Learning Responsibility? Exploring Doctors' Transitions to New Levels of Medical Performance

Summary

All doctors experience many transitions, both during their training and subsequent careers. These transitions include changes in status and seniority, changes in geographical location, change of speciality, change of clinical team but little is known about their effects on doctors' performance. This study used a combination of desk based research, interviews and observations to investigate selected key transitions at four levels - individual, clinical teams, employers and the regulatory and policy context.

Because a significant feature of many transitions is increase in responsibility, the focus was on two points of transition from having no responsibility to significant responsibility.The first transition was the point at which clinical practice begins - the change from medical student to foundation training: the focus here was on prescribing. The second transition was the move from generalist to specialist clinical practice - the change from Senior House Officer to Specialist Registrar: the focus was patient management.

The findings of this project have enabled us to develop understandings about how transitions can best be structured. It has developed a methodology and new conceptual understandings about transitions and identified key issues for the development of tools to map the effects of transitions.

Research Approach

The study has:

• Investigated the relevant national and local (region/site/trust) training requirements, protocols, policies and so on regarding transition processes. This will include specific local policies and more general guidance about both induction and risk management procedures. It will also include a interdisciplinary literature review.
• Studied the potential differences between formal transition frameworks and the observable and self-reported practice surrounding the doctors' transitions.
• Identified how performance is related to the transitionary period and how this is understood by the trainees, other healthcare professionals, the employers and the regulatory bodies.

What the research means for the policymakers and the wider community

Policymakers from medical schools, Foundation Training Schools, Post Graduate Deaneries, the General Medical Council, the National Clinical Assessment Service, the Post Graduate Medical Education Training Board, National Patient Safety Agency and the Department of Health will be able to draw on the outcomes of this study for strategic purposes.

The project will also develop a research methodology and new conceptual understandings about transitions and medical performance that will be of interest to the wider community.

Project Publications

Conferences

Kilminster, S, Quinton, ND, Roberts, TE and Zukas, M (2008) 'How do doctors learn responsibility? Understanding transitions in doctors' work', 13th Ottawa International Conference on Clinical Competence (Ozzawa) Melbourne, Australia, 5-8 March, 2008.

Kilminster, S, Quinton, ND, Roberts, TE and Zukas, M (2008) 'How do doctors learn responsibility? Understanding transitions in doctors' work', Association for Medical Education in Europe, Prague, Czech Republic, 30 August - 3 September 2008.

Zukas, M, Kilminster, S, Quinton, ND and Roberts, TE (2008) 'Putting values into practice, putting practice into values: exploring new doctors' decision-making', Society for Research in Higher Education, Liverpool, UK, 8-10 December 2008.

Kilminster, S, Roberts, TE and Quinton, ND (2008) 'Onwards and upwards? How junior doctors learn to cope when changing environments and responsibilities', Association for Society for Medical Education, London, 17 October, 2008.

Kilminster, S, Zukas, M, Roberts, TE and Quinton, ND (2009) 'The impossible dream: institutional and workplace perspectives on learning responsibility', Researching Work and Learning Conference, Roskilde University, Denmark, 1-3 July 2009.

Quinton, ND, Kilminster, S, Roberts, TE and Zukas, M 'Preparing doctors for responsibility: change the person or change the place?' Association for Medical Education in Europe Conference, Malaga, Spain, 1-3 September, 2009.

Roberts TE, Kilminster, M, Quinton, ND and Zukas,M 'Developing qualitative research in medical education: a focus on using observation as aresearch tool in clinical settings.' Association for Medical Education in Europe Conference, Malaga, Spain, 1-3 September, 2009.

Zukas, M. Kilminster, S, Roberts T and Quinton N 'Learning responsibility on the job? Exploring doctors' transitions to new levels of performance'. Association for Medical Education Research Conference, London, November 2009.

Kilminster, S, Zukas, M, Roberts, T and Quinton, N 'Preparedness is not enough: understanding doctors' performance during transitions'. Association of Medical Education, Cambridge, July 2010.

Zukas, M and Kilminster, S Becoming a doctor: cultures, practices and learning. Invited symposium participant on Cultures of Professions, led by Stephen Billett. European Association for Research on Learning and Instruction (EARLI) SIG 14 Learning and Professional Development meeting, Munich, August 2010.

Seminars

Zukas, M (2008) 'Researching doctors' learning in clinical settings', International Symposium, Roskilde University Graduate School in Lifelong Learning, Roskilde, Denmark, 17 August 2008.

Zukas, M and Quinton, NE (2008) 'Researching transitions from learning to work', Lifelong Learning Institute, University of Leeds, 15 October, 2008

Kilminster, S (2008) 'Strains and complexities in professional development', Lifelong Learning Institute, University of Leeds, 20 November, 2008

Zukas, M (2009) 'Learning responsibility on the job? Exploring doctors' transitions in the clinical workplace', St George's University of London, 29 January, 2009.

Zukas, M (2009) 'Learning responsibility on the job? Exploring doctors' transitions in the clinical workplace', Birkbeck College, London, 16 March, 2009.

Zukas, M (2009)'Learning responsibility on the job? Doctors transitions in the clinical workplace', Clinical Excellence Commission for New South Wales, Sydney, Australia, 10 June 2009.

Zukas, M (2009)'Learning responsibility on the job?' Centre for Medical and Health Sciences Education, Monash University, Melbourne, Australia. 28 May 2009.

Zukas, M (2009) 'Learning responsibility on the job? Doctors transitions in the clinical workplace.' Medical Education Unit, Melbourne University, Australia, 27 May 2009.

Zukas, M (2009) 'Learning responsibility on the job? Doctors transitions in the clinical workplace.' Centre for Health Communication, University of Technology, Sydney. 18 May 2009.

Zukas, M (2009) 'Learning responsibility on the job? Exploring doctors' transitions to new levels of performance.' University of Southampton, 2 November 2009.

Zukas, M (2010) 'Learning responsibility on the job.' Oxford University, November 2010.