Becoming a practitioner: Workplace learning during the junior doctor's first year

Background: Newly qualified doctors (interns) report that they learn a great deal in the first year of practice, but exactly what is learnt is not well understood. Aims: To document the reflections and perceptions of first year junior doctors in order to reveal and chronicle their informal and often tacit learning in the workplace within a practice methodology framework. Methods: New Zealand interns, from three sites, participated in group interviews modelled on a conversation and joint enquiry style. Results: We found that learning in the first year after graduation falls into three broad themes: (1) concrete tasks, (2) project management and (3) identity formation. Identity formation appeared the most challenging and included getting used to being seen by others as a doctor. Conclusion: All themes have implications for curriculum development and clinical supervision in both undergraduate programmes and during internship. The third theme (identify formation) is the most complex. We draw on a model from management literature, to describe intern education as a process of becoming: as an unfolding and as a transformation of the self over time. We argue that reconfiguring internship as a period of identity formation, and as a self-determined, active process of 'becoming a doctor' provides a wider perspective than enculturation or socialisation theories to understand this significant transition.