ORCID
- Brennan, Nicola: 0000-0002-2165-0155
Abstract
Introduction The goal of medical education is to develop clinicians who have sufficient agency (capacity to act) to practise effectively in clinical workplaces and to learn from work throughout their careers. Little research has focused on experiences of organisational structures and the role of these in constraining or affording agency. The aim of this study was to identify priorities for organisational change, by identifying and analysing key moments of agency described by doctors-in-training. Methods This was a secondary qualitative analysis of data from a large national mixed methods research programme, which examined the work and wellbeing of UK doctors-in-training. Using a dialogical approach, we identified 56 key moments of agency within the transcripts of 22 semi-structured interviews with doctors based across the UK in their first year after graduation. By analysing action within the key moments from a sociocultural theoretical perspective, we identified tangible changes that healthcare organisations can make to afford agency. Results When talking about team working, participants gave specific descriptions of agency (or lack thereof) and used adversarial metaphors, but when talking about the wider healthcare system, their dialogue was disengaged and they appeared resigned to having no agency to shape the agenda. Organisational changes that could afford greater agency to doctors-in-training were improving induction, smoothing peaks and troughs of responsibility and providing a means of timely feedback on patient care. Conclusions Our findings identified some organisational changes needed for doctors-in-training to practise effectively and learn from work. The findings also highlight a need to improve workplace-based team dynamics and empower trainees to influence policy. By targeting change, healthcare organisations can better support doctors-in-training, which will ultimately benefit patients.
DOI
10.1111/medu.15150
Publication Date
2023-06-09
Publication Title
Medical Education
ISSN
0308-0110
Embargo Period
2023-08-09
Organisational Unit
Peninsula Medical School
Recommended Citation
Mattick, K., Goulding, A., Carrieri, D., Brennan, N., Burford, B., Vance, G., & Dornan, T. (2023) 'Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis', Medical Education, . Available at: https://doi.org/10.1111/medu.15150
