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
| Position | Proportion New to Role |
|---|---|
| Deans | 15 of 125 were new deans (13%) |
| Department Chairs | 400 of 2,700 were new department chairs (15%) |
| Residency Directors | 1,500 of 7,730 were new program directors (20%) |
| Faculty | 16,000 of 105,00 were new faculty (15%) |
| Residents | 19,000 of 99,000 were new residents (20%) |
| Medical Students | 16,000 of 67,000 were new medical students (25%) |
*Note that numbers are approximate
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. The 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.
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: On Transition. Do these descriptions touch upon these stages of personal transition?
| Academic Change |
Endings |
Neutral Zone | Beginnings |
|---|---|---|---|
| Residency |
No longer student; no more school vacations |
Yikes! I’m the doctor now! |
Physician |
| New Post-doctoral position | No longer a student with a faculty advisor and intensive support of peers |
Responsible for own research success; excited about creating new identity, but… “Who will take care of me now?” |
Research scholar as independent investigator |
| First Faculty Position |
No more supervision; the safety net is less visible |
How will I establish a program of scholarship? |
Independent scholar |
|
New Chair |
No longer part of the team; less time for research and patient care. |
How will I solve all these problems? How can I please all these people? |
My leadership team and faculty are competent; I can work with them to create a strong department. |
| Retirement |
No one expects me in the office; I am no longer part of the day-to-day |
Who am I without my students, patients, research staff? |
I am my own boss. I can go fishing whenever the weather is fine. I am writing a book and mentoring new leaders. |
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)
- Take your time.
- Arrange temporary structures.
- Don’t act for the sake of action.
- Recognize why you are uncomfortable.
- Take care of yourself in little ways.
- Explore the other side of change.
- Find someone to talk to, including those who have “walked in your shoes.”
- Find a mentor.
- Discover what is waiting in the wings of your life.
- Use this transition as the impetus to a new kind of learning.
- Build a network of colleagues.
- 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 Leader to Leader Journal, No. 16.
- Grigsby, K. (May 2004). Pitfalls for Junior Faculty from Academic Physician and Scientist.