Junior doctors' experiences with vulnerability: A rich picture study

The transition to practice is a context in which junior doctors can feel vulnerable. Although we know junior doctors experience intense emotions during their transition to practice, we still do not understand the role of vulnerability in this process. Vulnerability may cause emotional suffering but also offers an opportunity for growth and connection. Set in the context of junior doctors' transition to practice, our research questions are: (a) What does feeling vulnerable mean to junior doctors? (b) What emotions arise when they feel vulnerable? (c) How do they make sense of their vulnerability experiences?

In this cross-sectional, observational, qualitative study, 14 junior doctors individually drew a rich picture of a vulnerability experience, after which a semi-structured interview was conducted. A rich picture is a visual representation of a situation and is well suited to capture (non-verbal elements of) complex experiences. Rich pictures and interview transcripts were analysed iteratively, for which we applied reflexive inductive thematic analysis.

Junior doctors experienced vulnerability as feeling overwhelmed, uncertain, powerless and lonely. The mismatch between the doctor they believed they should be and the beginning and inexperienced doctor they in fact were was often at the core of vulnerability experiences. Due to this mismatch, junior doctors felt inadequate and often experienced shame, fearing to be judged as incompetent. Junior doctors had to find their own way to make sense of these vulnerability experiences. Left unsupported or neglected, vulnerability could result in isolation and disengagement from learning. When junior doctors did engage with their emotions, vulnerability experiences could also lead to reflection and change.

Acknowledging, expressing, regulating and making sense of emotions is crucial to seize vulnerability experiences as opportunities for transformative learning. In order to facilitate transformative learning, embracing emotions and engaging with critical reflection need to become an explicit part of clinical supervision-enabling not only junior doctors' personal and professional development but also social connection.