Transition to professional practice

Introduction

Throughout life, a person experiences many transitions. Although transitions are a normal and necessary part of personal growth, significant transitions, like professional role transitions, can be stressful. These transitions often disrupt a person’s sense of self. ^, As Meleis notes, “Role transition is the process of learning behaviors necessary to carry out a new role effectively.” The ease of the role transition process is affected by the congruity of past and future roles and the preparedness of the transitioner for his or her new role and responsibilities.

The transition from physician assistant (PA) student to practicing PA is a significant role transition. Although all PA graduates are rigorously prepared for patient care as they are mentored and supervised by expert clinicians, the learning curve upon entry to professional practice is steep. Upon entering the workforce, it will be assumed, to a certain degree, that the newly graduated PA will know what he or she is doing and will no longer require constant supervision. Orders will be implemented, prescriptions will be filled, and all this will happen without anyone looking over the novice PA’s shoulder.

The purpose of this chapter is to give the new PA graduate perspective and insight into what to expect during the role transition process from PA student to practicing PA. The chapter summarizes the PA literature on what to expect during role transition and ends with tips on how to ensure a successful transition.

What to expect during role transition

A few studies have been conducted on the student-to-clinician transition for PAs, and their findings can help new PA graduates anticipate what to expect during their professional role transition. What follows is a brief summary of the key conclusions from each study, including specific information regarding job orientation/onboarding, emotions experienced, and sources of support during the role transition process.

A study by Forister and Chlup in 2017 focused on how novice PAs transfer learning from formal training to clinical practice. The authors found three common social perspectives concerning transfer of learning during the transition to practice: (1) partnership perspective, (2) self-reliant perspective, and (3) insecure perspective. The study concluded that novice PAs who held the partnership perspective experienced the smoothest transition. These PAs worked closely and collaboratively with their supervising physicians to build their knowledge and skills and were noted to be highly motivated and goal oriented. Study participants holding the self-reliant social perspective also experienced a mostly positive transition. They acquired new knowledge and skills necessary for their work without the assistance of others by harnessing their intrinsic motivation for learning and engaging in reflective practice. Lastly, novice PAs who held the insecure perspective had difficulty during role transition because of suboptimal environmental support from employers/supervising physicians and the influence of negative emotions (e.g., feeling insecure, anxious, or overwhelmed).

A national survey of new graduate PAs published by Polansky in 2011 explored how workplace learning occurs for PAs during their first 2 years of employment. In this study, three effective workplace learning methodologies were identified :

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  Accessing learning opportunities through direct patient care

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  Self-assessing learning gaps pertinent to patients’ health care needs

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  Having opportunities to observe and be observed in practice

Herrmann conducted a qualitative study in 2016 to characterize the student-to-clinician transition experience among PAs in their first 6 months of practice. Study participants worked in multiple areas of medicine (i.e., primary care, internal medicine, cardiothoracic surgery, psychiatry, rheumatology, urology, and emergency medicine). This study found that new PA graduates:

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  Had an immediate sense of increased responsibility in clinical practice compared with when they were students

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  Worried about not knowing answers, not knowing what to do, and looking and feeling incompetent

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  Found the support received from supervising physicians, other health professionals, other new graduates, and their PA programs to be essential to the transition process

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  Gained a sense of comfort, confidence, and clarity with their new roles and responsibilities within the first 3 months of professional practice