Learning processes and identity construction of newly qualified doctors : a narrative study.
McNamee, Lakshini Sandhya.
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This thesis reports on a narrative research study of medical internship experiences focusing on the learning processes, identity construction and aspirations of newly qualified doctors (NQDs). The aim of the study was a better understanding of how medical graduates negotiate their learning experiences and construct their identities during internship in South Africa. Six doctors who were graduates of a problem‐based learning curriculum participated by reflecting back on their internship experiences. Qualitative data in the form of written reflections three years post‐qualification were initially analysed using socio‐linguistic methods. The same participants were followed up with one‐on‐one, in‐depth interviews at six years post‐qualification. Using interpretive methodology, this qualitative study was underpinned by social constructionist thought. The theoretical framing innovatively combined psychology‐ and sociology‐based theories; for example, the classic theories of Vygotsky and Bourdieu, and more contemporary theories of Situated Learning and Dialogical Self Theory were used. A contemporary philosophy of recognition and disrespect further illuminated the nature of various relationships with regard to positive identity construction. ‘Ways of being’ of doctors were found to impact considerably on the nature and quality of relationships with patients, colleagues, institutions and the self. Insight was gained primarily into networks of relationships, especially with senior colleagues in the context of clinical workplace environments, which enabled or constrained positive identity construction. Tracing the journeys of medically qualified professionals at a more mature stage of their development revealed the importance of personal dispositions and aspirations. Learning processes during medical internship were found essentially to involve significant others. Identities of NQDs were not rigidly organised, and the study developed an understanding of multiple I‐positions in dialogical interaction within the self. Internship communities of practice enabled or constrained not only the development of knowledgeable skill, but also powerfully shaped identities. Strengthening the possibilities for positive identity constructions during internship would be a possible means of transforming medical culture to be more responsive to the needs, beliefs and abilities of NQDs. Deeper consideration for internship learning and promoting mutual recognition between NQDs and healthcare institutions may also lead towards more patient‐centred care.