Endured and prevailed: a phenomenological study of doctors’ first year of clinical practice

Abstract

Context The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors’ mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered. Methods Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year. Results The experience of transition was characterised by overlapping temporal stages. Participants’ initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year. Discussion Following initial anxiety regarding competence and performance, participants’ experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.

The benefits, barriers and facilitators of mentoring programs for first‐year doctors: A systematic review

“…1 To the knowledge of the authors, although the benefits of mentorship in broader medical cohorts are already known, no systematic reviews exist that synthesise articles on mentorship for first-year doctors specifically, despite the unique transition difficulties and vulnerability identified within this group; the shift from medical student to first-year doctor is widely described as notoriously challenging, 3,[10][11][12][13][14] with graduates and supervisors in one study reporting a failure rate of 28.3%. 12 Transition failure, or transition shock, 10,15 is attributed to performance gaps between academia and clinical practice, which manifest in relation to increasing complexity of communication, responsibility, time management, ability to cope with emergencies and capacity to manage overall resilience and professionalism. 13 It is theorised, that participation in a professional community is required in the formation of a professional identity, and thus, medical school cannot wholly prepare students for the reality of life as a doctor.…”

“…16 Therefore, transition shock is also due to the disparity, surprise and contrast in the reality of clinical practice, compared to the previous role of medical student. 15 In the United Kingdom, the August 'Black Wednesday' changeover tangibly exemplifies the transition gap, with higher patient mortality rates attributed to the timing of trainee changeover throughout the hospital, and a new wave of firstyear doctors entering the stream with limited clinical experience. 17 The particular stressors of the transition year are also known to produce temporal variation in emotional state and wellbeing, and a deterioration in mental health and wellbeing during this time, producing high rates of stress, anxiety and depression.…”

“…29 Similarly, there is said to exist an institutional norm that a strenuous internship is a rite of passage, 30 with acceptance of mistreatment by senior doctors signifying the first-year doctor's worthiness of the profession. 15 Conflating these issues, an overwhelming body of evidence exposes a mental health stigma within medical culture, with an associated perception of weakness in help seeking behaviours. 9,[22][23][24][25][26][27]31,32 Lastly, studies reveal the recent impact of the COVID-19 pandemic significantly interrupted first-year pathways, forcing this cohort beyond their skill capacity, increasing social isolation, stress, anxiety and further amplifying the pre-pandemic burnout crisis.…”

“…It is theorised, that participation in a professional community is required in the formation of a professional identity, and thus, medical school cannot wholly prepare students for the reality of life as a doctor 16 . Therefore, transition shock is also due to the disparity, surprise and contrast in the reality of clinical practice, compared to the previous role of medical student 15 . In the United Kingdom, the August ‘Black Wednesday’ changeover tangibly exemplifies the transition gap, with higher patient mortality rates attributed to the timing of trainee changeover throughout the hospital, and a new wave of first‐year doctors entering the stream with limited clinical experience 17 …”

“…Synergistically, bullying is shown as the result of intergenerational burnout and unsustainable stress, which breeds a self‐propagating cycle amongst each new generation of doctors 29 . Similarly, there is said to exist an institutional norm that a strenuous internship is a rite of passage, 30 with acceptance of mistreatment by senior doctors signifying the first‐year doctor's worthiness of the profession 15 . Conflating these issues, an overwhelming body of evidence exposes a mental health stigma within medical culture, with an associated perception of weakness in help seeking behaviours 9,22–27,31,32 .…”