Background: According to extensive international research, medical graduates continue to face significant challenges as they transition from student to doctor. Contributory factors include issues with preparedness, support, workplace interactions and challenges to their health and wellbeing. While research to date, in the form of attitudinal information, and common qualitative themes, has afforded us some insight into this formative period, a contemporaneous exploration of the lived experience of transition to practice is lacking. To improve work readiness and ease the transition, focused interventions have been designed and implemented; however, an overview of the research activity into these interventions is also lacking. My thesis aims to address these gaps by achieving a deeper understanding and appreciation of the experience of the first year of practice, by exploring the lived experience of anticipation of practice, the experience over the first year and the experience of intra-professional mistreatment. I will also describe the evidence for interventions to support these doctors.

Methodology: For my longitudinal exploration of the lived experience of the transition, I used the contemporary phenomenological approach of interpretative phenomenological analysis (IPA), which aligns with my interpretivist/constructivist worldview. The methodological frameworks and guidelines of Arksey and O’Malley, Levac and the Joanna Briggs Institute informed my scoping review of the literature into transitional interventions.

Methods: I purposively recruited 14 recent medical graduates. I interviewed them prior to commencing work, regarding their experience of anticipation of practice, and again at the end of their first year with respect to their experience of transition over the year. Each participant recorded audio diaries during the year relating to their experiences. Interviews were recorded, and all data was transcribed verbatim and anonymised. Analysis was carried out using IPA to identify common themes in respect of my research questions. To explore the experience of intra-professional mistreatment during the transition I focused on the data of a subset of three participants. For my scoping review, I assembled a research team of experts. Using relevant terms, we searched Medline Ovid, Embase, PsycInfo, SocIndex, ERIC and CINAHL databases, handsearched key journals, and tracked citations to identify empirical papers describing the implementation and/or evaluation of interventions designed to address preparedness for practice. Papers were screened by abstract and title and then by full text using inclusion and exclusion criteria. Data was extracted to address the focus of the review.

Results: The experience of anticipation of transition was characterised by the expectation of an abrupt transition, mixed feelings regarding commencing practice and strategic planning in anticipation of the challenges ahead. The hidden curriculum shaped participants’ understanding of what was expected of them and inspired dysfunctional strategies to meet these expectations. I identified overlapping stages in the experience over the first year. An initial emotional response, similar to the ‘transition shock’ described in newly graduated nurses was followed by an increase in confidence, challenges with workload, support and workplace interactions, and a final stage of rationalisation of the challenges encountered during the year. Distressing experiences of victimisation, disrespect and issues securing support from more senior doctors were described, which inspired some maladaptive behaviours. My scoping review revealed a lack of emphasis on real-patient care experiences, on the wellbeing of the graduate, or involvement of allied healthcare professionals, and a lack of standardisation regarding categorisation and terminology used to describe transitional interventions, with low level study design and evaluation.

Discussion: While the abrupt nature of the transition characterised the early experience of commencing work, beyond this, cultural, relational and contextual factors predominated. One way to alleviate the abrupt nature of the transition is to strengthen experience based learning as an undergraduate so that the role of senior medical student approximates that of newly qualified doctor. There is also a need for greater accommodation of the early transition period at organisational level. Deep cultural change is required to address the hidden curriculum and mitigate its negative effects. Interventions to address bullying and harassment, suboptimal supervision, issues with inter-professional collaboration and increased work intensity are also vital to improve the experience of transition to clinical practice. My findings have added to the extant knowledge relating to the transition to clinical practice and will inform undergraduate and postgraduate curricula and interventions to support this important period in the lives of medical graduates.

