The PAPERs Podcast

Episode host: Jason R. Frank.

Episode 70 transcript. Enjoy PapersPodcast as a versatile learning resource the way you prefer- read, translate, and explore!

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Episode article

Rozario, S. Y., Farlie, M. K., Sarkar, M., & Lazarus, M. D. (2024). “The die-hards, negotiators and migrants: Portraits of doctors’career pathways through specialisation”. Medical Education, 58(9), 1071–1085.

Background 

The ideal health professions education system produces just the right number of professionals of the right kind and mix of capabilities to meet the needs of the populations to be served. It doesn’t exist. Right now, in many countries, there are massive shortages of health professionals, and Western countries are robbing poorer ones to supplement their workforces. Not good.  

In some countries, there is a type-and-mix problem, with too many graduates in some types of practice and too few in others. For example, in many countries, too few medical graduates choose Anatomic Pathology (AP), despite all the glorious TV shows where only the AP specialist can solve murders in the field and look fabulous while doing autopsies with a sandwich in one hand… 

The HPE literature already has some research on career choice, primarily in medicine. Interventions that nudge people include: enhanced clinical exposure, specialty interest groups, mentoring, and role modeling. But what if there was another way to nudge future professionals into underserved career paths?

Purpose 

Enter Rozario, Farlie, Sarkar, and Lazarus from Monash Uni in Melbourne Australia. They set out to explore: 

1. “Why, how and when do doctors choose to pursue Anatomic Pathology training?”.

2. What can be learned from this for recruitment to AP and other specialties?”.

Methods

This paper doesn’t follow your typical grounded theory approach. Instead, it dives into narrative inquiry and re-storying, offering a fascinating look into career pathways. Here’s the scoop:

Interpretivist lens: The authors took an interpretivist stance, focusing on meaning-making.

Team Reflexivity: The research team conducted reflexivity exercises to examine their own biases.

Professional Identity Formation (PIF): They drew on PIF theory, exploring how career paths and professional identities are shaped by the stories we tell ourselves.

Why Narrative Inquiry? Narrative inquiry was the chosen method to delve into the lived experiences of doctors, aiming to understand why and how certain career paths were selected.

Theoretical Framework: Ollerenshaw and Creswell’s framework guided the storytelling process. They define a “life story” as a first-person account that includes key narrative elements: turning points, characters, settings, conflicts, actions, and resolutions.

Sampling Method: Using purposive sampling, the study focused on anatomical pathology (AP) trainees and professionals from Australia and New Zealand.

The 6-Part Process: This wasn’t a quick study! It spanned a year and followed a structured 6-step process:

1. Interviews (1-2 hours each): Participants’ stories were captured and auto-transcribed using Otter.ai.
2. Re-storying: The lead researcher synthesized the AP life stories by re-organizing the events for clarity and flow.
3. Familiarization: Transcripts were revisited for plot structure and chronology.
4. Story Mapping: Story turning points were identified, and problem-solution diagrams were created.
5. Rewrites and Feedback: Participants were involved throughout the process, consulting on and revising their stories.
6. Portraits: From individual stories, the researchers created archetypal portraits that represent the common career paths followed.

Throughout, the participants engaged in refining the final versions of their stories, ensuring authenticity. This resulted in rich, cross-participant narratives that offer archetypal career portraits in AP.

Results/Findings 

14 participants from trainees to consultants in Australia. 11 participated in follow up interviews. (Dedicated participants!) The team identified 3 portraits of career trajectories that led to choosing AP: 

1. The Die-Hards: early exposure and intense early commitment to AP, usually in UME; 

2. The Negotiators: multiple experiences, always weighing pros and cons of various choices before landing on AP, usually in PGME; 

3. The Migrants or Runaways: they tried other specialties and had bad experiences, so ran to AP’s positive features.

Conclusions 

The authors identified 3 career choice portraits that can be used to inform future efforts to influence specialty career choices.  

PaperClips 

1. This paper does a good job of walking the reader through a clear chain of logic, from a problem-gap-hook to stance to methods including theoretical framework.  

2. Not sure this paper really has as much to do with PIF as the authors suggest. If you took PIF out, it wouldn’t really change the study or the findings.  

3. The argument that this paper helps with workforce shortages doesn’t resonate with me, in the system I am in. The paper really is more about addressing the type and mix of physician careers, rather than shortages. 

4. Great intro to re-storying 

5. The reference list is a good intro to career choice litterature

References

Information Power summary from Episode 65

Lindas paper tips on preferences in speciality choices: Takeda, Y., Morio, K., Snell, L., Otaki, J., Takahashi, M., & Kai, I. (2013). “Characteristic profiles among students and junior doctors with specific career preferences”. BMC Medical Education, 13(1), 125.

