Much has focused on how traditional academic theoretical perspectives on professionalism can be translated into applied clinical practice at the front line of patient assessment, diagnosis and management. Written by a selection of dedicated practitioners and educators from the field of healthcare generally and podiatric medicine specifically, the overall aims of this book are to:

  raise an awareness of professional practice for podiatric practitioners through an engagement with the core clinical, intellectual and analytical skills required for healthcare generally and podiatric practice specifically;

  provide a resource for members of the podiatric practitioner community, which addresses the fundamental contributory factors of professional practice in key areas such as professional identity, clinical professional practice, management and leadership alongside education and continuing professional development;

  develop an approach which enhances the healthcare practitioner’s ability to engage with and build capacity between professions in an interdisciplinary and multi-disciplinary approach to high quality healthcare provision.

Initial qualification within a particular profession is now deemed a foundation for the building of a solid, continuing professional development portfolio, which may subsequently become part of an evidence base for individual accountability and governance by professional regulatory bodies. This book aims to address how we can best synthesise the evidence base for the provision of care rooted in the best published literature to date from specific fields of academic research.

After a significant period of professionalisation podiatric medicine is now a discipline which still engages heavily in debate around the concept of its own professional identity and the contextual framework for practice. This book offers an insight into how this might be sociologically framed as well as practically executed.

Principles of leadership and management which impact on individual career progression pathways and personal development opportunities within healthcare are discussed alongside the processes of appraisal, work loading and continuing professional development, which continue to shape the future of the profession as a whole through individual commitment to podiatric medicine.

Our sustained contribution to the concept of patient-centred care and our unique contribution to the allied healthcare professional arena have ensured that our own levels of clinical professional practice have never before been under closer scrutiny. Our commitment to its ongoing progression is therefore fundamental to our credibility as a profession.

Chapter One

Professional Identity – Who do we think we are?

Judith Barbaro-Brown

Framing Professional Identity

In podiatry, as in all healthcare professions, the development of a professional identity is an essential part of learning about what it is to be ‘a podiatrist’. For many practitioners this is a process which begins in the early years of clinical education and experience, and may be highly influenced by the attitudes and perceptions of those involved in helping the student along the educational pathway. The student is socialised into the profession by the development of a notion of what that profession is, and this continues throughout formal education and on into professional practice. Additionally, exposure to clinical situations and other healthcare professionals help students and practitioners learn about the roles of other professions, as well as the differences between them, contributing to an appreciation of what it is to be a ‘professional’, with the attitudes, behaviours, and perceptions that are attached to this. However, along with the benefits gained by this exposure come potential problems in that it is not only positive attributes which can be passed on. These detrimental influences may not only come from other professionals, but also from wider society and the media. Negative stereotypes relating to other professions and a poor perception of one’s own profession can be highly significant, and lead to dissonant views relating to inter-professional and group working. It is the aim of this chapter to examine the development of identity in terms of the social and professional self, and reflect on how we, as professionals, can enable the promotion of positive and cohesive identities which allow us to contribute effectively to teamworking, whilst appreciating the underlying issues which can interfere with a collaborative, inter-professional approach.

Social Identity and Identity Development

Professional identity can be seen as an extension of social group identity, a group being defined as a number of people who perceive themselves in terms of shared knowledge, skills, or attributes, which sets them apart and distinguishes them from other people (Hogg, 2006, p. 111). Professional identity involves group interactions in the workplace and more specifically relates to how individuals compare and differentiate themselves from other professional groups. Being a member of a group is a pivotal principal of social identity theory, which addresses phenomena such as in-group and out-group behaviour, stereotyping, discrimination, conformity, prejudice, leadership, and cohesiveness (Helmich et al., 2010).

Social Identity Theory

Social Identity Theory (SIT) was initially described by Henri Tajfel and John Turner (Tajfel & Turner, 1979), and was originally founded on their attempts to explain inter-group reactions and conflict (Hogg & Vaughan, 2005 p.411). It is based on the assumption that society is categorised into different social groups that are seen to have differing levels of status and power in relation to each other. Being a member of one of these groups gives an individual a social identity, which defines that individual in terms of their behaviours and attributes. In this way, members of different social groups develop an understanding of the perceived behaviours and characteristics of members from other social groups. Related behaviours to this are stereotyping, prejudice, in-group and out-group perceptions, and group cohesiveness.

A pivotal assumption of SIT is that in-group bias is wholly motivated by the wish to have one’s group valued highly, and therefore to see oneself in a positive light.

(Brown, 2000)

An individual can have numerous social identities depending on the number of social groups to which they feel aligned. These groups can sit within any aspect of society, from personal and reciprocal relationships (mother/daughter), to employment (teacher, cleaner, nurse), activity (footballer, cyclist, artist, Scout), ethnicity (Afro-Caribbean, South Asian, European), religion (Christian, Muslim, Hindu), or locality (Glaswegian, Cockney, Parisian).

