Study 4: ‘Like an infant … trying to run a marathon’: A longitudinal audio-diary study exploring the transition from medical school to internship

Methods

We conducted longitudinal qualitative research using audio-diaries and semi-structured interviews to collect data from students over 7 months as they transitioned from medical school to several different health care institutions for internship. 22 students took part in entrance interviews, 20 collected audio-diaries and 17 took part in exit interviews. Data were analysed using a narrative analysis approach, using communities of practice (CoP) theory as a sensitising–analytic framework.

Results We identified four dominant narrative plotlines in our data, revealing how legitimacy and PIF are constantly renegotiated through time. PIF faltered in medical school when students were excluded from hierarchical clinical teams, on graduation when they began to doubt their preparedness and in internship when participants were unable to demonstrate the competencies valued by CoPs within the demanding South African health care system.

Professional identity was built when participants perceived themselves as being valued through their meaningful contributions to the shared enterprise of the CoP. Discussion We call for a change in our framing of preparedness from ‘preparedness for practice’ to ‘preparedness for transition’, shifting our conceptualisation of preparedness towards equipping students with the resources they need for a complex, contextual, ongoing process rather than a moment in time.

This requires clinical learning environments that legitimise trainees as peripheral participants, where learning is orientated towards gaining experience, cultivating professional identity and supporting individuals in developing the confidence, adaptability and resilience that will allow them to thrive as they negotiate the ongoing transition from student to doctor. Data Files Title - Format - Description Participants 1-17 - Microsoft Word File (x17) - Pseudonymised Transcripts: Each transcript includes entrance interview, audio-diary entries and exit interview.