Exploring the longitudinal experiences of physicians transitioning to unsupervised practice: A realist study

Problem: The transition from residency to unsupervised practice is a longitudinal process that is fraught with challenges. Most new attendings do not feel adequately prepared or supported for their new roles and responsibilities. We need to better understand the challenges physicians face transitioning to unsupervised practice.Method of Study: The study aim was to explore the different mechanisms that shape a physician’s ability to successfully transition to unsupervised practice. As the transition to unsupervised practice is complex and highly context-dependent, a qualitative realist evaluation study design was used to explore how different factors (mechanisms) can lead to different outcomes for different individuals transitioning to practice. Participants in a variety of specialties were recruited for semi-structured interviews at three points in time - one in the final months of residency, and two at different points in their first year in unsupervised practice. Conclusion: Eight middle-range theories were developed from the data covering: the varying opportunities and challenges participants faced whether or not they stayed at the institutions they trained at, the challenges of learner supervision, the effects of fellowship training, how variable their practice was compared to what they were exposed to in residency training, the timing of orientation or training sessions, being hired into a locum contract, and how sheltered trainees were from the realities of unsupervised practice. Each of these theories have implications for key stakeholders. Residency programs should expose their trainees to the breadth of practice available in each specialty and provide resident autonomy that reflects realistic experiences of unsupervised practice. Departments should have formalized mentorship programs, shadow shifts, and site and department specific orientations. In addition, they should strive to protect new staff from unnecessary stressors through a graduated increase in responsibilities. Both residency programs and departments should provide sessions regarding the new supervisory role, specifically teaching how to manage senior learners and learners in difficulty.

Name thesis:degree_name

Master of Science (MSc)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor

Cumming School of Medicine

Year dc:date.issued

2022

Author dc:creator

• Zaver, Fareen

Advisor dc:contributor.advisor

• Ellaway, Rachel

Committee members dc:contributor.committeemember

• Lord, Jason
• Cooke, Lara
• Sherbino, Jonathan

• Transition to practice
• Transition to unsupervised practice
• Independent practice
• Competence by design

Language dc:language.iso

English

DOI

https://dx.doi.org/10.11575/PRISM/dspace/41192

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/116348