NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Warwick Business School, University of Warwick, Warwick, UK.
Soc Sci Med. 2024 Sep;357:117226. doi: 10.1016/j.socscimed.2024.117226. Epub 2024 Aug 10.
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in precarious and resource-constrained settings. Drawing on 146 qualitative interviews and seven focus groups, involving 121 new graduate medical doctors and nurses transitioning through internship training in Kenya, we describe three aspects of liminality. First, liminal professional practice, where interns realise that best practices learned during medical and nursing schools are often impossible to implement in resource constrained health care settings; instead they learn workarounds and practical norms. Second, liminal relational identities, where interns leave behind being students and adopt the identities and responsibilities of qualified professionals within pre-existing professional hierarchies of status and expertise. We explain how these new doctors and graduate nurses negotiate their liminal status, including in relation to more experienced but less qualified professional colleagues. We also discuss how interns cope with liminality due to disappointing and inadequate supervision and role modelling from senior colleagues but then find peer support and their place within their own professions. Finally, we discuss how new doctors and nurses come to terms with the precarity of working in resource constrained health systems, abandon expectations of secure, permanent employment and careers, and accept the realities of liminal professional careers. We explain how all three forms of liminality influence professionals' developing practices, identities, and careers. We call for further studies with a specific liminality lens to explore this critical period in health workers' careers, to inform policy and practice responding to global transformations in healthcare professions and practice.
我们研究了新医生和护士作为医疗保健专业人员从培训过渡到实践的新体验，借鉴了阈限概念。阈限是一种“中间状态”，涉及人们离开一个社会背景并重新融入新的社会背景时的不确定性和模糊性。令人惊讶的是，很少有研究探讨新的医疗保健专业人员在角色和职业过渡期间的阈限体验，特别是在不稳定和资源有限的环境中。本研究通过在肯尼亚进行的实习培训，对 146 名新毕业的医生和护士进行了 121 次定性访谈和 7 次焦点小组，描述了阈限的三个方面。首先，阈限的专业实践，实习生意识到在医学和护理学校学到的最佳实践在资源有限的医疗环境中往往无法实施；相反，他们学习变通方法和实用规范。其次，阈限的关系认同，实习生放弃学生身份，在现有的专业等级制度中采用合格专业人员的身份和责任。我们解释了这些新医生和毕业护士如何协商他们的阈限地位，包括与更有经验但资格较低的专业同事的关系。我们还讨论了实习生如何应对因资深同事监督和榜样作用令人失望和不足而导致的阈限状态，但随后在同辈支持和自己的职业中找到了自己的位置。最后，我们讨论了新医生和护士如何接受在资源有限的卫生系统中工作的不稳定状态，放弃对安全、永久就业和职业的期望，并接受阈限职业生涯的现实。我们解释了这三种形式的阈限如何影响专业人员不断发展的实践、身份和职业。我们呼吁进一步进行具有特定阈限视角的研究，以探索卫生工作者职业生涯中的这一关键时期，为应对医疗保健专业和实践的全球转型提供政策和实践依据。