Transcript of Episode 70

This transcript is made by autogenerated text tool, and some manual editing by Papers Podcast team. Read more under “Acknowledgment”.

Jason Frank, Lara Varpio, Linda Snell, Jonathan Sherbino.

Start

[music]

Jonathan Sherbino: Welcome back to the Papers Podcast where the number need to listen is one. We are feeling punchy. I have drank way too much espresso. I have lots of thoughts. Some of them may be coherence. And I have the gang all back, the squad. Lara, how are you?

Lara Varpio: I’m good. We’re part of a squad, are we?

Jonathan Sherbino: Squad sounds cooler. That’s what I’m going to say.

Jason Frank: Yeah, squad all the way. Yeah.

Lara Varpio: Really?

Jason Frank: Squads are tight.

Jonathan Sherbino: Yeah. Started from the bottom, now we’re here, I guess, is how we end that line. Linda, how are you?

Linda Snell: I’d like to think of us as part of a team. I’m a member of a number of teams, but I must admit, I like this team most of the time. We all contribute something different to the podcast. I’m still trying to figure out what Jason’s contributing. Me too. That’s okay.

Jason Frank: So true. But now I’m part of the squad.

Jonathan Sherbino: Speaking of different, speaking of different, Jason, how are you? You got a Bruce Willis, John McLean themed study for us this week. What’s going on?

Jason Frank: I do. I have an episode titled Live Fast and Die Hard, Finding Heroic Career Paths in Training Stories. Now, this is all relevant, and I’ll explain all this to set up. But Jon brought up…

Jason Frank: Bruce Willis’s famous series of movies the die hard series and it always strikes me how odd it is that die hard came out of christmas and now it’s a christmas movie which is just bizarre

Lara Varpio: No it is a christmas movie, ever I know ever

Jason Frank: All right all right so what’s this paper about so let me here’s a little setup from the paper they start talking about workforce problems and health professions around the world okay so this is the serious part of the of the of the intro, that right now around the world, there are a whole bunch of countries that don’t have enough health professions, health professionals to meet the needs of their populations.

Jason Frank: And then on top of that, there are some countries that are poaching from others. So it’s, it’s a, it’s a not good sort of scenario. You can tell me in a minute whether or not you think this paper really is about workforce, deficiencies.

Jason Frank: What was more compelling to me was that there is often a type and mix problem, which is don’t have enough of a certain specialty in a given health profession that there’s some skews in in the way people choose their their paths through their career so that’s what this paper is really about and this paper I don’t think we’ve ever done a paper about anatomic pathology can you guys think of one over the last 15 years together as a squad have we ever researched pathologists this is an exciting day so this is where I ask each of you, since pathologists are super hot on TV for years, what is your favorite TV pathologist of all time from all the TV shows you’ve seen?

Jason Frank: For example, is it Quincy? Is it somebody from NCIS? Is it somebody from some British show? What would you say? Lara, Jon, Linda?

Lara Varpio: Okay. First of all, Quincy, that was like a way back throwback moment. That was… Deep history.

Jason Frank: I subscribe to all of you.

Jonathan Sherbino: I think, right?

Lara Varpio: I don’t know. Wasn’t it a radio program? This is how far back it went. Anyway. No, but I do have a favorite pathologist on TV. Did you guys watch NCIS New York?

Jason Frank: Sometimes.

Lara Varpio: CIS. Sorry, not NCIS. Just CIS New York. CIS New York.

Jason Frank: Mean CSI?

Lara Varpio: They have a pathologist. What did I say?

Jason Frank: CIS?

Lara Varpio: Well, you know, there is three letters, it’s New York CSI.

Jason Frank: We’ll figure it out.

Lara Varpio: And the character’s name was Sheldon, Sheldon Hawkes he’s no but seriously though I am team pathology like that is the coolest sorry y’all health specialty that’s my jam that’s those are there that you know they’re quiet they’re doing their thing they’re all deep they’re all mysterious.

Jonathan Sherbino: Lara, I think you speak with a little bit of the lens of not knowing exactly what happens I will tell you my first moment of ever going to a post-mortem I was gripping that’s side of the table tight. Like second week of medical school and watching the sternum, the sternal saw go at it. I was like, we’re in the deep end here, baby.

Lara Varpio: Let’s make no mistake. There’s a reason I’m not in like why I don’t have an MD. There’s no way I’d survive week one. That would be like a one week trip to Azkaban, like gone, over, earth done.

Jonathan Sherbino: All right. So my favorite is Dexter. I’m not sure if he was a pathologist, but he was like some kind of crime scene.

