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Competing institutional logics in surgical training: a qualitative study of coping strategies in China's dual-track
Tong Su1, Feiyu Zhao2, Wenjuan Mo1
1School of Nursing, University of South China, Hengyang, China.
Background:
In China, clinical medicine professional master's education is closely integrated with standardized residency training, combining academic education with extensive clinical practice. However, trainees may experience competing demands between research-related responsibilities and clinical skill development.
Methods:
This qualitative study used a phenomenological design guided by institutional logics theory. Fourteen surgical postgraduates (12 males, 2 females) from a large teaching hospital in southern China were purposively sampled and participated in semi-structured interviews. Data were analyzed using Colaizzi's 7-step method, with rigor ensured through Lincoln and Guba's criteria.
Results:
Three interconnected themes emerged. First, institutional anxiety: surgical competence was central to professional identity, yet research tasks displaced training opportunities, generating ontological insecurity. Second, institutional barriers: participants perceived temporal constraints from research demands, an evaluative emphasis on research achievements, and relational barriers related to supervisors' control over learning opportunities. Third, coping strategies: students developed temporal reappropriation, informal learning communities, strategic visibility, and technology as a learning prosthesis, effectively "practicing in the cracks". A proposed Institutionally Mediated Model illustrates how macro-level logics shape meso-level mechanisms and micro-level agency.
Conclusion:
The findings suggest that, within the integrated professional master's and standardized residency training context, competing research and clinical demands may create temporal, evaluative, and relational barriers to surgical learning. Participants developed individual and collective coping strategies to preserve opportunities for clinical skill development, revealing a potential gap between formal training objectives and experienced learning priorities. System-level efforts are needed to align evaluation practices, protect opportunities for deliberate practice, support supervisors' educational roles, and integrate effective informal learning resources into surgical training.