'I feel much more confident as a doctor now': A qualitative interview study on how working on-call shapes learning in...

Newly graduated doctors provide after-hours care early in clinical practice. Although on-call work is widely acknowledged as formative, its educational potential-and the ways organisational and supervisory conditions shape learning-remain underexplored. This study examined how new graduates experience learning during on-call work, how supervisors contribute and how its organisation relates to learning in early practice.

We conducted a constructivist qualitative study in a large Dutch teaching hospital. Using purposive sampling, we recruited eight new graduates and eight supervisors from medical and surgical specialties. Semi-structured interviews explored learning during on-call work and the role of supervision and organisational context. Data were analysed iteratively, using Biesta's domains of educational purpose as a conceptual lens.

Participants described on-call work as a context in which learning extends beyond clinical competence to include participation in professional practice and the development of independent judgement. These were closely tied to the assumption of responsibility under conditions of uncertainty. New graduates described learning to articulate plans, negotiate decisions and position themselves more actively within clinical interactions. Supervisors supported this development by calibrating autonomy, providing accessible guidance and offering feedback that helped them assess their functioning. Organisational conditions, such as team configuration and timing, influenced how responsibility was experienced and what learning opportunities became available.

This study shows how early on-call work functions as a learning context in which qualification, socialisation and subjectification develop simultaneously and in interaction. Under conditions of responsibility, uncertainty and indirect supervision, new graduates are required not only to act but also to position themselves and exercise judgement in practice. By shaping supervisory and relational conditions-such as the calibration of autonomy, availability of support and the presence of trust-the organisation of on-call work acts as a pedagogical condition that influences how learning unfolds.