Lara Varpio: No wasn’t he the psychopath? I think you just mix psychopath and…

Jason Frank: Dexter Morgan

Jonathan Sherbino: He was a crime scene blood spatter or something.

Jason Frank: Forensic specialist

Jonathan Sherbino: Blood spattering on the side it was a little bit of reversal of fortune but my actual favorite pathologist is well maybe not the favorite pathologist not the favorite is Michelle Lazarus who’s the senior author she came out to mac and was a visiting prof for us and we had a great time super smart educational scientist I was really excited to see a paper from her.

Jonathan Sherbino: So thanks, Jason, for sending this along.

Jason Frank: Wow, you’re smooth. Way to slip that in there. Linda?

Linda Snell: I probably don’t watch enough TV to have a favorite TV pathologist, but I read a lot of, you know, police procedural novel and things for light reading. And there’s a pathologist, I think he’s in Michael Connelly’s Harry Bosch series, who’s got long hair that’s tied back.

Linda Snell: It’s a guy tied back very carefully, always wears sort of lovely suits, usually in pink or lavender. Is covered with not a cloth, but a plastic thing that allows you to see the colors, plays wonderful music in the morgue, and as you said, is always eating a sandwich at the same time. Yeah. That to me is what a pathologist looks like.

Jason Frank: Yeah. Tell me about it.

Jonathan Sherbino: He’s the guilty one in this whole murder series. I think it’s suspicious.

Jason Frank: There’s actually, if you Google top TV medical examiners, There’s actually a website, like there’s all these websites debating about who’s the best of all time. I’m surprised none of you mentioned Gil Grissom from CSI or Dana Scully from X-Files. Like, come on, guys, keep up.

Lara Varpio: I thought about Gil Grissom, but Gil Grissom, it doesn’t say he’s a pathologist. It said that he was a crime scene investigator and it wasn’t clear if he was a pathologist or not. Because the pathologist was played by the other guy who was the pathologist, not Gil.

Lara Varpio: Because Gil, too, is on the hottie McHodderson list. Like, honestly. My hottie list includes Gil Grissom. It includes MacGyver, the original. And it includes Alex Trebek. Because like, hello, he had all the answers. Boom. Wow.

Jason Frank: That is insight.

Jonathan Sherbino: I knew you well. This is a whole another layer. Also, we have a three-point scale. Are you a Trebek? Are you a MacGyver? I like it.

Lara Varpio: Or Gil Grissom.

Jason Frank: So anyway, that digression was brought to you by TV.

Jason Frank: So how is this related to anatomic pathology? How is it related to the title? These anatomic pathologists have sexy careers because they’re all over TV and played by movie stars. So the HPE literature already has some research on how people choose their careers, especially a bunch of interventions that help people become generalists because generalists are needed in every jurisdiction.

Jason Frank: So you’ll find papers about enhanced clinical exposure, specialty interest groups, getting a mentor, role modeling. We tried really hard to make sure Jon didn’t match to emergency medicine, but he still did, despite all of our interventions. So there you go. So what if there was another way to nudge future professionals into underserved career paths?

Jason Frank: That’s the premise of this paper. And so this paper is by Rosario, Farlie, Sarkar, and Lazarus. And it’s called “The die-hards, negotiators and migrants: Portraits of doctors’ career pathways through specialisation”. It’s in Medical Education, 2024 in September. So… These folks from Monash Uni in Melbourne, they set out to explore two things. So you ready?

Jason Frank: The first is, why and how do doctors choose to pursue anatomic pathology training? They say anatomic pathology is a great place to look at all specialties because it’s underserved in Australia. And they have some other reasons, but basically they said it’s generalizable. Number two is, what can we learn from this recruitment for our recruitment to AP and other specialties? So. I’ll just pause there.

Jason Frank: Does this study on anatomic pathology the way I’ve done a terrible setup, does that actually resonate with you? Let’s do it again, Linda, Jon, Lara.

Linda Snell: Well, I can get the first research question if you’re an anatomic pathologist and trying to recruit people, which is why and how and when do they choose to pursue that training.

Linda Snell: I’m a little more skeptical about the question about what can be generalized from this to other specialty. There’s a huge literature on specialty selection and choice and that. My friend and colleague, Yuko Takeda in Tokyo, has looked at Japanese students and, you know, what they wanted was a controllable lifestyle.

Linda Snell: And in Japan, unlike in other places in the world, students often picked a discipline based on what their parents did because they were going to take over, quote unquote, the family business. In other words, the practice, you know, and choice may differ by how important lifestyle is. You’ve got to be a dermatologist or an ophthalmologist or by personal reasons or by you like science.

