Feature: Academic Transitions — Saying goodbye, shifting into neutral, and moving forward

Not in his goals but in his transitions man is great.
Ralph Waldo Emerson

1. Change is easy; it’s the Transition that hurts!
2. Transitions in Academic Medicine: Endings, Beginnings, and the Neutral Zone
3. Transition Checklist

It is the nature of the educational system in our medical schools and teaching hospitals that thousands of residents and students in the health professions enter and leave our programs. Joining these changes are new faculty members and those faculty who undertake new roles, serving as directors, department chairs, and deans.

Transitions in medical schools and teaching hospitals in 2004
Deans		20 of 125 were new deans
Department Chairs		400 of 2,700 were new departmental chairs
Residency Directors		1,500 of 7,730 were new program directors
Faculty		16,000 of 105,000 were new faculty
Residents		19,000 of 99,000 were new residents
Medical Students		16,000 of 67,000 were new medical students
Note that the numbers are approximate. Sources include AAMC's Faculty Roster and FACTS database, NRMP, and ACGME.

Change is easy; it’s the Transition that hurts!

In concert or in conflict with these academic transitions, each of these health professions students, teachers, and researchers experience numerous changes in lifestyle as well as family and community relationships. Offices of human resources, loan officers, and real estate agents assist with our personal changes; staff in residency program offices and faculty affairs offices help manage the mechanics of professional change. Change involves signing forms for benefits and salary, moving into a new office, and ordering supplies for the lab or clinic. Change involves hiring a moving van and holding a yard sale, purchasing plane tickets, and renting a new apartment or buying a new house. Processes and procedures can be useful guides through the logistics of these changes. There are no set processes and procedures, however, for personal transition, the process of leaving familiar territory and an established identity and then moving through the adventure of establishing new competencies and patterns. Rather, transitions are experienced.

John Fisher’s model of personal change—The Transition Curve—describes over nine potential emotional stages common in personal transition, beginning with anxiety and progressing through happiness to fear, guilt, and depression before resolution. Gradual acceptance of the new skills, relationships, and identity leads to confidence and progress.

William Bridges provides another framework for thinking about personal and professional transitions. He describes three significant life shifts: endings of previous roles and identities; time in the “neutral zone” of adjustment to the change through exploration and pursuit of new positions and new possibilities; and beginnings that require new skills and goals.

	People move through the stages of transition at different paces, with those at higher levels of an organization often progressing more quickly from an ending into the neutral zone and to a new beginning.
Adapted from: http://www.pfdf.org/leaderbooks/L2L/spring2000/bridges.html

Transitions in Academic Medicine: Endings, Beginnings, and the Neutral Zone

How might Bridges’ framework of Transition manifest in academic medicine? Here are some possibilities. Do they match with your experience? Consider the descriptions of our contributors in Perspectives. Do these descriptions touch upon these stages of personal transition?

In Transitions, Making Sense of Life’s Changes, Bridges offers a Transition Checklist with suggestions for moving through change. The transition from endings to beginnings takes a different path for each of us. Don’t worry if your process takes a different set of steps than your peers. Remember to be patient with yourself and your family while trudging through the neutral zone.

Transition Checklist (adapted from Transitions, Making Sense of Life’s Changes)

1. Take your time.
2. Arrange temporary structures.
3. Don’t act for the sake of action.
4. Recognize why you are uncomfortable.
5. Take care of yourself in little ways.
6. Find someone to talk to, including those who have “walked in your shoes.”
7. Find a mentor.
8. Discover what is waiting in the wings of your life.
9. Use this transition as the impetus to a new kind of learning.
10. Build a network of colleagues.
11. Recognize that transition has a characteristic shape.

Resources

• Bridges, W. (1980). Transitions, Making Sense of Life’s Changes. Cambridge, Massachusetts: Perseus Books.

• Bridges, W. (2001). The Way of Transition. Cambridge, Massachusetts: Perseus Books.

• Bridges, W. (Spring 2000). The Marathon Effect in Leading Transition: A New Model for Change from Leader to Leader No. 16 on the World Wide Web: http://www.pfdf.org/leaderbooks/L2L/spring2000/bridges.html.

• Grigsby, K. (May 2004). Pitfalls for Junior Faculty from Academic Physician and Scientists on the World Wide Web: http://www.acphysci.com/aps/resources/PDFs/May04_feature.pdf.

- Diane Magrane, AAMC/Faculty Development and Leadership

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