The theoretical principles underlying the SCOPE approach

When we started with the development of our PPD education, a few theoretical principles were dominating the scholarly discussions. Some were helpful within the medical context where they originated, but had their limitations when we extended our work to other educational disciplines. This prompted a wider investigation into other theoretical principles, in order to create a coherent and complementary approach to PPD. Some principles originate in medical education research (e.g. Professional Identity Formation or PIF), others in educational sciences (e.g. subjectification, boundary crossing theory). Moreover, some describe processes (socialisation, PIF), whereas others refer to aims of education (subjectification) or learning mechanisms (boundary crossing).

In this chapter, we will briefly summarise the various theoretical principles underlying the SCOPE approach and share our experiences and considerations when applying them to our educational practices. Understanding these principles clarifies why the SCOPE approach is structured the way it is, and helps the reader understand how the principles connect to the practical methods (e.g. knowledge clips or educational materials) that can be found throughout the handbook. Further readings will be suggested for those looking for more theoretical grounding.

Professional Identity Formation

In the domain of medical education, the importance of a student’s professional identity formation is widely acknowledged. PIF describes the process that students undergo as they develop from laypersons into professionals (Cruess et al., 2015). More specifically, it emphasises that becoming a professional involves more than just mastering knowledge and skills—it also includes internalising the values, attitudes, and behaviours that define a profession. By the time students complete their education, they should be ready to step into their profession’s Community of Practice (CoP), not only as competent practitioners, but also as individuals who embody the professional identity of that particular CoP.

The development of a professional identity is a dynamic and personal experience. Remaining within the original context of this concept, each medical student enters their educational program with a unique background, personal motivations, and individual characteristics. Throughout their training, their development is influenced by the educational environment, the role models they encounter, their practical experiences, and their own aspirations. For educators and curriculum developers, understanding and actively supporting this process is crucial. It ensures that students do not only simply learn what to do, but they also become able to think, act, and feel as medical professionals (Cruess et al., 2015).

Importantly, while knowledge and skills are often taught explicitly —through clear learning objectives, textbooks, lectures, and hands-on training—the development of a professional identity is largely shaped through socialisation within the professional community. In the next paragraph, we will dive deeper into this concept of socialisation, which is connected to Biesta’s philosophy of education.

When using PIF for developing our PPD education, the concept turned out to be especially useful within educational domains that have a strong and recognisable CoP. As our team started to be involved in educational disciplines outside of the medical field, we noticed that PIF is less useful within educational programs that have less clearly identifiable CoPs. To illustrate, we have included an exercise conducted with medical students below. The same exercise is more difficult to integrate into curricula where the professional context is less clearly defined and internships (and exposure to the CoP) are not included. The concept of boundary crossing proved to be a valuable addition to this PIF framework for less clearly identifiable CoPs, which will be explained below.

The second concern we ran into had to do with what educationalist and philosopher Gert Biesta describes as the ‘three aims of education’. According to Biesta, there should be a balance between qualification, socialisation and subjectification (Biesta, 2020). When strong emphasis is placed on qualifying students for their future career—and thus on socialising them to become part of their CoP—we risk overlooking the aim of subjectification, which is about fostering autonomous, responsible, and reflective individuals. In turn, this can result in the three aims of education being out of balance. In the next paragraphs, we will dive deeper into Biesta’s work.

What are the aims of education?

Biesta proposes that all education has to cover three domains or purposes: qualification, socialisation and subjectification (Biesta, 2020). The first, qualification, is about making sure that education leads to the acquisition of knowledge and skills relevant for the student (e.g. how to perform a profession). In the second domain, socialisation, education introduces students to relevant aspects of the society or groups they belong to. This can, for example, include learning about the norms and values that define the culture students grow up in, or learning about beliefs that are dominant within the group of professionals they relate to. The third purpose, subjectification, states that education should also focus on the development of the student as a subject. This is about reminding students that they are a subject (not a mere object) with autonomy, can develop as a unique person, and have the freedom to make choices in how to behave (Fleer et al., 2025). Biesta argues that when these three domains are well balanced, education can be successful.

Socialisation

The process of socialisation is not restricted to education alone; indeed, it happens continuously throughout someone’s life. As individuals, we are all part of social systems: different groups, cultures and societies. Think, for example, about a family, a sports team or a department at work. Each of these social systems has its own characteristics, habits, values, norms, and beliefs that we transfer to new members through socialisation. Socialisation is defined by the Oxford English Dictionary as ‘the process by which a person learns to function within a particular society or group by internalising its values and norms’. Elias (2001) defines it as ‘the translation and internalisation of norms, beliefs, so it becomes a second nature’. We define socialisation as the process by which someone learns to function in a new social system by internalising the norms, values, and other relevant practices of this specific group. Often, this happens by observing what others do within a social system, how they act and behave as role models. Within education, this socialisation process is sometimes referred to as the ‘hidden curriculum’ (see Deep Dive below for an explanation).

