Learning to work and working to learn: a phenomenographic perspective on the transition from student to doctor

The transition from being a medical student to working as a doctor is a pivotal phase, often marked by challenges in balancing learning with the demands of clinical practice. Despite extensive research on the struggles faced by junior doctors, there remains a gap in understanding how other key stakeholders perceive this transition and how it can be viewed as more than just a struggle. In this phenomenographic study, we used the Swedish medical internship as a proxy for the transition and explored internship programme directors' (PDs) perceptions of the medical internship from a developmental point of view. A phenomenographic approach was chosen to capture the variation in how PDs conceptualise the meaning of the internship, offering a more nuanced understanding of the transition and its implications for educational practice. Interviews with twelve PDs gave rise to three perceptions: the internship as an education, as working as a doctor, and as a space for learning through work. These views highlighted the transition not merely as a preparatory phase but as a dynamic process in which learning and clinical work were intertwined. Our findings suggest that instead of focusing solely on better preparing students for work, empowering junior doctors to learn through work-supported by structured guidance-can turn this challenging period into an opportunity for professional and personal growth. This study offers a novel contribution by shedding light on the role of PDs in shaping the transition to clinical work and emphasising the need to view it as a learning-centred, reflective experience.