Uncertainty experienced by newly qualified doctors during the transition to internship.

Abstract

Introduction: Uncertainty is an inherent feature of medical practice. Uncertainty Tolerance (UT) describes how individuals experience and respond to uncertainty, with lower UT associated with negative outcomes, including burnout. Periods of career transition can be particularly uncertain, but there is little research into newly qualified doctors' uncertain experiences during their transition to internship (TTI). Early career doctors have a high incidence of burnout; therefore, understanding how new doctors experience uncertainty could be valuable. We explored the sources of, responses to and moderators of uncertainty during the TTI to inform support of this group.

Methods: Engaging social constructionism, we conducted a cross-sectional qualitative study with 13 intern doctors who graduated from a single Australian medical school during their TTI. Participants completed a semi-structured interview within five months of commencing practice in 2021. Data were analysed using framework analysis, informed by the integrative UT model.

Results: Although participants described clinical uncertainty during the TTI (i.e. unknown aspects of patient care due to ambiguity, complexity or probability), dominant sources of uncertainty related to novel scenarios (e.g. tasks and responsibilities experienced for the first time) and their professional role (e.g. boundaries and expectations). Participants described responding to uncertainty by asking for help from senior colleagues and reported feelings of stress. Key factors that moderated responses to uncertainty included support, time and perceived stakes.

Discussion: Our results suggest that educators, supervisors and employers should aim to reduce the extraneous uncertainties associated with the TTI. Approaches to achieve this could include orientation programmes that appropriately familiarise interns with workplace environments and systems, reducing role ambiguity by setting clear expectations and facilitating regular feedback, and creating psychologically safe working environments with adequate senior support. These approaches may allow newly qualified doctors the capacity to explore clinical uncertainties and develop their UT through methods such as critical reflection.