The Challenge

Becoming a practicing physician involves multiple transitions—from undergraduate student to medical student to resident, for some, to fellow, for others, to practicing physician. Each step involves demonstrating competency to gain more autonomy. This transition may also involve major life changes, including physical relocation, uncertain expectations, and new relationships. The upheaval, even when the transition is an exciting step, is emotionally challenging and often affects function in all aspects of life.

What Is Known

There are 3 phases in transitions: the “end” of your previous life; an in-between (neutral) period when loss, confusion, and frustration are common; and a time of increasing rootedness or anchoring as you create connections with a new place in life.1  The transition to a new job often involves uprooting your life with new people, new hours, and new expectations—not just at work but at home. Reframing stressors allows you to approach these challenges from a growth mindset. Schlossberg's theory of adult transition,2  depicted as 4 S's (Table), can help you think through the Situation and identify personal strengths and challenges (Self) and Support networks to help create Strategies to smooth the transition. This approach may help modify the situation, reframe challenges to give them meaning, and build new support systems aligned with your values and purpose to manage stress better.


Schlossberg's Theory of Adult Transition, Depicted as 4 S's

Schlossberg's Theory of Adult Transition, Depicted as 4 S's
Schlossberg's Theory of Adult Transition, Depicted as 4 S's

How You Can Start TODAY

  1. Acknowledge that you are ending your last role(s). Take time to celebrate your accomplishments and consider your strengths, as well as those who supported you in these achievements. Acknowledge that there will be an emotional impact, even when the transition has been long awaited.

  2. Identify ways to be successful in building trust. Pay attention to your social networks. Dedicate time to maintaining appropriate relationships and seeking opportunities to build new ones. Bring your best to work and be open to input from others.

  3. Your family/friends will also experience stress as they adjust to your new role, schedule, and responsibilities. Be open and willing to listen to their concerns. Help them to acknowledge endings (eg, lost friends) and allow them to grieve as needed. You can complete a screening tool, such as the Holmes and Rahe Stress Scale, to identify stressors that are affecting your life right now.3 

  4. Answer questions about each of the 4 S's. Writing down honest answers may crystalize your thoughts more than just thinking about them. Share your thoughts to promote meaningful discussions and identify other ideas for you and your loved ones. Identify options to build support and implement strategies, including how to manage accompanying stress. Be kind to yourself. Transitions are stressful and seeking help is not a sign of weakness but rather of professionalism, strength, and a growth mindset.

Rip Out Action Items

A senior trainee should:

  1. Review your career goals and priorities as you consider the transition to a new role or job.

  2. Realize that all transitions involve an ending, a period of confusion or discomfort, and then a connection to the new role.

  3. Use a framework, such as Schlossberg's 4 S's, to prepare for a transition.

  4. Be kind to yourself and know that you will make it through this transition.

What You Can Do LONG TERM

  1. Recognize that transitions will occur frequently throughout your life, and any transition, even those you are excited about, can leave you feeling a little disenchanted and disengaged.

  2. Be prepared for the 3 transition stages by (1) acknowledging the end of your previous position, (2) expecting the “neutral zone” while you emotionally adapt to the changes, and (3) moving toward feeling connected and anchored.

  3. Deal with planned/unplanned transitions by proactively addressing planned transition issues by asking yourself (and loved ones) questions about all 4 S's in preparation. When unplanned, ask yourself the same questions, while paying careful attention to the Situation and Self as you deal with the unexpected.

  4. Take time to address the transition and acknowledge that there is a new beginning to embrace. There is a growing body of resources, such as the book The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter,4  that offer additional strategies for easier transitions.


Transitions: Making Sense of Life's Changes. 2nd ed
Cambridge, MA
Da Capo Press;
Counseling Adults in Transition: Linking Practice With Theory
New York, NY
Springer Publishing Company;
Mind Tools Content Team
The Holmes and Rahe Stress Scale
. ,
The First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter
Boston, MA
Harvard Business Review Press;