Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education.

Abstract

Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice. 11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant. All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them. Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.