A Multi-Perspective Qualitative Exploration of Early-Career Medical Trainee Experiences of Rotational Transitions

  • Alisdair Smithies

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Medical education in the UK has undergone significant reforms over recent years. Tomorrow’s Doctors (2003) and Outcomes for Graduates (2015, 2016, 2018) have defined expectations that have driven undergraduate curriculum change and the Foundation Programme (2005) represents a restructuring of early postgraduate education.

    This study explored the experiences of junior doctors during their first two years of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced transitions during the Foundation Programme, from the initial experience through to the sixth and final rotation at the end of the two years.
    The study employed qualitative methods comprising of semi‐structured interviews, focus groups and audio diary recordings with newly qualified doctors based at the Scotland Foundation School, UK. Semi-structured interviews were also conducted with staff involved in training management, administration and delivery.

    Purposive sampling was used and 53 trainees from the Foundation Programme along with 27 staff were recruited. All 80 participants took part in an interview or focus group. Ten of the participants also kept audio diaries. Follow-up interviews were conducted with volunteer trainee participants from the first round of interviews and focus groups, one year on from the beginning of the data collection. Interview, focus group and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package, ATLAS.ti (version 7).

    A Framework Analysis (Ritchie and Spencer, 1994) was employed to conduct a first-stage broad analysis to explore key themes emerging in individual interviews and focus groups with staff and trainee participants. Interpretative Phenomenological Analysis (Smith et al, 2009) was then used to facilitate a critical in-depth analysis of trainee-participant experiences, expressed through audio diaries and follow up interviews in the second stage of this study. The journeys of three trainees, who participated in all three stages of the research, have been presented to provide a first-hand perspective of the experience of rotational transitions. Emphasis was placed on the way individuals and groups interact, when and where those interactions take place, and how the social world is constructed. In turn, the study explores the influences these interactions have on the way professional identity is formed.

    The study builds on and contributes to what is known about workplace-based professional education by specifically focussing on the professional socialisation and identity development of trainees as they transition into and between rotations, during the first two years of postgraduate medical training in Scotland. Although studies in this field have examined the factors that influence the trainee experience of transition into the two years of postgraduate education, there have been no known multi-perspective studies that make use of both cross-sectional and longitudinal data to explore the impact of the transitions trainees experience each time they move between rotations.

    The study provides insight into factors that support and inhibit students’ adaptation to a broad spectrum of training roles across the Foundation Programme in Scotland. Numerous studies have investigated graduate transitions into postgraduate learning, exploring performance and prescribing errors, but little research effort has been made in identifying other unanticipated outcomes of transitions on trainees’ professional identity development. Understanding the interplay between the individual, the communities they join and the acquisition of the culture of those communities over time were the key objectives of study for this research. The findings show that most participants found the transitions between rotations challenging. Adjusting to different responsibilities, managing uncertainty, working in multi‐professional teams, experiencing the pressure of acute situations out-of-hours and feeling unsupported were consistently reported themes. In this study, the analytic focus on trainees’ personal and professional identity formation as an outcome of their rotational transition experiences provides a significant contribution to this developing area of medical education research.
    Date of Award2019
    Original languageEnglish
    SponsorsNHS Education for Scotland
    SupervisorJean Ker (Supervisor) & Stella Howden (Supervisor)

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