When the profession itself is contested: Transformative learning and divergent identity pathways among first-year medical students during a macro-social crisis.

INTRODUCTION: Professional identity formation (PIF) research in medical education has largely examined micro-level dilemmas within relatively stable training environments. Less is known about how macro-social crises destabilizing the profession's public legitimacy shape early PIF. This study explored how first-year medical students narrated the impact of the 2024-2025 doctor-government conflict in South Korea on their professional identity development, using Transformative Learning Theory (TLT) as an interpretive lens. METHODS: We conducted a theory-informed qualitative study using written reflective essays submitted by first-year medical students as a professionalism course assignment upon returning to the formal curriculum. Using Big Q reflexive thematic analysis, we combined deductive use of TLT as a sensitizing concept with inductive latent analysis to examine students' pre-crisis assumptions, disorienting dilemmas, critical reflection, and evolving identities. RESULTS: Students' narratives were interpretable through four TLT-informed phases: pre-crisis frames of reference, disorienting dilemma, critical reflection, and evolving identity. Pre-crisis configurations included idealized, perfectionistic, system-naive, meritocratic, and hierarchical assumptions about medicine. Disorienting dilemmas centered on collapsing trust in the healthcare system, perceived patient harm, moral ambiguity, social rejection, and internal fragmentation within the medical community. Critical reflection involved deconstructing heroic and individualistic views of doctoring, reattributing problems to structural conditions, and renegotiating meanings of responsibility, competence, and solidarity. Many students described reconstructive identity work, culminating in more socially embedded, system-aware, and pragmatically collaborative identities. Others showed defensive retrenchment, reinforcing grievance, distrust, and a sense of professional victimhood. DISCUSSION: Macro-social crisis can function as a collective disorienting dilemma in early medical education, extending PIF and transformative learning beyond micro-level clinical experiences. Identity development during legitimacy shocks is not uniformly growth-promoting; it depends on reflective and relational conditions under which students process disruption. Medical schools should support early identity work through structured dialogue, attention to belonging, and engagement with healthcare policy.