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‘What do we do, doctor?’ Transitions of identity and responsibility: a narrative analysis

Yardley, Sarah; Kinston, Ruth; Lefroy, Janet; Gay, Simon; McKinley, Robert K.

Authors

Sarah Yardley

Ruth Kinston

Simon Gay

Robert K. McKinley



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.

Acceptance Date Jan 14, 2020
Publication Date Jan 20, 2020
Journal Advances in Health Sciences Education
Print ISSN 1382-4996
Publisher Springer Verlag
Pages 825-843
DOI https://doi.org/10.1007/s10459-020-09959-w
Keywords Doctor, transitions, identity, responsibility, analysis
Publisher URL https://doi.org/10.1007/s10459-020-09959-w