‘Just pretending’: Narratives of professional identity transitions in internal medicine

Abstract

Introduction Health professional identity transitions involve a dynamic period of liminality prompting a time of considerable uncertainty and self‐doubt. For postgraduate trainees in the United Kingdom, the transition to medical registrar can be a significant deterrent to recruitment and retention. Narrative analysis offers insight into identity work during transitions with potential to inform strategies for developing professional identities. This study aimed to use narrative analysis to explore trainees' experiences and their sense of agency during the liminal phase of this transition. Methods Following ethical approval, internal medicine (IM) trainees in their second year of IM training were interviewed. Transcripts were audio recorded, transcribed verbatim and analysed to identify narratives describing liminality during the transition to the role of medical registrar, including examples of rejecting and claiming identity grants. Narrative analysis, as described by Riessman and influenced by James Gee's units of discourse, was undertaken, with an agentive lens applied to the data. Results Between January 2021 and February 2022, 19 IM trainees were interviewed. Given the in‐depth analysis, four narratives were purposively selected to present, including trainees rejecting and claiming the medical registrar role. Trainees tended to describe negative experiences, but those with a higher sense of agency demonstrated positive reflection and identity construction through narrative. There was often identity dissonance between how trainees defined their stage in the transition to medical registrar and how their narrative illustrated their identity work. Conclusion This study exemplifies narrative analysis' linguistic and agentive lenses in exploring the experience of the liminal identity transitional period. The findings reflect the identity dissonance experienced by trainees during this time and sheds light on their sense of agency throughout. It heralds a need to acknowledge the significant liminality experienced during transitions throughout medical training and to empower a sense of agency to support identity work.

The power of stories: Supporting professional identity transitions through longitudinal coaching

“…‘This study adds to the claim that through narrative analysis, there is an opportunity for learners to make sense of their experiences and reflect on developing identities’ 3 ,p19…”

“…Not only do the narratives capture the readers in these studies, both highlight the importance of learners having the opportunity to revisit their reflections and make sense of experiences:

‘Being confronted with their reflections was beneficial for them to make meaning of their experiences and developing identity’ 2 ,p20

‘This study adds to the claim that through narrative analysis, there is an opportunity for learners to make sense of their experiences and reflect on developing identities’ 3 ,p19

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“…With the donning of each new title, learners are constantly changing and becoming to ‘cross a boundary’ into their new roles 2 . What follows can be a ‘dynamic period of liminality prompting a time of considerable uncertainty and doubt’ 3 . p1…”

“…‘Just pretending’: Narratives of professional identity transitions in internal medicine uses narrative analysis from linguistic and agentive lenses to explore the experience of internal medicine residents as they reflected on transitioning to medical registrar 2 . ‘Longitudinally exploring new clerkship students' identity formation using research poetry’ similarly focuses on narrative, though in a longitudinal approach, to better understand sociocultural aspects of the transitional period from pre‐clerkship to clerkship 3 . In both studies, the narrative stories are reconstructed into research poems, ensuring the reader approaches an understanding of what learners are experiencing during transitions to new roles and the ways in which participants are constructing their identities through these experiences 2,3 …”

“…Identity can be conceptualised as cognitive, owned by the individual through a process of identification, multiple, constructed in social interaction, shaped through language and shared social worlds or somewhere in between 6 . While both studies in this issue emphasise the importance of social interactions, where identity resides differs 2,3 . And yet, they come to a similar position on narrative and reflection through careful analysis of participant stories.…”