Gordon Lisi, Jindal-Snape Divya, Morrison Jill, Muldoon Janine, Needham Gillian, Siebert Sabina, Rees Charlotte
School of Management, University of St Andrews, St Andrews, UK.
Research Centre for Transformative Change: Educational and Life Transitions (TCELT), University of Dundee, Dundee, UK.
BMJ Open. 2017 Dec 1;7(11):e018583. doi: 10.1136/bmjopen-2017-018583.
To explore trainee doctors' experiences of the transition to trained doctor, we answer three questions: (1) What multiple and multidimensional transitions (MMTs) are experienced as participants move from trainee to trained doctor? (2) What facilitates and hinders doctors' successful transition experiences? (3) What is the impact of MMTs on trained doctors?
A qualitative longitudinal study underpinned by MMT theory.
Four training areas (health boards) in the UK.
20 doctors, 19 higher-stage trainees within 6 months of completing their postgraduate training and 1 staff grade, associate specialist or specialty doctor, were recruited to the 9-month longitudinal audio-diary (LAD) study. All completed an entrance interview, 18 completed LADs and 18 completed exit interviews.
Data were analysed cross-sectionally and longitudinally using thematic Framework Analysis.
Participants experienced a multiplicity of expected and unexpected, positive and negative work-related transitions (eg, new roles) and home-related transitions (eg, moving home) during their trainee-trained doctor transition. Factors facilitating or inhibiting successful transitions were identified at various levels: individual (eg, living arrangements), interpersonal (eg, presence of supportive relationships), systemic (eg, mentoring opportunities) and macro (eg, the curriculum provided by Medical Royal Colleges). Various impacts of transitions were also identified at each of these four levels: individual (eg, stress), interpersonal (eg, trainees' children spending more time in childcare), systemic (eg, spending less time with patients) and macro (eg, delayed start in trainees' new roles).
Priority should be given to developing supportive relationships (both formal and informal) to help trainees transition into their trained doctor roles, as well as providing more opportunities for learning. Further longitudinal qualitative research is now needed with a longer study duration to explore transition journeys for several years into the trained doctor role.
为探究实习医生向执业医生转变的经历，我们回答三个问题：（1）参与者从实习医生转变为执业医生时经历了哪些多重和多维转变（MMTs）？（2）促进和阻碍医生成功转变经历的因素有哪些？（3）MMTs对执业医生有何影响？
一项以MMT理论为基础的定性纵向研究。
英国的四个培训区域（卫生委员会）。
20名医生，其中19名是在完成研究生培训后6个月内的高级阶段实习生，1名是 staff grade、副专科医生或专科医生，被招募参加为期9个月的纵向音频日记（LAD）研究。所有人都完成了入职面试，18人完成了LAD记录，18人完成了离职面试。
使用主题框架分析法对数据进行横断面和纵向分析。
参与者在从实习医生转变为执业医生的过程中经历了多种预期和意外的、积极和消极的与工作相关的转变（如新角色）以及与家庭相关的转变（如搬家）。在各个层面都确定了促进或阻碍成功转变的因素：个人层面（如居住安排）、人际层面（如存在支持性的关系）、系统层面（如指导机会）和宏观层面（如医学皇家学院提供的课程）。在这四个层面的每一个层面也都确定了转变的各种影响：个人层面（如压力）、人际层面（如实习生的孩子在托儿所待的时间更长）、系统层面（如与患者相处的时间减少）和宏观层面（如实习生新角色的开始延迟）。
应优先发展支持性的关系（包括正式和非正式的），以帮助实习生转变为执业医生角色，同时提供更多学习机会。现在需要进行更长期的纵向定性研究，以探索进入执业医生角色数年后的转变历程。