Linda Snell: Interestingly enough, and I’m not really sure why, people going into emergency medicine had a more science orientation. So all this to say, I think there’s lots that goes into it for anatomic pathology. I’m going to really look forward to seeing how this can be generalized.

Jonathan Sherbino: I would not pick up this paper if they had the word anatomical, anatomic pathology in the title. They don’t. They use it as the case study for this idea of how to recruit into specializations. And I will tell you, I’m foreshadowing that I really like their, I love their methodologies. And I think their findings are important. And so I think they do a great job.

Jonathan Sherbino: I think we’ve done a disservice perhaps by talking about sexy pathologists because half the people are always like, I’m out. I’m out. I’m not listening to this podcast and we’re not reading that paper. You need to watch Steve. I need to read to you, dear authors, because I don’t think you set up your paper in the same way that we’re setting up the podcast.

Jason Frank: Look, they had diehard in the title.

Lara Varpio: There is that.

Lara Varpio: Okay, so this paper was an example of I started going on. I started, honestly, Jason, I started off by going, Jason, I’m not sure this is a great choice because we know a lot about.

Jason Frank: You say that every week.

Lara Varpio: And maybe. But I won’t say the second half every week because by the time I was done this paper, I was like, good choice, Jason.

Jason Frank: Yeah, that’s more like it.

Lara Varpio: I like it.

Jonathan Sherbino: Every now and then a blind squirrel gets a nut.

Lara Varpio: Right. It happens upon occasion.

Jason Frank: All right. Let this blind squirrel continue. So I just love this paper. Honestly, with every paragraph that went by, I was more enthralled with what they did. So here, let me set it up. Okay. So what did they do? This is not your everyday constructivist crowded theory. Watling. LaDonna Fair. This paper uses narrative inquiry, which I’ve never done, and restorying, which I didn’t know existed before this paper.

Jason Frank: But now I was just so enthralled. I find it fascinating. Here’s the scoop. So they explicitly, because they heard Lara out in the distance, explained that they have an interpretivist stance. They say that right off the top. The authors conducted a team reflexivity exercise. How sophisticated. They’re informed by a number of constructs.

Jason Frank: So the first is around professional identity formation literature. Linda, that was totally for you. They have a theoretical framework. There’s a nice subtitle that says, here’s our theoretical framework. They’re totally head Lava in their ears. Posits that career paths and professional identity formation are expressed in the stories we tell ourselves. Now, that has implications for Jon’s career, if nothing else does.

Jason Frank: They chose narrative inquiry because they really wanted to understand the lived experience and how why a given career path was chosen.

Jason Frank: The theoretical framework also uses stories. So they have a couple of key references for that. One of them is Ollerenshaw and Cresswell, which they said is first person oral telling and retelling of events related to personal and social experiences.

Jason Frank: I kind of like that as a definition of what a life story is. A life story can be thought of as having a number of turning points, characters, settings, problems, actions and resolutions.

Jason Frank: They did what kind of sampling, Jon? I just want to just check with you and see. What kind of sampling, if you noticed?

Jonathan Sherbino: Purposive.

Jason Frank: That’s so wrong. Purposive. Purposive. Ben Kinnear is going to tell you. Purposive.

Jason Frank: Dan Schumacher. So they did purposive sampling of apiphrates.

Lara Varpio: You can’t keep repeating it incorrectly. Purposive sampling. Yeah, moving on.

Jason Frank: If you say it often enough, it’s true.

Lara Varpio: That’s why I’m worried.

Jason Frank: Anatomic pathology trainees and practitioners from Australia and New Zealand. And they did a six-part process over a year. Like, this is dedication. These people were really, really deep into this research. I am so impressed. So here’s their six-step process. Are you ready? First, they recruit, and then they interviewed people for one to two hours.

Jason Frank: These pathologists are so dedicated. Then they auto-transcribed it with an AI. The principal investigator then created AP Life Stories by re-storying the transcript. So they take the transcript and they’re like, who are the characters? What are the turning points? And so on. And they put it in a sequence. So they said that restorying process has three steps.

Jason Frank: It’s familiarization with the transcript for plot structure and chronology, finding story turning points and creating problem solution diagrams. They rewrote into new versions of the stories. And then they did multiple steps of participant checking. So participants were consulted on the restories to make sure that it was authentic.

Jason Frank: They did further revisions. The fifth step is they constructed narratives across participants into some sort of archetypal portraits of career paths. And then participants were then consulted again on the portraits. So I have some questions for you about these methods that I adored. So Lara, I’m going to ask you first.

Jason Frank: What do you, like, I know you’re a bit more into this than me. So what would you say the principles of restorying are?

