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

Abstract

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. © 2021, The Author(s).

Keywords

Author Keywords

Transition medical education Contextual factors Qualitative research Ethnography Cultural Historical Activity Theory (CHAT) postgraduate Newly graduated doctors Struggles Workplace organisation

Index Keywords

adult human medical education Humans Article workplace qualitative research physician medical student Students, Medical Physicians time management responsibility clinical article semi structured interview postgraduate student Hospitals hospital organization university hospital ethnography theoretical study Denmark hospital hospital management tunica albuginea medical staff Hospital Administration Medical Staff, Hospital

Author Affiliations

Department of Postgraduate Medical Education, Aalborg Universitetshospital, Aalborg, Nordjylland, Denmark, Department of Clinical Medicine, Aalborg University, Aalborg, Nordjylland, Denmark

Northern Postgraduate Medical Training Region Secretariat, Viborg, Denmark, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Midtjylland, Denmark

Centre for Health Science Education and Problem-Based Learning, Aalborg University, Aalborg, Nordjylland, Denmark

Department of Clinical Medicine, Aalborg University, Aalborg, Nordjylland, Denmark, Clinical Nursing Research Unit, Aalborg Universitetshospital, Aalborg, Nordjylland, Denmark

Department of Postgraduate Medical Education, Aalborg Universitetshospital, Aalborg, Nordjylland, Denmark, Department of Clinical Medicine, Aalborg University, Aalborg, Nordjylland, Denmark, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Midtjylland, Denmark

Funding & Acknowledgements

Aalborg Universitetshospital

This study is a part of a PhD project funded by Aalborg University Hospital. The authors thank all participants during the study, and Lotte Hoelgaard Christensen for English proofreading.

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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

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