D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062 .
P.W. Teunissen is professor of workplace learning in healthcare, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, and gynecologist, Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Acad Med. 2021 Jun 1;96(6):906-912. doi: 10.1097/ACM.0000000000003708.
It takes many years for trainees to become physicians-so long that their individual journeys through medical school and residency are seldom systematically studied and thus not well understood. Lack of understanding hinders effective support of future physicians' development across traditional time-bound phases of medical education. The authors initiated a longitudinal qualitative study, tracing a cohort of 6 trainees through the same medical school and 6 different residencies. They asked, how do stability and change characterize the lived experience of trainees through time?
From 2010 to 2019, the authors conducted in-depth interviews every 6 to 12 months with 6 trainees, using reflective prompts about formative events and prior interviews. Data were inductively coded and analyzed in an iterative fashion. By scrutinizing data via time-ordered displays of codes, the authors identified 3 patterns of stability and change, particularly related to constructing careers in medicine. The study originated at a private medical school in New York, New York.
Patterns in the balance between stability and change were shaped by trainees' career interests. Trainees motivated by stable clinical interests perceived their journey as a "series of stepping-stones." Trainees motivated by evolving clinical interests described disruptive change or "upsets"; however, they were still accommodated by medical education. In contrast, trainees motivated by stable nonclinical (i.e., social science) interests perceived their journey as a "struggle" in residency because of the clinically heavy nature of that phase of training.
Based on this descriptive, 9-year study of a small number of trainees, medical education seems to accommodate trainees whose journeys are motivated by clinical interests, even if those clinical interests change through time. Medical education could consider alternatives to time-bound frames of reference and focus on the right time for trainees to integrate clinical and social sciences in medical training.
培训医师需要多年时间——长到他们在医学院和住院医师培训期间的个人经历很少被系统地研究，因此也不太被理解。缺乏了解阻碍了对未来医师在医学教育传统的限时阶段发展的有效支持。作者发起了一项纵向定性研究，通过同一所医学院和 6 个不同的住院医师培训项目跟踪了一组 6 名学员。他们提出，学员的真实体验在时间上的稳定性和变化性特征是什么？
从 2010 年到 2019 年，作者每隔 6 到 12 个月对 6 名学员进行一次深入访谈，使用关于形成性事件和之前访谈的反思提示。数据采用迭代方式进行归纳编码和分析。通过对通过代码的时间顺序显示进行数据审查，作者确定了 3 种稳定性和变化的模式，特别是与在医学领域构建职业相关的模式。该研究起源于纽约州纽约市的一所私立医学院。
稳定与变化之间平衡的模式是由学员的职业兴趣塑造的。以稳定的临床兴趣为动力的学员认为他们的旅程是“一系列的垫脚石”。以不断发展的临床兴趣为动力的学员描述了破坏性的变化或“颠覆”；然而，他们仍然被医学教育所接受。相比之下，以稳定的非临床（即社会科学）兴趣为动力的学员在住院医师培训期间因为该阶段的培训性质以临床为主，认为他们的旅程是一场“挣扎”。
基于这项对少数学员进行的为期 9 年的描述性研究，医学教育似乎可以容纳以临床兴趣为动力的学员，即使这些临床兴趣随时间而变化。医学教育可以考虑替代限时参考框架，并将重点放在学员在医学培训中整合临床和社会科学的适当时间上。
