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This collective case study explores the professional identity development of mid-career (7–15 years) elementary music teachers in China, a stage marked by identity re-evaluation and potential “mid-life crisis.” Using Organism Integration Theory, this study examined three teachers in rural, metropolitan, and urban settings through interviews, observations, and artifacts. Findings reveal that teachers at the mid-career stage are not necessarily "settled" but actively re-evaluate their professional identities, leading to varied outcomes including demoralization or purpose reconstruction. Teachers also experienced contrasting forms of autonomy, with some facing pseudo-autonomy masking institutional neglect. The study supports theorization that the quality of internalization varies based on how individuals make sense of their experiences and offers implications for sustaining teacher commitment during this critical stage.