Lara Varpio: I’m glad you asked, Jason. So restorying is super cool.

Lara Varpio: So restorying is the process of constructing a story from original data. And you do that by focusing on the narrative elements, right? Like characters, problems, settings, actions, resolution. And this paper does a lovely job of going through the steps they follow. So I’m not going to go into all that.

Lara Varpio: But what I would say is what I want to emphasize is that restorying process, like that work, shouldn’t leave you with just a short summary of what the participant said. So I would never want anybody to think that this is just… A summary, a condensing the content. That’s something that chat GPT could do, but that’s not what restorying is. Because restorying is interpretive work.

Lara Varpio: It’s the work that a researcher carries out to make an interpretation where the insights are generated into the data. And those insights are interwoven with the researcher’s knowledge and experience and expertise. So it’s a real interweaving of the participants’words and the researcher’s interpretations. And it should generate a new story. It’s the researcher’s account of the complexity that a participant shared.

Lara Varpio: A good restorying then enables us to see the data in new ways, right? It’s not just a simple summary of the participant. Instead, it’s an appreciation of how problems and characters and actions and settings and resolutions came together in important ways for the participant and in ways that can help us to see and understand their experiences.

Lara Varpio: And in this study, the restoring should generate a new story about professional identity development as an AP specialist, key considerations, events, influences and such. So restoring then is really an interpretive data analysis approach, and it really nicely aligns with the orientation of the researchers. So like so many thumbs up from me on this method section.

Jason Frank: Thanks so much, Lara. Okay, Linda, they mentioned PIF all over this paper. And does this really speak to PIF to you, this paper?

Linda Snell: Well, it certainly does in the introduction. And there’s a decent review and they’ve covered all the right literature. And they do talk about how identity can be formed and influenced by role models and by clinical experience and by the system around the individual. So…

Linda Snell: That, if we look forward, may come up in the results.

Jason Frank: Finally, Jon, do you have any concerns with the methods?

Jonathan Sherbino: So as an experimentalist, when I read Narrative Inquiry, insert Lara’s eye roll, I thought, oh, here we go. Now, I’ve actually been a middle author on a study that used Narrative Inquiry. So I have familiarity. I don’t have experience. I think the senior author and the lead author patted me on the head is pretty much what they did most of the time.

Jonathan Sherbino: I went to the supplementary material for this study, and I rarely say read the supplementary material. Go read it. It blows away your mind, the intensity of the analytic process. Let me just, like Lara said, the big philosophies, but let me just tell you what the work feels like. So you go through, encode two hours of someone’s interview.

Linda Snell: And that probably takes six hours or eight hours at least.

Jonathan Sherbino: Then you build a table. Find all the characters and the settings and the actions. And then you build from that, you build a flow diagram that’s labeled and tagged so you can see all of that. And then from that, you actually write a story. And then you actually ask the interviewee, what’d you think of the story and how do we need to correct it?

Jonathan Sherbino: This is not a small bite. Like I would be crying on cold and say, please just give me my SPSS back. I just want to push the button says run a T-test. Honestly, there is robustness. And I picked up something else that I just wanted to comment on, which is the idea of information power.

Jonathan Sherbino: We start hearing this word a lot before. And I’ve always wondered, like, how do you adjudicate it? What’s your score? What’s the standard deviation around your information power? And there’s not. But this study says we think we achieved information power at six interviews. And then we went on and did another eight.

Jonathan Sherbino: And yes, I 100% believe it because they have a very specific type of question. And the. Data sources of the individuals who are contributing to that make sense. They have a theory that provides boundary or a lens through which they can see. They have so deep, rich data.

Jonathan Sherbino: And then their analysis goes in depth that allows them to put together analysis that holds together. Like they’re hitting all the punchlines and information power that when you look at it and adjudicate in any way, say, yeah, darn right, you could stop at six. But God bless you for continuing on to make sure that you really understood what you’re doing.

Jonathan Sherbino: Anybody who’s going to eye roll at narrative inquiry. Slowly pull the Homer Simpson back into the hedge and shut the hells up. This study, this study is, is a perfect paper to template off. If you want to do narrative inquiry, God bless you. But if you’re going to do it, here’s a good example about how you might want to think about taking that bite.

Jason Frank: Awesome. Awesome. Well said, Jon. So, Lara, I’m certain that there’s somebody listening out there that says, before it was saturation, then it was sufficiency. Now it’s information power. Just tell me what I should be saying when I know that I’m right. So how, what should they be saying?

Lara Varpio: So we did a little thing on this just the other day in another episode. So I’m going to I’ll stick a link into the show notes for that because I did a whole little description about information power, even have the figure from Maltrud’s paper and all those sorts of things.

