Background Despite increased focus on improving the transition from being a medical student to working as a junior doctor, many newly graduated doctors (NGD) report the process of fitting the white coat as stressful, and burnout levels indicate that they might face bigger challenges than they can handle. During this period, the NGDs are in a process of learning how to be doctors, and this takes place in an organisation where the workflow and different priorities set the scene. However, little is known about how the hospital organisation influences this process. Thus, we aimed to explore how the NGDs experience their first months of work in order to understand 1) which struggles they are facing, and 2) which contextual factors within the hospital organisation that might be essential in this transition. Methods An ethnographic study was conducted at a university hospital in Denmark including 135 h of participant observations of the NGDs (n = 11). Six semi-structured interviews (four group interviews and two individual interviews) were conducted (n = 21). The analysis was divided into two steps: Firstly, we carried out a “close-to-data” analysis with focus on the struggles faced by the NGDs. Secondly, we reviewed the struggles by using the theoretical lens of Cultural Historical Activity Theory (CHAT) to help us explore, which contextual factors within the hospital organisation that seem to have an impact on the NGDs’ experiences. Results The NGDs’ struggles fall into four themes: Responsibility, local knowhow, time management and collaborators. By using the CHAT lens, we were able to identify significant contextual factors, including a physically remote placement, a missing overlap between new and experienced NGDs, a time limited introduction period, and the affiliation to several departments. These struggles and factors were highly intertwined and influenced by one another. Conclusion Contextual factors within the hospital organisation may aggravate the struggles experienced by the NGDs, and this study points to possible elements that could be addressed to make the transition less challenging and overwhelming.

Medical education programs are responsible for educating medical students to meet the demands of a complex and fast-changing healthcare system, that requires competent, reflective, robust, and engaged students who can collaborate in interdisciplinary settings. In this article, we examine and discuss how social identities affect medical students’ learning approaches regarding how, what, and why they learn in clinical problem-based medical education. We conducted an ethnographic study at Aalborg University Hospital, involving 7 medical students for 240 hours of participant observation and 8 hours of semi-structured interviews. During the analysis, we found that medical students’ social identities as well as the clinical problem-based practice were strongly associated with how, what, and why they learn. We highlight that there is a very fine balance to be found between the assumed and assigned social identities in clinical problem-based medical education if a learning outcome of high quality is to be ensured.

Background Newly graduated doctors find their first months of practice challenging and overwhelming. As the newly graduated doctors need help to survive this period, collaborators such as peers, senior doctors, registered nurses and other junior doctors are crucial. However, little is known about what characterise these collaborations, and how much is at stake when newly graduated doctors are striving to establish and maintain them. This study aims to describe and explore the collaborations in depth from the newly graduated doctors’ point of view. Methods We conducted 135 h of participant observations among newly graduated doctors (n = 11), where the doctors were observed throughout their working hours at various times of the day and the week. Furthermore, six semi-structured interviews (four group interviews and two individual) were carried out. The data was analysed thematically. Results Newly graduated doctors consulted different collaborators (peers, senior doctors, registered nurses, and other junior doctors) dependent on the challenge at hand, and they used different strategies to get help and secure good relationships with their collaborators: 1) displaying competence; 2) appearing humble; and 3) playing the game. Their use of different strategies shows how they are committed to engage in these collaborations, and how much is at stake. Conclusions Newly graduated doctors rely on building relationships with different collaborators in order to survive their first months of practice. We argue that the collaboration with peer NGDs and registered nurses has not received the attention it deserves when working with the transition from medical school. We highlight how it is important to focus on these and other collaborators and discuss different work-agendas, mutual expectations, and interdependence. This could be addressed in the introduction period and be one way to ensure a better learning environment and a respectful interprofessional culture.