Struggling to fit the white coat and the role of contextual factors within a hospital organisation - an ethnographic study on the first months as newly graduated doctors.

Autor: Klitgaard TL; Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark. tineklitgaard@gmail.com.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. tineklitgaard@gmail.com., Stentoft D; Centre for Health Science Education and Problem-Based Learning, Aalborg University, Aalborg, Denmark., Skipper M; Postgraduate Medical Educational Region North, Viborg, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Grønkjær M; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.; Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark., Nøhr SB; Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: BMC medical education [BMC Med Educ] 2021 Jan 25; Vol. 21 (1), pp. 74. Date of Electronic Publication: 2021 Jan 25.
DOI: 10.1186/s12909-021-02493-2
Abstrakt: Background: Despite increased focus on improving the transition from being a medical student to working as a junior doctor, many newly graduated doctors (NGD) report the process of fitting the white coat as stressful, and burnout levels indicate that they might face bigger challenges than they can handle. During this period, the NGDs are in a process of learning how to be doctors, and this takes place in an organisation where the workflow and different priorities set the scene. However, little is known about how the hospital organisation influences this process. Thus, we aimed to explore how the NGDs experience their first months of work in order to understand 1) which struggles they are facing, and 2) which contextual factors within the hospital organisation that might be essential in this transition.
Methods: An ethnographic study was conducted at a university hospital in Denmark including 135 h of participant observations of the NGDs (n = 11). Six semi-structured interviews (four group interviews and two individual interviews) were conducted (n = 21). The analysis was divided into two steps: Firstly, we carried out a "close-to-data" analysis with focus on the struggles faced by the NGDs. Secondly, we reviewed the struggles by using the theoretical lens of Cultural Historical Activity Theory (CHAT) to help us explore, which contextual factors within the hospital organisation that seem to have an impact on the NGDs' experiences.
Results: The NGDs' struggles fall into four themes: Responsibility, local knowhow, time management and collaborators. By using the CHAT lens, we were able to identify significant contextual factors, including a physically remote placement, a missing overlap between new and experienced NGDs, a time limited introduction period, and the affiliation to several departments. These struggles and factors were highly intertwined and influenced by one another.
Conclusion: Contextual factors within the hospital organisation may aggravate the struggles experienced by the NGDs, and this study points to possible elements that could be addressed to make the transition less challenging and overwhelming.
Databáze: MEDLINE
Externí odkaz: