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Commentary: Forks in the road: disruption and transformation in professional development.

The dynamic influences underlying the development of the professional identity of physicians are not completely understood; however, one can easily imagine that the transition from the supervised work of the resident to the relative autonomy and increased authority of the attending physician is a watershed moment in this developmental process. In this issue of Academic Medicine, Westerman and colleagues present a qualitative, interview-based study exploring the experiences of newly appointed attending physicians during this transition, and from the participants' responses, they construct a conceptual model in which the new attending physicians' attempts to understand and cope with novel disruptive elements (i.e., new and unfamiliar tasks, roles, and settings) eventually give rise to a sense of mastery and personal and professional development. Although the authors use the literature of transition psychology and organizational social theory to support their model, valuable lessons may be learned from looking at the processes from an educational perspective as well. The disruptions which the authors describe find resonance in Piaget's state of "cognitive disequilibrium" or Dewey's "forked road situation," both of which link the experience of challenging or ambiguous situations with the act of reflection. Disruptive influences may stimulate explorations of self, others, and the world during this critical transition, and educational efforts in mentorship and in the creation of thoughtful discourse about these critical explorations may ultimately contribute to the development of a reflective professional self.