title: Navigating specialty training through agency
title: The Fellowship of the Colleges of Medicines of South Africa
titleType: Subtitle
Creators: name: Chauke, Lawrence
Publisher: name: Lancaster University
Year: 2024
Subjects: navigating
constraints
medical specialist
education
agency and structure

description: This thesis examines the experiences of trainee medical specialists in
 South Africa's national medical specialist certification framework,
 implemented in 2011. The framework aimed to integrate specialist medical
 education and establish a unified, quality-assured national certification
 system. This research project responds to the need for teaching and
 learning (T&amp;L) research in higher education that considers agency,
 context, and different research methodologies and philosophies in its
 conceptualisation of T&amp;L in this field. It is also motivated by my
 curiosity about how structure and agency interact in specialist medical
 training, given the health system and educational challenges reported in
 this area. The thesis seeks to explain how trainee medical specialists use
 agency to navigate structural constraints during specialist training. 
 
 The study is grounded in the interpretive-constructivist research
 philosophy and employed a constructivist grounded theory methodology to
 investigate the interaction between trainees' agency and structural
 constraints in the postgraduate (PGME) training environments.
 Semi-structured interviews were conducted with 30 trainees and recently
 qualified medical specialists in four specialist disciplines: Medicine,
 Obstetrics and Gynaecology, Paediatrics, and Surgery in Gauteng Province,
 South Africa. Participants were selected using purposeful and theoretical
 sampling techniques. The sample size was determined based on data
 adequacy. This approached ensured that sufficient data was generated to
 address the research questions. Interviews were digitally recorded,
 professionally transcribed, and analysed according to the constructivist
 grounded theory research methodology.
 
 The study provides insights into the structural challenges faced by
 trainee medical specialists during their training. These challenges seek
 to hinder them from achieving their personal dreams or aspirations. These
 challenges include, among others, the organization and structure of the
 specialist training programs, institutional culture and practices,
 supervision related challenges, gender and racial discrimination. Some of
 these constraints (e.g. gender and racial discrimination) reflect the lack
 of transformation within the PGME training environments and the persistent
 legacy of apartheid. 
 
 The study’s findings suggest that, instead of yielding to the constraints,
 the trainees utilised individual and collective agency to successfully
 navigate and overcome them in pursuit of their personal
 dreams/aspirations. Internal dialogues (autonomous and communicative) and
 social support emerged as important mediators of the trainees’ agency. The
 above findings are in contrast with the structuralist and individualist
 perspectives on the relationship between structure and agency which
 assigns determining power to structure and agency respectively. 
 
 On the conceptual level, this thesis contributes to the conceptualization
 of T &amp;L learning in PGME from the perspective of structure and
 agency, including using different research methodology to conceptualise
 the structure and agency interaction. It proposes that reflexivity,
 personal history, and social support are crucial factors that influence
 personal agency, and as such, should be taken into consideration in all
 endeavours aimed at comprehending the interplay between structure and
 agency. From a practical standpoint, this research offers valuable
 information on the challenges facing medical specialist training in study
 sites that can be utilised to improve training and to inform PGME policy
 direction.