Doctors’ identity transitions: Choosing to occupy a state of ‘betwixt and between’

Lisi Gordon (Lead / Corresponding author), Charlotte Rees-Sidhu, Divya Jindal-Snape

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Abstract

Context: During transitions, doctors engage in identity work to adapt to changes in multiple domains. Accompanied with this are dynamic ‘liminal’ phases. Definitions of liminality denote a state of being ‘betwixt and between’ identities. From a social constructionist perspective, being betwixt and between professional identities can involve either a sense of disrupted self, requiring identity work to move through and out of being ‘betwixt and between’ (i.e. temporary liminality); or where temporary workers (e.g. locum doctors) or those in dual roles (e.g. clinician-managers) experience being perpetually ‘betwixt and between’ professional identities (i.e. perpetual liminality), using identity work to make themselves contextually relevant. In the healthcare literature, liminality is conceptualised as a linear process, but this does not align with current notions of transitions which are depicted as multiple, complex and non-linear.

Methods: We undertook a longitudinal narrative inquiry study using audio-diaries to explore how doctors experience liminality during trainee-trained transitions. In three phases, we: (1) interviewed twenty doctors about their trainee-trained transitions; (2) collected longitudinal audio-diaries from seventeen doctors for six to nine months; and (3) undertook exit interviews with these seventeen doctors. Data were analysed thematically, both cross-sectionally and longitudinally, using identity work theory as an analytical lens.

Results: All participants experienced liminality. Our analysis enabled us to identify temporary and perpetual liminal experiences. Furthermore, fine-grained analysis of participants’ identity talk enabled us to identify points in participants’ journeys where they rejected identity grants associated with their trained status; instead preferring to remain in and thus occupy liminality (i.e. neither trainee nor trained doctor).

Conclusions: This paper is the first to explore longitudinally doctors’ liminal experiences through trainee-trained transitions. Our findings also make conceptual contributions to the healthcare literature, plus the wider interdisciplinary liminality literature, through adding further layers to conceptualisations and introducing the notion of occupying liminality.
Original languageEnglish
Number of pages13
JournalMedical Education
Early online date13 May 2020
DOIs
Publication statusE-pub ahead of print - 13 May 2020

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