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.

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.

The experiences and attitudes of inclusion for pupils with autism attending mainstream primary schools and relevant stakeholders in Leinster were ascertained through the use of questionnaires, interviews, focus groups, visual methodology and documentary analysis. Eight primary schools participated in this research and each school had access to a special class for pupils with autism. This study looked at the impact of inclusive policies on the provision of supports and services for pupils with autism and their overall learning and social experiences in each school. The findings of this research highlight many positive elements of good practice in each school. It was apparent throughout this research that professionals in schools were committed to enhancing the learning and social experiences for pupils with autism. The importance of positive home-school relationships was identified, as positive relationships greatly influenced the outcomes for young children with autism. The majority of teachers, principals and SNAs would like to see more opportunities regarding continuous professional development to accommodate the diverse needs of pupils presenting in schools on the autism spectrum. Evidence in this study highlighted inconsistencies in practice and mixed experiences for all stakeholders across each school environment. Findings from this study suggest that schools are working within a policy vacuum that is negatively impacting on the learning and social experiences for pupils with autism. In this research, the majority of parents had difficulty accessing adequate clinical and educational supports. Many parents do not have access to a special class in their locality, which can cause isolation and loneliness for their children locally. Most schools had exclusionary clauses in enrolment policies that made school choice difficult for parents. There was overwhelming consensus from parents and professionals that mixed ability special classes are not viable and the current structure, purpose and role of the special class needs to be revised in that regard. Mixed experiences were reported from parents regarding their children transferring between schools. The transfer from primary to post-primary was a great source of anxiety for the majority of parents of children with autism. This research suggests that inclusive policies must be implemented to provide adequate resource provision and requisite funding to enhance the learning and social experiences for all pupils with autism attending mainstream primary schools.