Becoming a doctor—The potential of a change laboratory intervention

Abstract

In a previous ethnographic field study, we found that newly graduated doctors (NGDs) found their first months of practice challenging and overwhelming. By including an organisational perspective (Cultural Historical Activity Theory), we were able to identify contextual factors within the hospital organisation, which influence the NGDs’ challenges. This raised the question: What can be done about it? To address this, we designed a Change Laboratory intervention (CL), consisting of six sessions, involving NGDs, junior doctors, and consultants across eight departments (on average, 18 doctors participated in each session). Through the CL, the participants were able to get a mutual understanding across departments and develop two initiatives to support the NGDs: An NGD introduction day with a ‘need-to-know’ focus, where the NGDs meet their future collaborators, and are introduced to important work procedures, and are given the opportunity to establish a peer network. This is followed up by a monthly NGD forum with a ‘nice-to-know’ focus, where new topics are introduced, allowing time for reflections, and supporting the further strengthening of a peer community. The CL approach promoted agency among participants and the results show how CL offers a unique opportunity for stakeholders to challenge and rethink their work practices within the hospital organisation.

Keywords:

• Change laboratory
• organisational development
• participatory research
• postgraduate medical education
• transition

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

The authors thank all participants during the study and Lotte Hoelgaard Christensen for English proofreading.

Author contributions

TLK, MS, and SN designed the study. TLK, SG, and SN held the sessions. TLK, SG, and SN analysed the data between the sessions. TLK wrote the draft. All authors contributed to the interpretation and commented on the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Change Laboratory (CL): Is an intervention method introduced by Engeström and colleagues in the 1990s. CL aims to support expansive learning in which the research team works together with practitioners to analyse existing practices in depth and create new ways of working within their organisation. CL has proven successful in facilitating changes within the field of medical education (Engeström et al. 1996; Virkkunen and Newnham 2013).

Additional information

Funding

This study is a part of a Ph.D. project funded by Aalborg University Hospital.

Notes on contributors

Tine Lass Klitgaard

Tine Lass Klitgaard is a Ph.D. student, Department of Clinical Medicine, Aalborg University, Department of Post Graduate Medical Education, Aalborg University Hospital, Denmark. She has a MA in Anthropology.

Sofie Gjessing

Sofie Gjessing is a Ph.D. student, Center for General Practice, Aalborg University, Denmark. She is an MD and is an experienced teacher and researcher in medical education.

Mads Skipper

Mads Skipper is the medical director of Postgraduate Medical Education in Region North, Denmark, and an affiliated researcher at the Centre for Health Sciences Education, Aarhus University. He is a medical specialist in paediatrics and holds a Ph.D. in Medical Education with a focus on workplace learning and organisation.

Susanne Backman Nøhr

Susanne Backman Nøhr is the leader of the Postgraduate Medical Education Research Unit (PGME), Aalborg University Hospital, and the leading associate professor at the Department of Clinical Medicine, Aalborg University. She is a medical specialist in obstetrics and gynecology, has a MA in Learning Processes Specialising in Leadership and Organisational Psychology, and holds a Ph.D. in Medicine.