Student to Clinician. Identity Development within the supervisory relationship

Introduction
A core task of postgraduate clinical training is for the trainee to develop the identity of a clinician.
This development occurs over time in the context of supervisory relationships. Therefore, in order
to support this identity development, it is necessary to understand how it occurs within the
supervisory relationship. We aimed to explore clinical trainee identity development, as it occurs
over time in supervised practice, using naturalistic data. Our overarching purpose was to develop
a conceptualisation of identity development in this context to better support clinical trainee
identity formation in general practice (GP). To this end, we asked two questions:
1. What shapes the clinical trainee’s identity in the context of supervised practice?
2. How does the clinical trainee’s identity change over time in the context of supervised practice?
Methods
We took a critical realist approach using case study design and Holland et al’s theorising on
cultural worlds as a conceptual frame(1). Each case comprised a GP trainee and a supervisor. Our
main data was weekly audio-recordings of interactions of the trainee, supervisor and a patient
over 12-weeks. We also collected post-interaction reflections and undertook sequential
interviews during the placements. All audio-recordings were transcribed. An interpretivist
approach was taken for analysing the data using Sullivan’s dialogic methods with the focus on
the doing of language and the cultural Discourses expressed(2). Human Research Ethics approval
was granted.
Results
We identified three social Discourses which were: the Discourse of clinical responsibility; the
Discourse of ownership of clinical knowledge; and, the Discourse of the measure of trainee
competency. Versions of these Discourses defined four trainee/supervisor relational
arrangements within which supervisor and trainee assumed reciprocal identities. We labelled
these relational arrangements as: student assistant/expert clinician; apprentice/master coach; coclinicians; and, trainee as lead clinician/supervisor as advisor. We found a trajectory across the
identity arrangements that occurred over time. This trajectory was facilitated by particular
features of the supervisory pair. These were: invitation of a clinician identity by the supervisor to
the trainee; readiness on the part of the trainee to accept this invitation; sufficient time for a
transition to occur; supervisor safety netting of the trainee during the transition; congruence
between the way the supervisor and trainee positioned each other; and, mutual respect and good
will.
Discussion and Conclusions
In the supervisory relationship, trainee and supervisor adopt reciprocal identities. In order for the
trainee to progress to the identity of lead clinician, the supervisor needs to invite the trainee into
this space and vacate it themself. Congruence between supervisor positioning of the trainee and
trainee authoring of themselves is important. Congruence is aided by explicit dialogue and
common purpose. We offer a model and language for trainees, supervisors and faculty to
facilitate this.
References
1. Holland D. Identity and agency in cultural worlds: Harvard University Press; 2001.
2. Sullivan P. Qualitative Data Analysis. Using a Dialogical Approach. London: Sage; 2012.