1848: New Professionals and Experiences of Extreme Values Violations: A Study of Novice Physicians in Kenya (18593)

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We explore how novice professionals experience and respond to violations of professional values that are severe and recurring when working at the organizational frontline in highly resource-constrained contexts. We investigate this important question through a qualitative study of novice physicians undergoing internship training in public hospitals in Kenya as new entrants into the medical profession. Our findings show that lived experiences of extreme values violations are variously interpreted in relation to selfhood, shared professional identity, and fatalism. For individual professionals, these triggers activate cycles of moral emotions and practical actions leading to systemic outcomes along three different pathways: traumatized departure, peer-supported survival and pragmatic acceptance. Our study makes three contributions to the literature on professions and values. We develop a new concept of ‘extreme values violations’ as institutionally embedded in resource-constrained contexts. We cast fresh light on theories of professional socialisation and identity construction through a dynamic process model of how novice professionals cognitively, emotionally and practically navigate extreme values violations in frontline work. Finally, we offer insight into the grand challenge of healthcare in Africa and open up the boundary conditions of Western explanations of how professional values shape frontline work.

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