Kwong Sin-Yee Patty, Yu Shiuan-Ruey, Liao Kuo-Chen, Liao Shu-Chen, Hsiao Cheng-Ting, Chaou Chung-Hsien
Chang-Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Taiwan.
Chang Gung University College of Medicine, Taoyuan, Taiwan.
Perspect Med Educ. 2025 Feb 14;14(1):55-65. doi: 10.5334/pme.1499. eCollection 2025.
The transition from medical school to residency, especially during the postgraduate year (PGY) internship, poses unique challenges as graduates navigate clinical practice complexities. Understanding PGYs' experiences is crucial for developing effective support strategies to promote their professional growth and well-being.
This qualitative, longitudinal study followed ten PGYs from August 2021 to July 2023, using biannual audio diary based on open-ended questions to capture their experiences. Data analysis, guided by Activity Theory, focused on role conflicts and contradictions as PGYs transitioned from learners to practicing physicians.
The analysis revealed prevalent role conflicts and contradictions, primarily due to the tension between the PGYs' roles as learner and healthcare provider. Differences in objectives between PGYs and practicing doctors further exacerbated these conflicts, leading to clashes in priorities and care approaches. Consequently, PGYs experienced reality shock, lack of confidence, and feelings of incompetence, compounded by heavy workloads and exhaustion. These findings underscored the need for support and resources to help PGYs navigate these challenges and succeed in their healthcare roles.
Using Activity Theory to analyze the inherent challenges and contradictions within the PGY experience, this study offers insights for enhancing PGY preparedness, fostering both professional development and well-being. Drawing on recommendations supported by existing literature, which are stratified by tools, rules, and division of labor, we propose targeted strategies to address specific facets of the PGY role, thereby improving the overall training environment. This research highlights the need for tailored interventions to support PGYs through the challenging transition into clinical practice.
从医学院过渡到住院医师阶段，尤其是在研究生第一年（PGY）实习期间，毕业生在应对临床实践复杂性时面临着独特的挑战。了解PGY的经历对于制定有效的支持策略以促进他们的职业成长和幸福感至关重要。
这项定性的纵向研究从2021年8月至2023年7月跟踪了10名PGY，使用基于开放式问题的半年期音频日记来记录他们的经历。在活动理论的指导下进行数据分析，重点关注PGY从学习者转变为执业医生过程中的角色冲突和矛盾。
分析揭示了普遍存在的角色冲突和矛盾，主要是由于PGY作为学习者和医疗服务提供者的角色之间的紧张关系。PGY与执业医生之间目标的差异进一步加剧了这些冲突，导致在优先事项和护理方法上的冲突。因此，PGY经历了现实冲击、缺乏信心和能力不足的感觉，繁重的工作量和疲惫感使情况更加复杂。这些发现强调了需要支持和资源来帮助PGY应对这些挑战并在其医疗角色中取得成功。
本研究运用活动理论分析PGY经历中固有的挑战和矛盾，为增强PGY的准备、促进职业发展和幸福感提供了见解。借鉴现有文献支持的建议，这些建议按工具、规则和劳动分工进行分层，我们提出了针对性策略来解决PGY角色的特定方面，从而改善整体培训环境。这项研究强调了需要量身定制的干预措施，以支持PGY度过向临床实践的艰难过渡。
