Abstract
BACKGROUND: Belongingness is an individual sense of "connection" or "acceptance" from others, created through an interaction between an individual and their surrounding environment, and impacts medical education. How anesthesiology interns develop a sense of belongingness within anesthesiology is poorly understood. This study explores the pathway and mechanisms by which anesthesiology interns develop a sense of belongingness. METHODS: Semi structured interviews were conducted with 23 anesthesiology trainees during the 2023-2024 academic year. A constructivist, qualitative approach rooted in grounded theory was used to generate a middle-range theory on the development of belongingness among anesthesia interns. RESULTS: The authors identified 4 primary facets of anesthesiology interns' Belongingness Journey described as (1) Stepping into liminality, (2) Cohesion with(out) contact, (3) Purpose-driven belonginess, and (4) Perceived self-actualization. As trainees entered the liminal space of internship, multiple mechanisms destabilizing their sense of belongingness emerged, described here as performing normalcy and managing otherness. Interns combated destabilization by widening their social networks, most often to include other interns, and less frequently to include clinical anesthesia residents and faculty mentors. Alignment with purpose appeared protective, and to enhance this alignment, interns turned to multiple strategies including reframing and deliberate engagement. Upon crossing the threshold into their next year of training, interns described a sense of self-actualization and renewed belongingness despite entering a perhaps equally liminal space. CONCLUSIONS: Anesthesiology interns' idiosyncratic lived experiences track along a belongingness journey. Knowledge of this pathway may help to inform the creation of future professional development and belongingness curricula.