Lara Varpio: The most important thing about information power is there’s different criteria to think about in terms of knowing if you have the richness and depth of insights and in the data itself. And that has things to do like with the breadth of the question and the nature of the population you’re sampling, all those sorts of things. But I’ll make sure that we link into that in the show notes.

Jason Frank: All right. So what they find. So I hope we’re making a case here that this kind of a legendary paper. They had 14 participants who were a mix of trainees, all the way up to consultants in Australia and New Zealand. 11 of the 14 participated in follow-up interviews.

Jason Frank: And so this is a huge dedication for the participants as well. The team identified three, what they called portraits of career trajectories that led to choosing their specialty. And they thought this was actually generalizable to others. And they had some literature in the discussion that suggests that as well.

Jason Frank: So here’s the three groups. They’re from the title. The Diehards are the ones where they had some early exposure and that developed an intense early commitment to anatomic pathology or insert whatever specialty. And this usually happened in undergraduate training. So, and UME in this case.

Jason Frank: The negotiators, these are people who had multiple experiences, always weighing the pros and cons, you know, should I play in Jon’s hockey team or not? There’s some definite downsides of that. And before landing on. In this case, anatomic pathology. And this usually happened for them in postgraduate Medical Education.

Jason Frank: And then finally, the Migrants, who I actually think should be called the runaways, they tried other specialties, had bad experience and said, the hell with that, and ran to the positive features, in this case of anatomic pathology, found their tribe, settled down.

Jason Frank: So those are the three. And if I think of people that I know that chose their medical specialty, I can definitely sword people into the Diehards, negotiators, and Migrants. I’m really curious if that’s your experience about people you know about career paths. We’re going to go Jon, Linda, Lara.

Jonathan Sherbino: I don’t think of myself as an anatomical pathologist, although I have killed many patients on purpose, I think. And not, but I’m pumped. But I found their archetypes very helpful. And I think it’s not specific just to the context of pathology. I can see… And they do a good argument of trying to transfer their findings to a broader group.

Jonathan Sherbino: I’m going to say this. You heard it here first. I really like their diagrams.

Lara Varpio: I was gonna ask what you thought of their pictures.

Jonathan Sherbino: I thought they were great. I think they make the complex analysis come to life and make some of the nonlinear types of relationships that they’re trying to show become even more apparent.

Jonathan Sherbino: So yeah, I thought this idea of these three archetypes in… Obviously, they aborted too many versions of it so that they had clear punchlines. But they also then did the good work in the discussion part, which they said, and here’s the implications for.

Jonathan Sherbino: So now that we see these archetypes, what do we actually mean in terms of addressing this under recruitment or this under resourcing in a type of specialty? So you don’t have to be a pathologist to say who cares. Who cares? They do that work for you in the discussion. Say, okay, if you are a surgical specialty, here’s how you might want to think about the diehard.

Jonathan Sherbino: Or if you are in a different type of specialty, this is why the migrant is important and not to strike them off your list. Too many of us have one focus and one solution. There’s not enough of us in our clinical environment. So we’re going to focus only on the diehard. We’re going to try to make it happen at that first week of medical school. And then we give up.

Jonathan Sherbino: And in fact, we have systems. Don’t allow Migrants to actually be Migrants. And so, you know, you might be a champion for more flexibility in postgraduate training if you are a specialty that is struggling with your numbers.

Jason Frank: All right, Linda. Does this resonate?

Linda Snell: It does. And I’m a migrant.

Linda Snell: I’ll tell you why I say that. I’m a migrant when it comes to this paper. Because as you heard at the beginning of this podcast, I was pretty skeptical given the questions. But now I’m a convert. And what made me a convert?

Linda Snell: Well, the whole talk about archetypes. And secondly, as with Jon, the figures. I think it’s really helpful, these three figures in color yet. So I think this is really important and very applicable, despite my early skepticism. And I like migration.

Lara Varpio: So I personally am a migrant in many ways. I left Canada, immigrated to the U. S., but I also from like a career pathway.

Lara Varpio: Jason, your phrase works better for me. I ran away from traditional Ph. D. In English because I did not belong there. I was a worse Ph. D. In English. Like one course I took.

Lara Varpio: We were supposed to read all the great novels I ended up watching most of the great movies because I couldn’t like I fell asleep reading moby dick so often I gave up it was so boring I was like I and like that’s how like no when the movies don’t follow the book for a while there I was really against that but anyway I love the study I love the phenomenon their their their perspectives on the different pathways and archetypes made so much sense to me.

