Abstract
Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients. This multiphase ethnographic study explores realities of transition through anticipatory, lived and reflective stages. We utilised Labov’s narrative framework (Labov in J Narrat Life Hist 7(1–4):395–415, 1997) to conduct in-depth analysis of complex relationships between changes in responsibility and development of professional identity. Our objective was to understand how these concepts interact. Newly qualified doctors acclimatise to their role requirements through participatory experience, perceived as a series of challenges, told as stories of adventure or quest. Rules of interaction within clinical teams were complex, context dependent and rarely explicit. Students, newly qualified and supervising doctors felt tensions around whether responsibility should be grasped or conferred. Perceived clinical necessity was a common determinant of responsibility rather than planned learning. Identity formation was chronologically mismatched to accepting responsibility. We provide a rich illumination of the complex relationship between responsibility and identity pre, during, and post-transition to qualified doctor: the two are inherently intertwined, each generating the other through successful actions in practice. This suggests successful transition requires a supported period of identity reconciliation during which responsibility may feel burdensome. During this, there is a fine line between too much and too little responsibility: seemingly innocuous assumptions can have a significant impact. More effort is needed to facilitate behaviours that delegate authority to the transitioning learner whilst maintaining true oversight.
Highlights
In order to learn optimally medical students need to understand the complexities of clinical workplaces and how best to engage in workplace activities (de Feijter et al 2011; Mennin 2010)
In this paper we provide an in-depth analysis of these issues unpacking the facets of responsibility and identity found in our large data set of audio diaries, interviews and focus groups with people as they made the transition from medical student to doctor
The novel contribution of this study is to illuminate the complex relationship between responsibility and identity, which occurs pre, during, and post transition to qualified practice as a doctor
Summary
In order to learn optimally medical students need to understand the complexities of clinical workplaces and how best to engage in workplace activities (de Feijter et al 2011; Mennin 2010). There is a fine balance to be found between not enough and too much autonomy in this process (Cruess et al 2016) This is so at points of transition (Cruess et al 2014; Yardley et al 2018). We previously published a realist evaluation of the transition to qualified doctor, moving from anticipation, through lived experience, to post hoc reflection (Lefroy et al 2017). This confirmed that identity and accepting responsibility are intertwined and critically significant to readiness for practice.
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