Klitgaard Tine Lass, Stentoft Diana, Skipper Mads, Grønkjær Mette, Nøhr Susanne Backman
Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
BMC Med Educ. 2021 Jan 25;21(1):74. doi: 10.1186/s12909-021-02493-2.
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.
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.
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.
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.
尽管人们越来越关注改善从医学生到初级医生的过渡过程，但许多新毕业医生（NGD）表示，适应白大褂工作的过程压力很大，职业倦怠水平表明他们可能面临超出自身应对能力的更大挑战。在此期间，新毕业医生正处于学习如何成为医生的过程中，而这一过程发生在一个工作流程和不同优先事项构成工作场景的组织环境中。然而，关于医院组织如何影响这一过程，我们却知之甚少。因此，我们旨在探究新毕业医生如何体验他们工作的头几个月，以便了解：1）他们面临哪些困难；2）医院组织中的哪些背景因素在这一过渡过程中可能至关重要。
在丹麦的一家大学医院进行了一项人种志研究，包括对11名新毕业医生进行135小时的参与观察。进行了6次半结构化访谈（4次小组访谈和2次个人访谈）（共21人）。分析分为两个步骤：首先，我们进行了“贴近数据”的分析，重点关注新毕业医生面临的困难。其次，我们运用文化历史活动理论（CHAT）的理论视角审视这些困难，以帮助我们探究医院组织中哪些背景因素似乎对新毕业医生的经历产生了影响。
新毕业医生的困难可分为四个主题：责任、当地知识、时间管理和合作者。通过运用CHAT视角，我们能够识别出重要的背景因素，包括工作地点偏远、新老医生之间缺乏交接、入职培训期有限以及隶属于多个科室。这些困难和因素相互交织、相互影响。
医院组织中的背景因素可能会加剧新毕业医生所经历的困难，本研究指出了一些可能需要解决的因素，以使过渡过程的挑战性和压力更小。
