'Like an infant … trying to run a marathon': A longitudinal audio-diary study exploring the transition from medical school to internship.

introductionThe transition from student to doctor represents a challenging shift in identity and responsibility that many graduates find difficult to manage. To understand better how to support the transition to practice we need an exploration of graduates' experiences that does not see the transition as a single moment, but a continuous learning process. This study aimed to explore how medical students negotiate legitimate participation and professional identity formation (PIF) through time as they transitioned to internship in South Africa.

methodsWe conducted longitudinal qualitative research using audio-diaries and semi-structured interviews to collect data from students over 7 months as they transitioned from medical school to several different health care institutions for internship. Twenty-two students took part in entrance interviews, 20 collected audio-diaries and 17 took part in exit interviews. Data were analysed using a narrative analysis approach, using communities of practice (CoP) theory as a sensitising-analytic framework.

resultsWe identified four dominant narrative plotlines in our data, revealing how legitimacy and PIF are constantly renegotiated through time. PIF faltered in medical school when students were excluded from hierarchical clinical teams, on graduation when they began to doubt their preparedness and in internship when participants were unable to demonstrate the competencies valued by CoPs within the demanding South African health care system. Professional identity was built when participants perceived themselves as being valued through their meaningful contributions to the shared enterprise of the CoP. DISCUSSION: We call for a change in our framing of preparedness from 'preparedness for practice' to 'preparedness for transition', shifting our conceptualisation of preparedness towards equipping students with the resources they need for a complex, contextual, ongoing process rather than a moment in time. This requires clinical learning environments that legitimise trainees as peripheral participants, where learning is orientated towards gaining experience, cultivating professional identity and supporting individuals in developing the confidence, adaptability and resilience that will allow them to thrive as they negotiate the ongoing transition from student to doctor.