Topic 14: Transitioning to Practitioner

Question 1

Magola et al. (2018) identified three distinct transition challenges for novice physicians and nurses in the United Kingdom. What are they?

Answer 1

1. Personal
   - Fear and anxiety due to new responsibility, accountability, and expectations. Grief over loss of safety net.
2. Social
   - Inter- and intra-professional conflicts, lack of personal and professional acceptance, inadequate support
3. Job-related
   - Volume of work, time constraints, unfamiliar or complex tasks or patients, working rotations, and shift patterns.

Question 2

Magola et al. (2018) also identified some of the implications associated with the transition challenges. Such as? (3)

Answer 2

1. Learning and reflection
   - Time and workload pressures. Unable to consolidate learnings through discussion with experienced peers.
2. Performance
   - A prescriptive way of working impairing ability to perform skilled tasks, problem-solve, and think critically.
3. Patient care
   - In the interest of ‘fitting in’, may compromised standards of care, or not challenge decisions perceived as poor.

Question 3

What is workforce readiness? (2)

Answer 3

1. Workforce readiness refers to the degree new graduates possess the knowledge and skills deemed essential for practice, such as:
   communication, teamwork, problem-solving, resilience, and commitment to life-long learning.
2. High levels of practice readiness are seen to mitigate the stress and uncertainty associated with transitioning from university to the workforce.

Question 4

In a study of student physicians, dentists, and pharmacists, Malau-Aduli et at. (2022) identified enablers associated with workforce readiness. What are they? (3)

Answer 4

1. Knowledge and skills
   - Students believed their programs provided the necessary theoretical knowledge, and communication and clinical skills.
2. Clinical placement experiences
   - Seen by students as a key to developing the knowledge and skills needed to successfully transition to the work-force.
3. Support from friends, family, peers, and faculty
   - Friends who are recent graduates, and health professional family members were seen as particularly helpful.

Question 5

Malau-Aduli et at. (2022) also identified barriers to workforce readiness. What are they? (2)

Answer 5

1. Academic workload
   - Heavy academic workloads while on placement seen to prevent learning key clinical and technical skills.
2. Health system and governance knowledge
   - Lack of confidence in areas such as time management, and in meeting business targets and the expectations of other staff members.

Question 6

The transition from student to practitioner is seen as particularly challenging for pharmacy graduates (Nobel et al., 2015). What is a key enabler for weathering the transition process?

Answer 6

A strong professional identity seen as a key enabler for weathering the transition process and allowing new pharmacists achieve their professional goals.

Question 7

The processes by which one creates and maintains an identity (professional or otherwise) may be explained using different theoretical perspectives. What are they? (3)

Answer 7

1. Individual
2. Interactional
3. Institutional

Question 8

What is “Individual Identity Theory” (3)

Answer 8

1. Identity is constructed in the mind of each individual and therefore unique.
   - We pass through many identities from infancy to adulthood.
2. Transition between each identity due to a crisis that causes reflection and change.
   - Change is abrupt rather than gradual.
3. Similar processes occur with our professional identity
   - For example: the 2020 pandemic and the resulting needs of our communities made it necessary to quickly redefine what it meant to be a pharmacist.
   - New roles and responsibilities

Question 9

What is “Interactional Identity Theory” (2)

Answer 9

1. Based on how individuals present themselves to others, and how others interpret this representation.
   - Behaviours associated with professionalism signal to others how you see yourself; how others respond signals how your self-identity aligns with their expectations.
2. Identity is co-created by the person (actor) and those they encounter (the audience).
   - For example: at one time being a pharmacist did not include a range of clinical services.
   - Now a broadly held expectation that individual pharmacists have of themselves.
   - An expectation reinforced by the expectations of our pharmacy peers, as well as the expectations of other health professions, our patients, and the public.

Question 10

What is “Institutional Identity Theory” (3)

Answer 10

1. The manner by which organizations and their cultures affect identity
   - In the academic environment the clinical identity construct is dominant.
2. Upon entry-to-practice a business or corporate model of practice is dominant
   - Particularly within community practice.
3. A disconnect between what is desired and what is available results in a ‘crisis” for the new practitioner.
   - Conflicting vs. conforming with the dominant model

Question 11

A strong identity allows us to… (3)

Answer 11

1. Maintain or advance professional status in times of changing scopes of practice.
   - Less willing to accept dispensing-focussed status quo
2. Self-regulate one’s behaviour in a manner that supports high professional standards.
   - More likely to prioritize patient welfare over other competing objectives within the practice setting.
3. Have the confidence needed to practice effectively, and in the way we prefer.
   - More likely to advocate for the needs of your patients and yourself.

Question 12

What are some ways during academic training in which we do Professional Identity Formation (PIF)? (2)

Answer 12

1. Program design (content):
   - Clinical Knowledge and skills are essential; but… an over emphasis of these aspects during training can lead to a weak understanding of one’s professional role and a fragmented understanding of our professional selves.
2. Program elements key to PIF:
   - Opportunities for self-reflection (assessment)
   - Opportunities for authentic role playing (labs)
   - Meaningful experiential learning (practicums)
   - Patient-facing faculty/preceptors (role models)

Question 13

What are ways in which we do Professional Identity Formation (PIF) after Entry-to-practice? (3)

Answer 13

1. Supportive practice settings
   - Allow you to practice in a way that reflects your professional identity.
2. Strong mentoring/role models
   - Both inspirational and aspirational.
3. Active peer support
   - Provide collegiality and re-enforcement of professional values and behaviours.
   - We is Us!