Understanding the Transition From Resident to Attending Physician: A Transdisciplinary, Qualitative Study

Westerman, Michiel MD; Teunissen, Pim W. MD, PhD; van der Vleuten, Cees P.M. PhD; Scherpbier, Albert J.J.A. MD, PhD; Siegert, Carl E.H. MD, PhD; van der Lee, Nadine MD; Scheele, Fedde MD, PhD

doi: 10.1097/ACM.0b013e3181fa2913
Career Transitions

Purpose: There is a paucity of research into the processes surrounding the transition from residency to the position of attending physician. This report retrospectively investigates the question: Are attending physicians adequately prepared and trained to perform the tasks and duties of their new position? This study aimed at formulating a conceptual framework that captures the transition and is applicable beyond discipline- or location-specific boundaries.

Method: Individual semistructured interviews were conducted and analyzed using a qualitative, grounded theory approach. Between January and May 2009, 14 physicians were interviewed who had commenced an attending post in internal medicine or obstetrics–gynecology between six months and two years earlier, within the Netherlands. Interviews focused on the attendings' perceptions of the transition, their socialization within the new organization, and the preparation they had received during residency training. The interview transcripts were openly coded, and through constant comparison, themes emerged. The research team discussed the results until full agreement was reached.

Results: A conceptual framework emerged from the data, consisting of three themes interacting in a longitudinal process. The framework describes how novel disruptive elements (first theme) due to the transition from resident to attending physician are perceived and acted on (second theme), and how this directs new attendings' personal development (third theme).

Conclusions: The conceptual framework finds support in transition psychology and notions from organizational socialization literature. It provides insight into the transition from resident to attending physician that can inform measures to smooth the intense transition.

Dr. Westerman is a medical doctor and PhD student, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. Teunissen is a resident in obstetrics–gynecology and researcher, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dr. van der Vleuten is professor of medical education and chair, Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dr. Scherpbier is professor of quality assurance in medical education and scientific director, Institute for Medical Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands.

Dr. Siegert is a nephrologist, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. van der Lee is a medical doctor and PhD student, St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Dr. Scheele is a gynecologist, St. Lucas Andreas Hospital, Amsterdam, the Netherlands, and professor of medical education, Free University Medical Centre, Amsterdam, the Netherlands.

Editor's note: A commentary on this report appears on pages 1819–1820.

Correspondence should be addressed to Dr. Westerman, St. Lucas Andreas Hospital, Onderwijscoördinaat, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; telephone: (0031) 20-6158790; e-mail: mchwesterman@gmail.com.

First published online October 25, 2010

© 2010 Association of American Medical Colleges