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Area of Science:

  • Medical Education
  • Professional Development
  • Health Professions Education

Background:

  • Medical education settings are diversifying, posing challenges for postgraduate trainees in new environments.
  • Trainees struggle to adapt their existing knowledge and skills to unfamiliar contexts.
  • Understanding the specific needs and processes for trainee adaptation is crucial but poorly understood.

Purpose of the Study:

  • To explore how trainees develop awareness of contextual changes in new settings.
  • To understand the process of adaptation and learning required for trainees entering diverse clinical environments.
  • To apply a capability approach to analyze trainee adjustment in medical education.

Main Methods:

  • Constructivist grounded theory utilizing in-depth interviews.
  • 29 internal medicine trainees and recent graduates from Canadian programs participated.
  • Participants had experience with community-based rotations distant from their primary training sites.

Main Results:

  • Contextual competence develops through five stages: meeting basic needs, establishing belonging and legitimacy, reconstituting competence, and achieving autonomy.
  • Adaptation is facilitated by a continuous cycle of applying foundational knowledge and identifying needs for new learning.
  • Trainees must recognize contextual differences to effectively adapt and learn.

Conclusions:

  • The ability to recognize and adapt to contextual change is a key capability for professional development.
  • Current postgraduate training models and support systems inadequately address this crucial skill.
  • Recommendations include structured debriefing of transition experiences and enhanced coaching by clinical teachers.