Navigating landscapes of practice: a longitudinal qualitative study of physicians in medical education.

Balmer, Dorene F; Rosenblatt, Samuel; Boyer, Donald

INTRODUCTION Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (i.e., their landscape of practice) has implications for professional development but limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice. METHODS 11/29 physicians in one cohort of a masters in medical education program were interviewed annually from 2016 (program start) to 2020 (2 years post-graduation). We iteratively collected and analyzed data, creating inductive codes and categorizing coded data by mode of identification (engagement, imagination, alignment) and time. We organized narratives into time-ordered data matrices so that final analysis wove together mode, time, and participant. RESULTS All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate program; but that single community "doesn't define the journey itself." They shifted engagement from teaching individual learners to translating what they learned in the graduate program to develop educational projects and produce scholarship. They shifted imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate program's community of practice, then belonging to different communities in their landscape of practice, and ultimately focusing on communities that mattered most to them. DISCUSSION Physicians in a graduate program in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.