Into the Unknown: Characterizing Fellow Uncertainty During the Transition to Unsupervised Practice.

Area of Science:

• Medical Education
• Professional Development
• Physician Training

Background:

• Medical education increasingly focuses on managing patient-related uncertainty.
• Less attention is given to how fellows manage professional transition uncertainty.
• Understanding fellows' transition experiences can aid fellows, programs, and institutions.

Purpose of the Study:

• To explore how fellows in the United States experience uncertainty during their transition to unsupervised practice.

Main Methods:

• Constructivist grounded theory approach.
• Semi-structured interviews with 18 physicians in their final year of fellowship.
• Interviews conducted between September 2020 and March 2021 at two large academic institutions.
• Inductive coding for data analysis.

Main Results:

• Uncertainty experiences during transition are individualized and dynamic.
• Key sources of uncertainty include clinical competence, employment prospects, and career vision.
• Mitigation strategies involve graduated autonomy, professional networking, and institutional support.

Conclusions:

• Fellows' transition to unsupervised practice involves individualized, contextual, and dynamic uncertainty.
• Shared themes emerge regarding the nature and management of this uncertainty.