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Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis.

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Title: Constraints and affordances for UK doctors‐in‐training to exercise agency: A dialogical analysis.
Authors: Mattick, Karen, Goulding, Anna, Carrieri, Daniele, Brennan, Nicola, Burford, Bryan, Vance, Gillian, Dornan, Tim
Source: Medical Education. Dec2023, Vol. 57 Issue 12, p1198-1209. 12p.
Subjects: Education of physicians, Occupational roles, Well-being, Professional practice, Hospital medical staff, Research methodology, Interviewing, Organizational change, Qualitative research, Experience, Job involvement, Responsibility, Learning strategies, Research funding, Descriptive statistics, Physicians, Medical education, Secondary analysis, Group dynamics
Geographic Terms: United Kingdom
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. Using a dialogical approach, Mattick and colleagues analysed 56 key moments of agency from 22 interviews with UK doctors and make recommendations for workplace changes that could increase agency. [ABSTRACT FROM AUTHOR]
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: 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. Using a dialogical approach, Mattick and colleagues analysed 56 key moments of agency from 22 interviews with UK doctors and make recommendations for workplace changes that could increase agency. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/medu.15150
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              Text: Dec2023
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