'Waiting in the wings'; Lived experience at the threshold of clinical practice.

Context: The transition to clinical practice is challenging. Lack of preparedness and issues with support, responsibility and complex workplace interactions contribute to the difficulties encountered. The first year of clinical practice is associated with negative consequences for new doctors' health and well-being. The contemporaneous lived experience of new graduates on the threshold of clinical practice has not been described. Deeper understanding of this phase may inform interventions to ease the transition from student to doctor.

Methods: We used interpretative phenomenological analysis (IPA) to explore the individual experience of making the transition from medical student to doctor, focusing on the period prior to commencing clinical practice. Fourteen recent graduates were purposively recruited, and semi-structured interviews were conducted with each, with respect to how they anticipated the transition.

Results: We draw on the metaphor of the actor 'waiting in the wings' to describe participants' lived experience on the threshold of practice. The experience of the actor, about to step into the spotlight, was mirrored in participants' perceptions of an abrupt transformation to come, mixed feelings about what lay ahead, and the various strategies that they had planned to help them to perform their new role convincingly.

Discussion: Participants in this study braced themselves for a trial by ordeal as they contemplated commencing clinical practice. The hidden curriculum shaped their understanding of what was expected of them as new doctors, and inspired dysfunctional strategies to meet expectations. Solutions to make the experience a more positive one lie in the approximation of the roles of senior medical student and newly qualified doctor, in explicitly addressing the hidden curriculum and generating cultural change. An emphasis on experience-based learning through contribution to patient care, guided reflection on the hidden curriculum and shifting cultural expectations through faculty development and strong local leadership can contribute to these objectives.