#70 Live Fast and Die-Hard: Finding Heroic Career Paths in Training Stories
Episode host: Jason R. Frank
This week, Jason’s paper dives into how health professionals find their career paths. Learn about die-hards, negotiators, migrants, and how Jon almost joined the clergy
Episode article
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:
- “Why, how and when do doctors choose to pursue Anatomic Pathology training?
- 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:
- Interviews (1-2 hours each): Participants’ stories were captured and auto-transcribed using Otter.ai.
- Re-storying: The lead researcher synthesized the AP life stories by re-organizing the events for clarity and flow.
- Familiarization: Transcripts were revisited for plot structure and chronology.
- Story Mapping: Story turning points were identified, and problem-solution diagrams were created.
- Rewrites and Feedback: Participants were involved throughout the process, consulting on and revising their stories.
- 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:
- The Die-Hards: early exposure and intense early commitment to AP, usually in UME;
- The Negotiators: multiple experiences, always weighing pros and cons of various choices before landing on AP, usually in PGME;
- 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
- 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.
- 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.
- 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.
- Great intro to re-storying
- The reference list is a good intro to career choice litterature
References
Information Power summary from ep 65
References
Information Power summary from ep 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.
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