Learning processes and identity construction of newly qualified doctors : a narrative study.
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Date
2015
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Abstract
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.
Description
Doctor of Philosophy in Education Studies. University of KwaZulu-Natal, Edgewood 2015.
Keywords
Physicians -- Study and teaching (Internship) -- South Africa., Interns (Medicine) -- South Africa., Medical education -- Social aspects -- South Africa., Theses -- Education., Newly qualified doctors (NQD's).