Lara Varpio: They rang true. One of the things, though, for me that I took away from the results, and I just want to underscore, is like, isn’t it fascinating that they have a little throwaway sentence or two somewhere in the results talking about how people could have been inspired by TV shows, by modern media representations of these different career paths.

Lara Varpio: And so, like, for me, part of me is like, yes, I completely agree with Jonn. Let’s not assume everybody’s a diehard. Let’s think about recruitment across their educational continuum. But part of me is also like, and let’s go talk to Hollywood. Let’s go talk to Hollywood or whoever it is in your neck of the woods who makes the movies to get really awesome shows about like family physicians.

Lara Varpio: If we can make that cool, we can get people into that specialty, I think. But that said, I consistently stay with my original comment. I’m teen pathology. Like, yes.

Jason Frank: As I said, you guys all mocked me. Sexy pathologists. Like right off the top. Hollywood’s got it figured out. They solve things. You forgot Sherlock Holmes, by the way. Sherlock Holmes is also a sexy pathologist. Okay. The authors concluded that they…

Lara Varpio: Okay. I read that book. No, there’s no pathologist in it.

Linda Snell: No, no, no, no, no. He wasn’t a pathologist.

Jason Frank: The version with Benedict Cumberbatch, he’s always…

Lara Varpio: He’s not a pathologist. He’s beating on the bodies. That’s not the same.

Jason Frank: He’s doing all kinds of medical examiner experiments to try and figure things out. Spatter and, you know…

Jason Frank: Etc etc you [overlapping dialogue] you can watch the shows you don’t have to read it, it could be all right so anyway according to my website it’s right, authors identified three [overlapping dialogue]

Linda Snell: I think we need to to bring in a common sort of approach here is called fact check

Lara Varpio: All good just let them go with it it’s fine.

Jason Frank: So anyway these authors identified three career choice portraits that can be used to inform future efforts to influence, especially career choices. And so I just want to emphasize something Jon alluded to earlier, that they did all of this work.

Jason Frank: The participants did all this work. They did restorying. They found some common threads. They identified these portraits. And then they finished the paper with, hey, here’s the implications. If you want to find Diehards, you want to find them early. You want to give them some amazing experience.

Jason Frank: And then there’ll be really an intense early commitment. You want to find the negotiators. You got to talk about pros and cons. You got to talk about what’s great about doing things this way and whether or not they’re a good match. And you want to find them sort of late undergraduate, early postgraduate.

Jason Frank: And then the Migrants, you want to create pathways so that people can get out of a bad deal that isn’t a good match for them. And I think that all makes sense. And I think it applies to a lot of things. So you need multiple channels. Here’s a couple of paperclips.

Jason Frank: What I really loved was the methodology in this. The restorying was so compelling.

Jason Frank: And, the reference list about career choice, this is a great paper. It’s all in one place. If you’re thinking about career choice, scan through this reference list and you’ll find a number of really, delicious papers. What they lost.

Linda Snell: You’ll also find some, you’ll also find some good references on identity formation here too.

Jason Frank: They lost me a little bit with their opening argument that there are shortages. I don’t think it’s really about shortages. We’re not making new, positions to train doctors in this paper. What you’re doing is you’re nudging people towards type and mix, so a different choice of career.

Jason Frank: So I wish they had been a bit clearer about that. And I also thought that, I’m sorry, Linda, but if they took PIF out of this paper, I still think they would have found the same findings and would have executed the same methodology. So I wasn’t sure PIF really added a lot, even if it informed their theoretical framework.

Linda Snell: Well, I think that’s the point. It did inform the theoretical framework and probably informed the way they analyzed their analysis.

Jason Frank: Maybe. It took up a lot of real estate, though, in the words. So that was just a couple of thoughts I had about this paper. It does not take away from how wonderful this paper was. Legendary, amazing, dedicated.

Jason Frank: Okay, so let’s do some quick votes. And feel free to add in any editorial you wish you have. So just on the methods, tell us how amazing you thought the methods were. Lara, Jon, Linda.

Linda Snell: There’s something called bias which I feel is being expressed here. [overlapping dialogue]

Jason Frank: I’m being accused of a lot of things today.

Lara Varpio: No, but he’s right. This is a five.

Linda Snell: Whether it’s a five or not, he doesn’t have to tell us before we get our numbers.

Lara Varpio: Yeah, but it’s not a court of law. So yeah, he can bias us.

Jason Frank: Can I get a gorge at all? What’s a gorge?

Lara Varpio: Probably. It was gorge. There you go. Totally gorge.

Jason Frank: Thank you. I thought so too. Yeah. Jon?

Lara Varpio: You’re welcome. Anytime.

