Learning the ropes:strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Background: Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of 'learning the ropes' is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs' perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents' socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. Methods: We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. Results: We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents' tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents' needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. Conclusions: PDs' used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD's strategy. PDs' strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents' perceptions of PD's efforts to facilitate their socialization process during transitions

Transitions to and within residency training:Unraveling the importance of social interactions and networks

Transitions to and within residency trainingUnraveling the importance of social interactions and networksThis dissertation explores the journey of medical students transitioning into residents and their experiences moving from one rotation to another during residency. Residents’ challenges do not only consist of how to perform their tasks and duties, but also to integrate into their new medical team, department, and specialty. One of the challenges is mastering the unwritten rules: knowing when you can leave work, how to approach various supervisors, and how to collaborate effectively with nurses. This process is known as organizational socialization. Gerbrich Galema investigated in this dissertation the strategies residents themselves use to adapt to their new environment (such as observing, asking questions, experimenting, building social relationships, and seeking information) and how they cope with challenges in collaboration. Despite encountering barriers in interacting with certain supervisors and program directors, residents were found to have an extensive social network to achieve their goals.Furthermore, Gerbrich examined the impact of other healthcare professionals and organizational factors on residents' transitions, identifying various preferences among residents for socialization strategies. Four types of residents were distinguished: dependent, social capitalizing, autonomous, and development-oriented residents. This diversity underscores that one approach to guidance is not sufficient and that healthcare professionals and departments should tailor their strategies to the individual needs of residents for a successful transition. This dissertation provides practical guidance for residents, healthcare professionals, hospital departments, and teaching hospitals on how transitions of residents can be optimized

Program directors strategies to foster (organizational) socialization of newcomer residents in PGME

ABSTRACT:Background: In Postgraduate Medical Education (PGME), newcomer residents experience the transition to their new role as demanding. Part of Program Directors (PD) role is to facilitate this transition. However, they tend to focus on organizing / structuring the curriculum rather than supporting residents in theirorganizational socialization process, an important topic that has received little attention. To deepen our understanding and develop strategies to foster residents socialization, we investigated PDs perceptions of how they support residents socialization. Summary of Work: We conducted a multi-site, qualitative study with semi-structured interviews. An inductive-deductive approach was employed. In an iterative process, we inductively analyzed the data bythematic analysis and deductively interpreted the data through the theoretical lens of OS. The latter was based on the six organizational socialization tactics of van Maanen & Schein (1). A key characteristic of these tactics is the description of how others in the organization facilitate socialization processes fornewcomer individuals in transition from one role to another.Summary of Results: We inductively discovered that some PDs supported socialization explicit, other PDs were more implicit in their approach. This is illustrated alongside the six organizational tactics; collectiveindividual,formal-informal, sequential-random, fixed-variable, serial-disjunctive and investiture-divestiture. (I) PDs implicitly valued peer group processes and used explicitly individual tactics when residents failed or underperformed. (II) One PD explicitized socialization in the introduction program, but often socializationwas not considered a learning objective. (III) Some PDs explicitly sequenced the socialization process, but in other situations collaboration had not been arranged. (IV) The fixed and variable tactic could not be divided in explicit and implicit support. (V) Role modelling influenced residents socialization. PDsawareness and explicit use of role modelling varied. The disjunctive tactic (absence role modelling) was not identified. (VI) Some PDs accepted newcomer residents as who they were, but others expected residents to conform to their (implicit) expectations. Discussion and Conclusions: PDs support to promote residents organizational socialization was often implicit, occurred more by default than by design and lacked structure. However, some PDs structured andformalized their support. Take-home Messages: The challenge for PDs, faculty and residents is to establish socialization as learning objective for all newcomer residents in transition

Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions:A Q-study

INTRODUCTION: To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences.METHODS: Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments.RESULTS: Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development.DISCUSSION: This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.</p

Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions:A Q-study

INTRODUCTION: To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences.METHODS: Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments.RESULTS: Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development.DISCUSSION: This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.</p