On the transition from student to doctor

Abstract

The transition from student to doctor is a central and demanding phase in medical education. Despite increasing efforts to prepare students for clinical work, starting work as a doctor is still described as difficult. At the same time, transition periods may also be understood as intensive periods of learning and professional development. In Sweden, the medical internship has long provided a structured introduction to clinical work after graduation and before licensure, offering an established setting for examining the transition from student to doctor. To examine the transition across graduation, the thesis also studied a late undergraduate primary care placement. The thesis comprises four qualitative studies. Study I explored junior doctors’ experiences of the medical internship. Studies II and III used phenomenography to investigate how medical interns and internship programme directors understood the meaning of the internship. Study IV drew on ethnographic fieldwork and relational agency theory to explore how interactions between students and supervisors shaped students’ opportunities to act in clinical work. Studies I–III showed that the medical internship was understood as a substantial and valued introduction to clinical work. Interns participated in patient care and gradually assumed greater responsibility, with access to support and a legitimate position as learners. However, sustained support for their development over time was less prominent. Study IV showed that students could take responsibility with support when they made sense of clinical situations together with supervisors or were allowed to act while supervisors remained available. Together, the studies show that the transition from student to doctor is not only a matter of being sufficiently prepared for work before graduation, but also of how clinical work is organised for learning and how students and junior doctors are supported in practice. The thesis supports understanding the transition as a longer developmental trajectory, with learning continuing through participation in clinical work before and after graduation. This challenges an overly individualised view of becoming a doctor and redirects attention to the conditions that make such development possible.