Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Abstract

Background Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of ‘learning the ropes’ is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs’ perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents’ socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. Methods We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. Results We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents’ tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents’ needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. Conclusions PDs’ used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD’s strategy. PDs’ strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents’ perceptions of PD’s efforts to facilitate their socialization process during transitions.

Transitioning to residency: a qualitative study exploring residents' perspectives on strategies for adapting to residency

“…Both groups could consider responding to each other's needs and interests by adapting their strategies to individual preferences. 23 Practical implications practical implications logically follow from the results of our study. First, we recommend to incorporate information about individual adaptation strategies into onboarding programs for residents.…”

“…In contrast, program directors did not identify absence of a role model as a strategy they could use. 23 To our knowledge, other studies did not address absence of a role model, but instead they showed the tension between support and autonomy. 2,60,61 Residents' responsibilities did not always match their desired degree of autonomy, but were perceived as either too excessive or too limited.…”

“…Studies ranged from undergraduate medical students transitioning to a new clinical clerkship and nurses transitioning to their rst jobs to program directors' perspectives on the transition from student to resident. [15][16][17][18][19]23 Although these studies have used qualitative, quantitative and mixed methods to investigate both individual and organizational perspectives, [15][16][17][18][19]23 only one study identi ed individual tactics in undergraduate medical students 19 and one study explicitly identi ed the six OS tactics described by van Maanen & Schein from the perspective of residency program directors. 23 This study will add to the theory of OS by lling the gap and exploring the individual and organizational strategies from the perspective of residents.…”

“…[20][21][22] Program directors, supervisors and nurses play a critical role in navigating residents through their socialization process by employing different strategies. [23][24][25] These strategies range from introducing residents to the departments' processes (nurses) 24 and organizing formal and informal orientation programs (supervisors) 25 to paying attention to the socialization processes and expectations which, in turn, ranges from tailoring approaches to address individual residents needs to expecting residents to adapt to the implicit norms of the workplace. 23 To our knowledge, research has not yet explored residents' perspectives on how social interactions with other healthcare professionals can help them adapt to residency.…”

Supervisors’ roles for newcomer adjustment: review of supervisors’ impact on newcomer organizational socialization outcomes

“…Newcomers may learn role expectations from their supervisors via knowledge and feedback (Ostroff and Kozlowski, 1992). Also, supervisors serve as role models for newcomers (Galema et al , 2022; Holton and Russell, 1997; Weiss, 1977), as well as define proper role behaviors, and can provide more and accurate information about newcomers’ positions than can coworkers (Graen, 1976; Schein, 1988). Based on Graen’s (1976) interpersonal role-making model, supervisors also have official power in newcomers’ role negotiations.…”