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Into the Unknown: Characterizing Fellow Uncertainty During the Transition to Unsupervised Practice
Daniel Herchline1, Margot E Cohen2, Marietta Ambrose3
1is an Assistant Professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
Journal of Graduate Medical Education
|May 4, 2023
Summary
Physician fellows face individualized uncertainty during their transition to unsupervised practice, stemming from clinical competence, employment, and career vision. They utilize strategies like graduated autonomy and professional networks to manage these challenges.
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.
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