Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK.
Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Med Educ. 2020 Nov;54(11):1006-1018. doi: 10.1111/medu.14219. Epub 2020 Jun 23.
During transitions, doctors engage in identity work to adapt to changes in multiple domains. Accompanied by this are dynamic 'liminal' phases. Definitions of liminality denote a state of being 'betwixt and between' identities. From a social constructionist perspective, being betwixt and between professional identities may either involve a sense of disrupted self, requiring identity work to move through and out of being betwixt and between (ie, temporary liminality), or refer to the experiences of temporary workers (eg, locum doctors) or those in dual roles (eg, clinician-managers) who find themselves perpetually betwixt and between professional identities (ie, perpetual liminality) and use identity work to make themselves contextually relevant. In the health care literature, liminality is conceptualised as a linear process, but this does not align with current notions of transitions that are depicted as multiple, complex and non-linear.
We undertook a longitudinal narrative inquiry study using audio-diaries to explore how doctors experience liminality during trainee-to-trained transitions. In three phases, we: (a) interviewed 20 doctors about his or her trainee-to-trained transitions; (b) collected longitudinal audio-diaries from 17 doctors for 6-9 months, and (c) undertook exit interviews with these 17 doctors. Data were analysed thematically, both cross-sectionally and longitudinally, using identity work theory as an analytical lens.
All participants experienced liminality. Our analysis enabled us to identify temporary and perpetual liminal experiences. Furthermore, fine-grained analysis of participants' identity talk enabled us to identify points in participants' journeys at which he or she rejected identity grants associated with his or her trained status and instead preferred to remain in and thus occupy liminality (ie, neither trainee nor trained doctor).
This paper is the first to explore longitudinally doctors' liminal experiences through trainee-to-trained transitions. Our findings also make conceptual contributions to the health care literature, as well as the wider interdisciplinary liminality literature, by adding further layers to conceptualisations and introducing the notion of occupying liminality.
在过渡期间，医生会进行身份工作，以适应多个领域的变化。伴随着这一点的是动态的“阈限”阶段。阈限的定义表示一种“在身份之间”的状态。从社会建构主义的角度来看，在专业身份之间可能会有一种自我被打破的感觉，需要通过身份工作来过渡并走出这种状态（即暂时的阈限），或者指的是临时工（例如，临时医生）或双重角色（例如，临床医生-管理者）的经历，他们发现自己永远处于专业身份之间（即永久的阈限），并使用身份工作使自己与环境相关。在医疗保健文献中，阈限被概念化为一个线性过程，但这与当前描述为多个、复杂和非线性的过渡观念不一致。
我们进行了一项纵向叙事探究研究，使用音频日记来探索医生在从受训者到受训者的过渡期间如何体验阈限。在三个阶段中，我们：（a）采访了 20 位医生，了解他们从受训者到受训者的过渡经历；（b）从 17 位医生那里收集了 6-9 个月的纵向音频日记；（c）对这 17 位医生进行了离职访谈。数据使用身份工作理论作为分析镜头进行了跨节和纵向的主题分析。
所有参与者都经历了阈限。我们的分析使我们能够识别暂时和永久的阈限体验。此外，通过对参与者身份话语的细致分析，我们能够确定参与者旅程中的某些点，此时他或她拒绝与他或她的受训状态相关的身份授予，而是宁愿保持并因此占据阈限（即，既不是受训者也不是受训医生）。
本文首次通过从受训者到受训者的过渡，纵向探讨了医生的阈限体验。我们的研究结果还为医疗保健文献以及更广泛的跨学科阈限文献做出了概念上的贡献，通过进一步阐述概念并引入占据阈限的概念。