The overarching aim of the thesis was to identify and explore a behavioural typology of the use of reactive and proactive aggression in a sample of 9-14 year-old English children and adolescents. To date, few studies have employed a person centred approach to investigate behavioural patterns of the use of both reactive and proactive aggression. Of these only two have investigated the behaviour of community, rather than specialised or clinical participant samples (Crapanzano, Frick and Terranova 2010; Mayberry and Espelage 2007). However, these two studies employed methods which raise questions regarding the reliability and/or generalisability of the results obtained. For example, neither study asked participants whether they had actually engaged in the behaviours of interest; rather they asked children to report on how likely they felt they were to react in the same way as described in a list of aggressive scenarios presented to them. As such the studies did not actually record engagement in aggressive behaviour, rather the participants’ perceived likelihood that they would behave in a certain way. Furthermore, neither study was conducted in the UK, leading to questions of generalisability between participant samples. Both research and school policy in England and Wales has focused on exploring the use of proactive forms of aggression (including bullying) in schools, and reactive aggression has to date been neglected. However, it is essential that we identify the prevalence and patterns of the use of both reactive and proactive forms of aggression as both are prevalent in schools and place children and adolescents at risk of harm. Employing a mixed methodological approach, a two-phased data collection procedure was followed to identify and explore a behavioural typology of the use of reactive and proactive aggression and differences in associated demographic, behavioural and socio-cognitive risk factors between the behavioural groups identified. In Phase 1, focus groups were conducted with 57 (20 males, 37 females) children and adolescents aged 9 – 18 years, in order to understand how they define terminology utilised across the research literature to describe acts of negative interpersonal behaviour. Across three data collection sites participants reported consistent definitions of the terms provided to them and differentiated between the terms aggression, violence and bullying. Social representations of the reasons they believed people engaged and avoided engaging in interpersonal aggression also emerged from their talk. These related to the role of taking the perspective, or empathising with others and the perception of a level of justification for certain types of behaviour, enacted under certain conditions. In Phase 2 a survey design was used to collect both qualitative and quantitative data from 658 children and adolescents aged 9-14 years (302 males, 356 females). The aim of Phase 2 was to identify a behavioural typology of the use of reactive and proactive aggression based on self-report data collected using a modified version of the Reactive-Proactive Aggression Questionnaire (RPAQ; Raine et al 2006). Once the behavioural subtypes were identified, associations between subtype and, involvement in bullying relationships, demographic (age and gender) and social-cognitive characteristics (empathy, perceived acceptance of behaviour and social representations of why people become involved in negative interpersonal interactions) were examined. Cluster analysis of the RPAQ data identified three distinct behavioural groups characterised by lower than the sample median use of both types of behaviour (Low Aggression: characterising 57.1% of the sample), Moderate-high reactive and Low-moderate proactive aggression (characterising 34.4% of the sample), and finally a group indicating frequent use of both reactive and proactive aggression (High Aggression: characterising 8.5% of the sample). The only age and gender related differences within the clusters were found in the low frequency aggression cluster. Specifically, there were a greater proportion of females compared to males in this cluster. The only age related difference found was a greater percentage of primary school children compared to 13-14 year olds in the Low aggression cluster. Group membership was found to be associated with self-reported bullying as measured by the Peer Victimization and Bullying Scale (Mynard and Joseph 2000). The High frequency aggression cluster contained a significantly higher percentage of those indicating being a bully or a bully-victim compared to the other two clusters. Whereas the Low frequency cluster contained a significantly higher percentage of those indicating not being involved in bullying compared to the other two clusters. However, reporting being a victim of bullying was not associated with any one of the three clusters. Of the socio-cognitive variables, a significant incremental increase was found in the perceived acceptance of both reactive and proactive aggression as the reported frequency of the use of both types of behaviour increased across the three behavioural groups (as measured by a modified version of the RPAQ; Raine et al 2006). Conversely, an incremental decrease was observed between the frequency of the use of aggression and reported affective empathy (as measured by the Basic Empathy Scale; Jolliffe and Farrington 2006), with a significant difference being found between the Low and High frequency aggression groups. No significant differences between the groups in self-reported cognitive empathy were found. Finally, participants were asked two open-ended questions relating to their perception of why people are ‘picked on’, or ‘pick on’ others. Thematic Analysis identified a number of social representations held across the participant sample, with a further content analysis identifying that there were no significant differences in the extent to which these representations were endorsed by the three behavioural groups. The findings of the current research have important implications for our understanding of the developmental pathways for the use of reactive and proactive aggression. They identify that both types of behaviour co-occur, suggesting that the risk factors for the development of these two types of behaviour may not be so distinct and/or the risk factors associated with each are likely to co-occur. Consequently, school behaviour policies need to include strategies for addressing both forms of aggression. Interventions to reduce/prevent this behaviour need to be designed to address the risk factors which are promoting the specific motivations of both reactive and proactive behaviour.

Research in the field of bisexuality has identified that bisexuals experience a unique kind of phobia, in that phobic responses to their sexual preferences appear from both mainstream and LGBT communities. However, little research in the UK has been conducted within the arena of sport culture to cater for the particular welfare needs of bisexual athletes. As an additional consequence, there is little theorisation of bisexuality available within the context of sport sociology. This research contributes to debates in the politics of identity by exploring a fairly new landscape within sport culture using a Foucauldian analysis of power. Discourse analyses have been utilised to interpret thirteen semi-structured interviews conducted with British athletes on the topics of bi-invisibility and the general problem of homophobia. This research also contributes to discussions concerning the mobilisation of power through discourse – certain discursive practices function to legitimize normative over non-normative sexualities and queer/fluid/bisexual identities are further stigmatized and othered. The main findings suggest that exclusions are mobilised most effectively, ironically, through sport cultural practices of inclusion, in that they are almost exclusively sexual identity-based. Additionally, this study offers a theoretical explanation for the peripheralisation of bisexuality in sport culture which can shed new light on bisexual theory in mainstream culture. It makes important suggestions as to the new directions future research can take in order to advance the current knowledge bases concerning the effects of bantering. This research proposes that practices of bantering can be just as marginalising as those of bullying. In the resultant climate of covert exclusions, organizational sporting bodies could benefit from paying close attention to the disempowering effects of biphobic and homophobic language, whether humorously intended or otherwise. This is with particular respect to youth footballing academies and spectator communities.