Successful socialisation within a group has several benefits. First, because socialisation indicates what is expected of an individual, it can provide a sense of belonging for members of that group. Second, as socialisation is the main mechanism in professional identity formation, it helps students form this professional identity successfully, especially when a strong CoP is in place (Cruess et al., 2015). Third,  socialisation helps to create structure and stability within the group as members understand what is expected of them, ultimately leading to greater predictability and efficiency (e.g. within a team).

On the other hand, socialisation can also have negative consequences. Disruptive and dysfunctional thoughts, norms, beliefs and behaviours, for instance, can be transferred via socialisation as well. For example, if there is a strong belief within a group that commitment/work ethic is demonstrated by staying later at the office than your supervisor, you might adopt this belief and stay longer, even though this is not the way you want to behave.

In education, therefore, this means that we need to focus on questions such as ‘What does it mean to be part of a CoP?’, or ‘Which values, norms and skills are common in the CoP’? In curricula, these questions are often (implicitly) covered in many courses alongside specific PPD activities. In our PPD education, we often touch upon these aspects as a starting point for students to reflect on.

We often use this knowledge clip to inform students, during a workshop or as homework before a session.

Subjectification

Besides qualification and socialisation, subjectification has been introduced as another aim of education (Biesta, 2020). Subjectification represents ‘a broad pedagogical principle that aims to foster discussions and contemplation about the existential dimensions of education’ (Biesta, 2010, p.19; Friso et al., 2026). Subjectification is about reminding students that they are a subject striving towards autonomy, the development of uniqueness and the freedom to make choices in how to behave (Fleer et al., 2025; Friso et al., 2026). However, this description still does not fully capture what Biesta meant by the educational domain of subjectification, and notions about the difficulties for teachers to apply the principle to their teachings exist in scholarly discussions (Friso et al., 2026).

While developing our PPD education, further operationalizing subjectification was useful. We came to see subjectification as a critical reflection on socialisation processes that students find themselves in. Additionally, ‘subjectification is a process whereby students become more autonomous and independent in their thinking and acting rather than adapting, as individuals, to the group’s collective identity’ (Biesta, 2010, as referenced in Hesen et al., 2022). Education that focuses on subjectification, therefore, encourages students to develop and get to know themselves, pushing them to continuously develop their personal identity and relate that to all that they learn in their education. This also means that students are not mere objects undergoing the socialisation process as described in the PIF-process, but subjects who play an active role in their socialisation. This requires a certain responsibility—students can or even must play an active role in their own professional and personal development. This is also where making room for subjectification can help reduce the negative consequences of socialisation. By reserving space in our PPD education for reflection on what has been conveyed in an educational/work-related context, students will become more aware of their socialisation process and, as a result, make more deliberate decisions. This will not necessarily solve the negative consequences of socialisation within the context of the learners, however. Rather, it is about increasing awareness and exploring how the learner wants to relate to this behaviour in light of their own development and who they want to become as a professional.

Within education, this means that we ask questions to learners such as ‘What do I want to do with all that I have learned?’ and ‘How do I relate to the socialisation processes I am in?’ In most of SCOPE’s developed educational material for medical students, the focus is on the balance between what happens in the educational domain of socialisation and that of subjectification. In other words, it is about a balance between designing PPD education so that the student has an opportunity to adapt to the professional group they want to belong to, and providing space for students to develop their own identity within a professional context. The Values workshop is a good example of how we put this into practice.

Boundary crossing

Our work at SCOPE originated in a medical education context. When our PPD education was integrated into more inter– and transdisciplinary programs, however, we stumbled upon the limitations of the theories addressed in the previous section. The main reason for that was that the CoP, a central aspect of PIF, is less explicit in these other contexts: within inter- and transdisciplinary programs, there is not always a clearly defined Community of Practice that holds specific norms, behaviours and beliefs that students get socialised in. However, these different educational contexts turned out to be valuable environments for students to learn how to become active subjects in their education, connecting to the concept of subjectification. The theory of boundary crossing provided us with a useful perspective on how to make use of this context in ways that stimulate students to become active subjects in their learning. In this section, therefore, we will dive into the basic concepts of this theory that we have used in designing the PPD education. In turn, these concepts will provide a lens through which we, and students themselves, can learn about the contexts we are exposed to.

An important note to make when reading about the theory of boundary crossing is that the boundaries refer to the distinction between ‘what is part of me’ and ‘what is not (yet) part of me’ (Akkerman & Bakker, 2011). Boundaries in this context do not refer to transgressive behaviour. Here, we will briefly explain this theory and the concepts of ‘boundaries’, ‘boundary experiences’, ‘boundary crossing’ and ‘learning mechanisms’.

