How is transition to medical practice shaped by a novel transitional role? A mixed-methods study

Abstract

ObjectivesThis study considered a novel ‘interim’ transitional role for new doctors (termed ‘FiY1’, interim Foundation Year 1), bridging medical school and Foundation Programme (FP). Research questions considered effects on doctors’ well-being and perceived preparedness, and influences on their experience of transition. While FiY1 was introduced in response to the COVID-19 pandemic, findings have wider and ongoing relevance.DesignA sequential mixed-methods study involved two questionnaire phases, followed by semi-structured interviews. In phase 1, questionnaires were distributed to doctors in FiY1 posts, and in phase 2, to all new FP doctors, including those who had not undertaken FiY1.Setting and participantsParticipants were newly qualified doctors from UK medical schools, working in UK hospitals in 2020. 77% (n=668) of all participants across all phases had undertaken FiY1 before starting FP in August. The remainder started FP in August with varying experience beforehand.Outcome measuresQuestionnaires measured preparedness for practice, stress, anxiety, depression, burnout, identity, and tolerance of ambiguity. Interviews explored participants’ experiences in more depth.ResultsAnalysis of questionnaires (phase 1 n=441 FiY1s, phase 2 n=477 FiY1s, 196 non-FiY1s) indicated that FiY1s felt more prepared than non-FiY1 colleagues for starting FP in August (β=2.71, 95% CI=2.21 to 3.22, p<0.0001), which persisted to October (β=1.85, CI=1.28 to 2.41, p<0.0001). Likelihood of feeling prepared increased with FiY1 duration (OR=1.02, CI=1.00 to 1.03, p=0.0097). Despite challenges to well-being during FiY1, no later detriment was apparent. Thematic analysis of interview data (n=22) identified different ways, structural and interpersonal, in which the FiY1 role enhanced doctors’ emerging independence supported by systems and colleagues, providing ‘supported autonomy’.ConclusionsAn explicitly transitional role can benefit doctors as they move from medical school to independent practice. We suggest that the features of supported autonomy are those ofinstitutionalised liminality—a structured role ‘betwixt and between’ education and practice—and this lens may provide a guide to optimising the design of such posts.

Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis

“…Interviews were conducted via a video conferencing tool (Zoom) and focussed on participants' experiences of their work and wellbeing to date. The interviews were designed by DC, AG and KM and used prompts inspired by SCT, with an illustration of the pandemic timeline as an aid to recall where necessary 26 (interview schedule provided as supporting information). Interviews ranged from 26 to 93 min (median 62 min), equating to 1374 min of audio data.…”

“…This study is a secondary analysis of qualitative data from a large national mixed methods research programme, which examined the work and wellbeing of UK doctors-in-training. 26 It did so during the COVID-19 pandemic, which provided a context where normal structures were disrupted, and thereby provided new insights into how doctors-in-training could work and learn. SCT assumes an inseparable link between action and discourse, which led us to choose a dialogical approach to examine agency.…”

“…They were located in multiple hospitals within England, Northern Ireland, Wales and Scotland and had indicated willingness to be interviewed at an earlier stage of the research programme. 26 They were purposively selected to provide a range of gender, age, ethnicity, geography and self-reported stress. We prioritised those who had engaged significantly in earlier stages of the research since they were potentially articulate and reflective participants.…”

“…Thus, participants typically had 3–6 months of post‐qualification work experience when interviewed. They were located in multiple hospitals within England, Northern Ireland, Wales and Scotland and had indicated willingness to be interviewed at an earlier stage of the research programme 26 . They were purposively selected to provide a range of gender, age, ethnicity, geography and self‐reported stress.…”