Self-Categorisation Theory

Since SIT was first put forward there has been a great deal of further development from which other theories have emerged, and perhaps the most significant of these was by Turner et al., known as Self-Categorisation Theory (Turner, 1996), with the proposition that the actual process of categorising oneself as a member of a group produces social identity, and from this, group and intergroup behaviours are developed. In essence, social identity is the definition of ‘self’ in regard to the groups to which one belongs, and it may be more appropriate to view this in terms of the social identity perspective (Hogg & Vaughan, 2005, p. 408).

Self-Categorisation Theory (SCT) states that the perception a person has of themself varies, and each person has the capacity to hold multiple self-concepts (social identities), and therefore belong to a number of categories, although at a given time only one of these self-concepts is salient. However, this does not imply that this is always the dominant self-concept, but that depending on the circumstances, different self-concepts can be activated (Mackie & Smith, 1998; Salzarulo, 2004). The category to which an individual assigns him or her self at any given moment is termed the self-category, or in-group. It is the fundamental hypothesis of Self-Categorisation Theory that as we group the individuals around us into subsets, we identify ourselves with the group whose membership shows the most similarity to ourselves (Oakes et al., 1991).

Categorisation, Prototypes and Depersonalisation

The practice of categorisation (the clustering of people, objects, ideas, and/or events into meaningful groups) represents a very basic step in human judgement and perception, allowing an individual to process information rapidly and instinctively (Brewer, 2003). Categorisation forms the basis for identification of groups, and is a fundamental part of the study of how group relationships develop. Much of the early work in identifying the characteristics of categorisation was carried out by Gordon Allport in the early 1950s, from which he developed a model which stated that there were five important features of categorisation (Allport, 1979):

1. It forms large classes or clusters.

2. It assimilates as much information as possible into the cluster.

3. It enables rapid identification of a related object.

4. All members of the category are imbued with the same ideas and emotions.

5. Categories are based on existing differences between characteristics of objects or people.

Depending on the perception of the viewer, categorising another individual into a social group classifies that individual as being part of an in-group (to which the viewer also belongs) or an out-group (of which the viewer is a nonmember), and therefore is subject to irrational reasoning. Allport recognised this, and stated therefore that social categorisation was often less than rational and frequently based on personal beliefs about social groups rather than actual evidence of group differences (Allport, 1979). In essence, it was at the mercy of personal bias and opinion.

A further step on from categorisation is the recognition that there is a tendency for exaggeration of the extent of differences between groups. Once a group has been identified, a prototype group member is represented, which consists of a group of attributes which distinguishes this group’s members from another’s. The prototype conforms to the metacontrast principle in that the average differences between members of the in-group are less than the average differences between the in-group and out-group members (Turner, 1996), which in turn accentuates group entitativity – the property of the group that makes it appear different, distinct, and coherent (Lickel et al., 2000). The prototype is not a typical or average group member, but is more of the ‘ideal’ group member, embodying all the characteristics that would be associated with group membership, even if no single group member displayed all of the characteristics. In essence, the prototype is the context-dependent, cognitive representation of the group (Hogg & Vaughan, 2005, pp. 409).

As an illustration of the metacontrast principle and entitativity, Hopkins and Moore (2001) looked at national group perceptions, and found that Scots had a clear perception of the differences between themselves and English people, but this amount of perceived difference between Scots and English reduced when comparing themselves to continental European groups such as Germans, i.e. the Scots were different to the English, but had more in common with English people than with German people.

This process of categorising people results in the depersonalisation of the individual, where they are perceived as a group member rather than an individual with their own views and idiosyncrasies. There is the tendency to project the group prototype on to the individual, thereby enhancing the perception of them as typical group members, holding standardised group values, and exhibiting standardised behaviours – known as stereotyping. This also occurs in the re-definition of the self (self-stereotyping), and consequently individuals begin to act in terms of their group identity rather than their personal identity (Tajfel & Turner, 1986). Once this group identity is salient, the individual looks for a positive evaluation of the group. From an intra-group perspective, this leads to cohesion and co-operative behaviour, whilst from an inter-group perspective, the in-group membership wish to feel superior to relevant out-groups (Voci, 2006). The resulting outcome in group behaviour is the development of in-group bias, or ethnocentrism (showing a preference for all aspects of the in-group relative to other groups). This process of depersonalisation appears to be the basis for the development of group cohesiveness, co-operation, trust, positive regard, and in-group favouritism (Hewstone et al., 2002, Turner, 1996, Oakes et al., 1991).

Salience

Salience, in this context, refers to the current, psychologically significant persona of the individual within a specific social group or category, and the alteration of behaviour to act