Role modeling is an established teaching method in medical education, where medical students learn by observing more experienced physicians. Role models play an important role in students’ socialization, professional identity development, and medical specialty choice [1,2,3,4], making them a powerful factor in medical education [5,6,7,8,9].

Considering the importance of clinical role modeling, it makes sense that medical education scholars have investigated clinical role models extensively. Traditionally, these studies emphasize role models’ behavioral value, where physicians model behaviors for students to emulate. Central to these studies are the attributes of excellent clinical teachers. These role model attributes are typically inventoried and then categorized into clinical qualities, teaching qualities, and personal qualities, a trichotomy introduced by Wright in 1997 [2, 10,11,12,13,14,15,16].

In more recent years, role modeling has regained scholars’ interest, only this time in the context of the increasingly culturally diverse student body. This line of research emphasizes role models’ symbolic value, where role models are seen as inspirational and motivational, representing the possible, and helping students permeate medical schools’ hidden curriculum. For ethnic minority students, also referred to as culturally underrepresented in medicine (URiM), clinical role models who share the same ethnic background (representative role models) strengthen their enthusiasm and offer guidance and support [17, 18]. They also help recruit and retain URiM students [19,20,21,22].

Conversely, the absence of representative role models is associated with a range of negative outcomes. These include a negative effect on URiM students’ matriculation, experiencing “inadequacy, inc ompetency, and self-doubt” and having limited access to relatable experiences [23, 24]. Additionally, URiM students risk being tokenized which means that a small number of underrepresented individuals are included to create an illusion of equality [25]. Summarizing, representative role models fulfill a critical role in URiM students’ study experience and ultimately in combatting the leaky pipeline phenomenon [26].

Between these two lines of research, where one established the importance of clinical role models and the other the particular significance of representative role models, lies a knowledge gap to be bridged. A systematic, empirical analysis of students’ role model definitions is needed to pinpoint if and how students’ definition of role models is shaped by (1) their own ethnicity and (2) how ethnically representative their role models are.

To compare URiM and non-URiM students’ image of role models and extend our scope beyond clinical role model attributes, we developed a conceptual framework of the broader role modeling process [27] (see Fig. 1). Drawing upon theoretical advancements from various academic disciplines, the framework offers a schematic representation of four stages of role modeling: idealization, social comparison, composition, and behavioral and symbolic outcomes.

Conceptual framework: schematic representation of medical students’ role modeling process

The role modeling process starts when students identify positive or negative attributes of the physicians around them. Organizational research on career role models for women refers to this as the idealization of proto-models [28]. This idealization process builds on the premise of selective imitation, where one does not aspire to imitate another person in their entirety, but rather selects specific attributes while ignoring others [29, 30]. Most research on clinical role models focuses on this idealization part of the role modeling process, asking: which attributes do students wish to emulate?

The second stage involves social comparison between the student and their role model. In the management theory, social comparison is described as “the processes through which individuals construct their identities, often through comparing and contrasting themselves to others” [31]. The perceived similarity between the student and their role model enables them to assess the feasibility and desirability of following in their role model’s footsteps [32,33,34]. Although the significance of similarity between diverse medical learners and their role models has previously been stated [35], it is not typically taken into account in studies about clinical role models.

The next stage follows from a social constructivist approach to role models and is novel to medical education research. It views a role model not as an actual person, but as the mental representation of attributes from real people (proto-models), selected during the idealization phase [29, 30, 32, 36, 37]. Together, these attributes form a dynamic, ever-evolving mental image of “the perfect physician” that can guide the student through whatever circumstances they are facing. As organizational theorist Zetterquist puts it: “People do not model their behavior on real persons, but on mental constructs they make loosely inspired by actual people” [28]. The cognitive construal of role models largely takes place at a subconscious level.

Finally, having a role model can result in different and multiple outcomes. First, there are the more tangible behavioral outcomes, as role models in medical education are usually viewed. An example of a behavioral outcome is clinical skill acquisition. The behavioral value is also recognized in economics, where it was first distinguished from mentoring and other forms of role modeling [32].

Second, role models carry a more intangible, symbolic value, a term coined by organizational researchers. Examples they give of symbolic role model outcomes are increased optimism and trust, commitment, and reduced stereotyping [33]. Psychologists also recognize role models as more symbolic “representations of the possible” and as sources of inspiration [34]. In humanities and philosophy, we see a less dichotomous, more gradual continuum of inspiration as a more sophisticated form of imitation [38]. Symbolic outcomes are particularly important to URiM students because “the outcomes build on the premise that ‘someone like them’ […] can succeed” [37].