Multiple and multidimensional transitions from trainee to trained doctor: a qualitative longitudinal study in the UK.

OBJECTIVES: To explore trainee doctors' experiences of the transition to trained doctor, we answer three questions: (1) What multiple and multidimensional transitions (MMTs) are experienced as participants move from trainee to trained doctor? (2) What facilitates and hinders doctors' successful transition experiences? (3) What is the impact of MMTs on trained doctors? DESIGN: A qualitative longitudinal study underpinned by MMT theory. SETTING: Four training areas (health boards) in the UK. PARTICIPANTS: 20 doctors, 19 higher-stage trainees within 6 months of completing their postgraduate training and 1 staff grade, associate specialist or specialty doctor, were recruited to the 9-month longitudinal audio-diary (LAD) study. All completed an entrance interview, 18 completed LADs and 18 completed exit interviews. METHODS: Data were analysed cross-sectionally and longitudinally using thematic Framework Analysis. RESULTS: Participants experienced a multiplicity of expected and unexpected, positive and negative work-related transitions (eg, new roles) and home-related transitions (eg, moving home) during their trainee-trained doctor transition. Factors facilitating or inhibiting successful transitions were identified at various levels: individual (eg, living arrangements), interpersonal (eg, presence of supportive relationships), systemic (eg, mentoring opportunities) and macro (eg, the curriculum provided by Medical Royal Colleges). Various impacts of transitions were also identified at each of these four levels: individual (eg, stress), interpersonal (eg, trainees' children spending more time in childcare), systemic (eg, spending less time with patients) and macro (eg, delayed start in trainees' new roles). CONCLUSIONS: Priority should be given to developing supportive relationships (both formal and informal) to help trainees transition into their trained doctor roles, as well as providing more opportunities for learning. Further longitudinal qualitative research is now needed with a longer study duration to explore transition journeys for several years into the trained doctor role.

Overflow in science and its implications for trust.

To explore increasing concerns about scientific misconduct and data irreproducibility in some areas of science, we interviewed a number of senior biomedical researchers. These interviews revealed a perceived decline in trust in the scientific enterprise, in large part because the quantity of new data exceeds the field's ability to process it appropriately. This phenomenon-which is termed 'overflow' in social science-has important implications for the integrity of modern biomedical science.

A social learning perspective on the development of doctors in the UK National Health Service.

How best to develop doctors is a problem for many healthcare systems. The current trend towards competence-based models, especially in UK postgraduate medical education, appears to neglect lessons emerging from social learning theories in the workplace. However, social learning itself, especially communities of practice (CoP), also has shortcomings because it needs to take into account broader social, economic and political factors. Our contribution is to show how an extended version of CoP might shed light on the education and development of doctors by drawing on data from a qualitative interview study of participants' experiences of three eras of postgraduate medical education. We also make recommendations for further research and practice in this critical field of healthcare.