Jonathan Sherbino: Five.

Jason Frank: Linda?

Lara Varpio: Linda?

Linda Snell: Five. I was waiting for Jon to say something sensible, but he didn’t.

Jason Frank: You know, Jon’s a man of a few words sometimes.

Jason Frank: Okay, now here’s the important part. What is the impact of this paper? Are you going to use this paper for anything, or is it just gorge and hanging out all on its own, leaning against the bar? Same sequence, Lara, Jon, Linda.

Lara Varpio: I’m totally going to use this when somebody wants to do narrative research and wants to engage in restorying, or even, you know, to Jon’s point, if they want to see how images can actually make your paper easier to understand. All those reasons. Five.

Linda Snell: Five.

Jonathan Sherbino: Jon? Okay, we’ll do it in a different order.

Jason Frank: No, we’ll give you four.

Jonathan Sherbino: Four. I will walk.

Jason Frank: And Jon.

Lara Varpio: Five. No, here, Samuel.

Jonathan Sherbino: I can be easily convinced. Five. I will take the different side, which I’m not just going to use this as a great example how to do narrative inquiry. I also think there’s some meaning and salient points for those specialties that are looking at how do we enhance recruitment into our discipline? And so, yeah, five.

Jason Frank: Awesome. So cool. There you have it. That’s the paper. Big thanks to these authors. They opened my eyes to a whole bunch of new things. So thank you, Rosario Et Al.

Jason Frank: We hope you enjoyed it. We’d love to hear from you. We want to know if you have any comments or disagreements or enhancements to this discussion.

Jason Frank: You know the drill. It’s thepaperpodcast.com and paperpodcast at Gmail. And we’d love to hear from you. But first, before we go, we have a couple of shoutouts. Lara.

Lara Varpio: Speaking of hearing from you, I’m just going to say thank you to Ayush Ghabrani, who wrote to us about the episode that we did. It was episode 63 when we talked about revealing mental health issues in clinical practice and those sorts of things. And Ayush, I’m just going to wrote us a beautiful letter.

Lara Varpio: So unfortunately, Ayush, I can only pull a few sentences out here. So just a quick summary. He writes, quote, I hear from my trainees every day that they are being offered or voluntold to write a paper. Sit on committees, take on more roles without taking into consideration if it’s even possible for those trainees to do it.

Lara Varpio: And to justify this overcommitment, the excuse of good academic job prospects or good future is used. A little further down, he writes, I agree with you that the system needs to change, which is us. However, for that to happen, the largest stakeholders in this area are the higher ups and administration, often the non-physician C-suite staff for whom trainee well-being is often not a priority.

Lara Varpio: Ayush, we really appreciate the, like I said, this was just a short summary of some of your comments. Thank you so much for writing to us. We really do read all of your emails, friends. So please write in and let us know what you think of the different episodes.

Lara Varpio: And with that, Jason is pointing to me and he wants me to be the first to sign off. And so I will say, see, look, I’m paying attention. I’m reading and looking all of the same.

Jason Frank: Breaking the third wall by doing the stage directions. I’m just saying.

Lara Varpio: Okay, this whole third wall thing, we got to revisit the concept because I’m not sure we’re using it right. But that’s a whole other issue.

Jason Frank: You’re the English major.

Lara Varpio: Yeah, but I just told you how I got that degree.

Linda Snell: But the other thing is, he could have been pointing for you because he wanted you to say where people could leave their comments and the website.

Lara Varpio: He already said that, honey.

Linda Snell: I know, but he wants you to do it because he thinks you’re going to do it wrong.

Jonathan Sherbino: I’m going to jump in. And say goodbye from all of us.

Jonathan Sherbino: Pull into your parking station, finish your run.

Jason Frank: We’re done.

Lara Varpio: Unplugged.

Linda Snell: All right.

Jason Frank: Linda.

Lara Varpio: Say bye-bye, Linda.

Linda Snell: Bye-bye. He said goodbye from all of us.

Jason Frank: Take care, everybody. You’ve been listening to The Papers Podcast. We hope we made you just slightly smarter. Podcast is a production of the Unit For Teaching And Learning at the Karolinska Institutet. The executive producer today was my friend, Teresa Sörö.

Jason Frank: The technical producer today was Samuel Lundberg. You can learn more about the Papers Podcast and contact us at www.thepaperspodcast.com. Thank you for listening, everybody, and thank you for all you do. Take care.

Acknowledgment

This transcript was generated using machine transcription technology, followed by manual editing for accuracy and clarity. While we strive for precision, there may be minor discrepancies between the spoken content and the text. We appreciate your understanding and encourage you to refer to the original podcast for the most accurate context.