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Title: Becoming a clinician: Trainee identity formation within the GP supervisory relationship.
Austin Authors: Brown, James;Reid, Helen;Dornan, Tim;Nestel, Debra 
Affiliation: EV GP Training, Suite B2, 50 Northways Road, Churchill, VIC, AUS, 3842, Australia
Queen's University Belfast, Centre for Medical Education, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7BL
Monash University, Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, AUS, 3168, Australia
Maastricht University, Department of Educational Development and Research, PO Box 616, Maastricht, NL, 6200 MD, Netherlands
Queen's University Belfast, Centre for Medical Education, 97 Lisburn Road, Belfast, Northern Ireland, UK, BT9 7BL
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: Nov-2020 2020-04-29
Publication information: Medical Education 2020; 54(11): 993-1005
Abstract: Becoming a clinician is a trajectory of identity formation in the context of supervised practice. This is a social process where the supervisory relationship is key. Therefore, to know how to support identity formation of clinical trainees, it is necessary to understand how this happens within the supervisory relationship. Our aim was to develop a conceptualisation of trainee identity formation within the general practice(GP) supervisory relationship to aid its support. We took a critical realist approach using case study design and 'cultural worlds' theory as a conceptual frame. Each case comprised a GP trainee/supervisor pair. Our data were weekly audio-recordings of interactions between trainee, supervisor and a patient over 12-weeks augmented by post-interaction reflections and sequential interviews. We undertook interpretive analysis using dialogic methods focusing on the doing of language and the cultural Discourses expressed. We identified three social Discourses centring on: clinical responsibility; ownership of clinical knowledge; and, measures of trainee competency. Versions of these Discourses defined four trainee/supervisor relational arrangements within which trainee and supervisor assumed reciprocal identities. We labelled these: junior learner/expert clinician; apprentice assistant/master coach; co-clinicians; and, lead clinician/advisor. We found a trajectory across these identity arrangements. Behind this trajectory was an invitation by the supervisor to the trainee into the social space of clinician and a readiness of the trainee to accept this invitation. Congruence in supervisor and trainee positioning was important. In the supervisory relationship, trainee and supervisor adopted reciprocal identities. For trainees to progress to identity of lead clinician, supervisors needed to invite their trainee into this space and vacate it themselves. Congruence between supervisor positioning of their trainee and trainee authorship of themselves was important and was aided by explicit dialogue and common purpose. We offer a model and language for trainees, supervisors and faculty to facilitate this.
DOI: 10.1111/medu.14203
ORCID: 0000-0002-7262-1629
PubMed URL: 32350873
Type: Journal Article
Appears in Collections:Journal articles

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