Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients. This multiphase ethnographic study explores realities of transition through anticipatory, lived and reflective stages. We utilised Labov’s narrative framework (Labov in J Narrat Life Hist 7(1–4):395–415, 1997) to conduct in-depth analysis of complex relationships between changes in responsibility and development of professional identity. Our objective was to understand how these concepts interact. Newly qualified doctors acclimatise to their role requirements through participatory experience, perceived as a series of challenges, told as stories of adventure or quest. Rules of interaction within clinical teams were complex, context dependent and rarely explicit. Students, newly qualified and supervising doctors felt tensions around whether responsibility should be grasped or conferred. Perceived clinical necessity was a common determinant of responsibility rather than planned learning. Identity formation was chronologically mismatched to accepting responsibility. We provide a rich illumination of the complex relationship between responsibility and identity pre, during, and post-transition to qualified doctor: the two are inherently intertwined, each generating the other through successful actions in practice. This suggests successful transition requires a supported period of identity reconciliation during which responsibility may feel burdensome. During this, there is a fine line between too much and too little responsibility: seemingly innocuous assumptions can have a significant impact. More effort is needed to facilitate behaviours that delegate authority to the transitioning learner whilst maintaining true oversight.

中文翻译：

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“我们怎么办，医生？” 身份和责任的转变：叙事分析

从学生到医生的转变是出了名的具有挑战性。新获得资格的医生觉得需要在拥有新身份之前做出决定。必须了解责任与身份形成的关系，以改善医生和患者的过渡。这项多阶段的民族志研究通过预期、生活和反思阶段探索了过渡的现实。我们利用 Labov 的叙事框架（Labov in J Narrat Life Hist 7(1-4):395-415, 1997）深入分析了责任变化与职业认同发展之间的复杂关系。我们的目标是了解这些概念如何相互作用。新合格的医生通过参与式体验来适应他们的角色要求，这些体验被视为一系列挑战，讲述为冒险或探索的故事。临床团队内的互动规则很复杂，依赖于上下文并且很少明确。学生、新合格的医生和主管医生对是否应该掌握或授予责任感到紧张。感知到的临床必要性是责任的共同决定因素，而不是有计划的学习。身份形成与承担责任的时间顺序不匹配。我们为合格医生在过渡前、过渡期间和过渡后的责任和身份之间的复杂关系提供了丰富的说明：两者本质上是交织在一起的，通过实践中的成功行动相互产生。这表明成功的过渡需要一段支持身份协调的时期，在此期间责任可能会感到负担。在这，责任太多和太少之间有一条细线：看似无害的假设可能会产生重大影响。需要更多的努力来促进将权力下放给过渡学习者的行为，同时保持真正的监督。