Boundaries and boundary experiences

In the theory of boundary crossing, boundaries can be seen as socio-cultural differences leading to ‘discontinuation in action or interaction’ (Akkerman & Bakker, 2011). An example of a boundary can be the moment that a student is hesitant about speaking up during their first clinical rotation, as they are used to being perceived as a student watching from the sidelines rather than ‘the clinician’. This brief moment of disruption (i.e. the discontinuation of action) might be experienced by the student as hesitation or insecurity, and this internal experience can be referred to as the boundary experience. Often, these boundary experiences present themselves before the boundary that has caused it can even be explained.

Boundaries can take place at different ‘levels’. The example above can be seen as an intrapersonal boundary, as there is a difference between the roles the student can take on (being a student on the sidelines versus a clinician in training). Other levels are interpersonal (boundaries between individuals) and institutional (boundaries between institutional structures). More about these ‘levels’ you can find in the example box below.

Within education, these boundaries happen all the time; they can be perceived as a starting point for learning by reflecting on them. Often, these boundaries are resolved without the individual even becoming aware of what caused them. Indeed, students experience ‘boundary experiences’ all the time, without being aware of what the boundary was that elicited the experience in the first place. In our education, we ask students to explicitly reflect on these boundary experiences as a starting point of the reflection process. Reflecting on ‘what is part of me’, and ‘what is not (yet) part of me’, stimulates students to make their starting point explicit, to become curious as to why a ‘discontinuation of action or interaction happened’ and to make active choices in how to act. If you want to pay attention to subjectification in your education, these ‘boundaries’ can encourage students to be active subjects. In our education, therefore, it is essential that these moments of reflection are built into the curriculum and learning activities. As you will read in the following chapter, reflection is a central learning mechanism of the SCOPE approach.

Boundary crossing

While a boundary can be perceived as an opportunity to learn, boundary crossing is an essential step in proceeding towards change. Boundary crossing is defined as the ‘continuation of action or interaction’ (notice the absence of the prefix ‘dis-’). Here, the initial boundary experience (that follows from the boundary) will dissolve and create space for restoring the (inter)action. This is not always a self-evident process. On the one hand, it helps to understand where the boundary stems from. For example, if you are an intern and you perform a task independently for the first time, you know that this is the goal of the internship. Each time you try something for the first time it might create some tension, but as the internship functions as a space where students can practise new behaviours, this boundary is crossed quickly. However, when a boundary is rooted in aspects that are not directly related to the learning outcomes, it can be challenging to bring this to the surface. For instance, when there is an interpersonal boundary (for example, when there is a disagreement between a proactive student and a more timid student on whether to go out and interview people on the streets) it might be that the conversation will be about the quality of the assignment. However, it might also be that the boundary is more related to personality differences, rather than what the right approach is. In this case, it is not only sufficient to understand where the boundary stems from, but also to be able to externalise it and discuss this situation with each other. In this example, students might reach the ‘continuation of action’ sooner if they have a discussion on a meta-level rather than a discussion on the ‘right’ approach to the assignment. However, being able to do so requires students to stop, observe the situation, and act as active subjects. Practising to observe and cross boundaries contributes to a fruitful learning environment.

I am more aware of the fact that I look with a specific lens to the world, and that, parallel to mine, other realities exist. Because of this realization, I’ve gained much more patience and respect for other opinions than before. (Bachelor student minor Expeditie het Gezonde Noorden)

In education, therefore, we want to teach students not to perceive boundaries as hindering factors but as opportunities to learn. What do we need to move away from this emotional experience (i.e. boundary experience) and towards constructive (inter)action (i.e. boundary crossing)? What can one do to go from being stuck to making active decisions? Actively investigating the boundary with a curious and reflective attitude can make aspects of this boundary explicit that would otherwise have remained implicit. Within our education, we aim to reserve time during learning activities to ask students about the boundaries they have encountered, how they acted afterwards and what made them act in this way. To understand how learning from these boundaries takes place, Akkerman and Bakker (2011) have reviewed the literature and found four distinct mechanisms of learning. The term ‘learning’, however, was used in a broad sense; it is more than just gaining knowledge. Indeed, the term also refers to identity development, a change of practices, or new understandings. Extensively exploring these learning mechanism concepts is beyond the scope of this chapter. However, you can find a brief summary in the Deep Dive below if you are interested in learning more.

Conclusion

This chapter has discussed the different theoretical principles that underlie the SCOPE approach. These principles and theories help to explain PPD and show how to encourage students to become active subjects in their own learning processes. Throughout this book, we will refer back to these principles.

All that you have read in this chapter, we teach students as well. We believe that explaining how certain processes work provides the tools for students to also reflect on them. A question such as ‘What is conveyed to you through socialisation in this department and how does that relate to your identity?’ can prove more fruitful than ‘Reflect on your experiences in this department’.

With the concepts of PIF, socialisation, subjectification and boundary crossing in mind, we can now move towards thinking about how to actually design educational activities and programmes that reach PPD learning goals. For that, we will first need to explore the central learning mechanism of PPD education: (critical) reflection. After that, we will explain our pedagogical approach using seven steps to develop and improve PPD education.