Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Med Teach. 2022 Dec;44(12):1376-1384. doi: 10.1080/0142159X.2022.2098099. Epub 2022 Jul 21.
In a previous ethnographic field study, we found that newly graduated doctors (NGDs) found their first months of practice challenging and overwhelming. By including an organisational perspective (Cultural Historical Activity Theory), we were able to identify contextual factors within the hospital organisation, which influence the NGDs' challenges. This raised the question: What can be done about it? To address this, we designed a Change Laboratory intervention (CL), consisting of six sessions, involving NGDs, junior doctors, and consultants across eight departments (on average, 18 doctors participated in each session). Through the CL, the participants were able to get a mutual understanding across departments and develop two initiatives to support the NGDs: with a 'need-to-know' focus, where the NGDs meet their future collaborators, and are introduced to important work procedures, and are given the opportunity to establish a peer network. This is followed up by a with a 'nice-to-know' focus, where new topics are introduced, allowing time for reflections, and supporting the further strengthening of a peer community. The CL approach promoted agency among participants and the results show how CL offers a unique opportunity for stakeholders to challenge and rethink their work practices within the hospital organisation.
在之前的人种学实地研究中，我们发现新毕业的医生（NGD）在他们的第一个月的实践中感到具有挑战性和压倒性。通过纳入组织视角（文化历史活动理论），我们能够确定医院组织内影响 NGD 挑战的背景因素。这就提出了一个问题：对此可以采取什么措施？为了解决这个问题，我们设计了一个变革实验室干预措施（CL），包括六个部分，涉及 NGD、初级医生和八个部门的顾问（平均每个部分有 18 名医生参加）。通过 CL，参与者能够在部门之间建立相互理解，并制定两项举措来支持 NGD：以“需要知道”为重点，NGD 与未来的合作者会面，并了解重要的工作程序，并获得建立同行网络的机会。接下来是以“很高兴知道”为重点，引入新的主题，为反思留出时间，并支持进一步加强同行社区。CL 方法促进了参与者的能动性，结果表明 CL 如何为利益相关者提供了一个独特的机会，以挑战和重新思考他们在医院组织内的工作实践。
