Transition curve when changing posts or roles

This has been used extensively in business and when someone changes job they expect it will take 18 months for integration into a full time post. The change from hospital to General Practice is a huge transition. Use the curve to help us recognise how these stages influence confidence at different times of the year. Discuss this at induction since most think they are the only ones suffering difficulty.


Stage 1 is common as the flood of information, new people, new systems and ways of doing things threatens to overwhelm.

Stage 2 is resorting to previous successful behaviour. So for example the trainee who was a good efficient consulter in out patients persists with a hospital disease model forcing it to work even though it’s not right for General Practice. There is a level of unconscious competence here but with a less than ideal amalgam of competencies for the GP situation that needs to be challenged.

Stage 3 is an awareness of difficulties but a level of conscious incompetence that frustrates and confidence can become low. In hospital trainees often don’t see patients after their initial assessment. Now in spite of trying their best some patients are coming back no better. In other words the “November Blues” You can buy them a light box but it is better to move them on and to accept that change is hard but necessary. The over conscientious trainee may start to struggle as this trait demands more perfection than is possible in GP.

Stages 4 and 5 Moving them on sounds easy but there is often a rollercoaster of success and failure during this conscious competence phase. Watching a trainee video where they have tried to think about all the COT competencies can look very clunky.

It takes a lot of practice with good feedback to move onto Stages 6 and 7