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Background Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students’ evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF. Methods A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data. Results A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF. Discussion PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students’ identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students’ balanced integration of personal and professional identities over time.

Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge despite advancements in surgical techniques and investigation modalities. We seek to identify key clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries in our practice. 592 patients underwent UGI surgeries with an anastomosis in a single center between January 2011 and Jan 2021. The cohort comprises were 237 (40.0%) distal gastrectomies, 120 (20.3%) total gastrectomies, 104 (17.6%) Roux-en-y bariatric bypasses, 53 (9.0%) Ivor-Lewis esophagectomies, 41 (6.9%) proximal gastrectomies, 17 (2.8%) palliative gastro-jejunostomies and 20 (3.4%) Mckeown esophagectomies. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed. The overall occurrence of AL was 6.4%. AL was highest in esophagectomies (13.7%) and total gastrectomies (10.0%). Clinical parameters associated with AL include HR >120 BPM, desaturation, bilious or food contents in drain and leukocytosis. On multivariate analysis, HR >120 BPM and leukocyte count >19x1000000000/L were independent predictors of AL. Patients with high-risk anastomosis who had pre-emptive investigations, were more likely to be managed with antibiotics instead of requiring invasive therapy (p = 0.025). Methylene blue test, oral contrast study and Computed Tomography scan with intravenous and oral contrast had respective false negatives of 50.0%, 20.0% and 9.1%, while esophagogastroduodenoscopy had none. Our study demonstrates that the presence of a triad including desaturation, tachycardia and leukocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed to exclude a AL. A practice of evaluating high risk anastomosis prior to feeding decreases need for surgical intervention and improves the chances of successful conservative treatment.

Additional file 1: Appendix A. PubMed Search Strategy