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The purpose of this paper is to explore specific instances of junior doctors' responsibility. Learning is often understood to be a prerequisite for managing responsibility and risk but this paper aims to argue that this is insufficient because learning is integral to the management of responsibility and risk.

This is a “collective” case study of doctors designed to focus on the interrelationships between individual professionals and complex work settings. The authors focussed on two key points of transition: the transition to beginning clinical practice which is the move from medical student to foundation training (F1) and the transition from generalist to specialist clinical practice.

Responsibility in clinical settings is immediate, concrete, demands response and (in) action has an effect. Responsibility is learnt and is not always apparent; it shifts depending on time of day/night and who else is present. Responsibility does not necessarily increase incrementally and can decrease; it can be perceived differently by different actors. Responsibility is experienced as personal although it is distributed.

This detailed examination of practice has enabled the authors to foreground the particularities, urgency and fluidity of everyday clinical practice. It recasts their understandings of responsibility – and managing risk – as involving learning in practice. This is a critical insight because it suggests that the theoretical basis for the current approach to managing risk and responsibility is insufficient. This has significant implications for policy, employment, education and practice of new doctors and for the management of responsibility and risk.

The aims of this paper are to understand the links between work transitions and doctors' performance and to identify the implications for policy, regulation, practice and research.

The paper explains transitions in terms of the inseparability of learning, practice and performance and introduces the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. It also identifies implications for practice, research and regulation

Drawing on empirical data in relation to prescribing and case management, the paper will show that, in contrast to current assumptions of, understanding about and practice in doctors' transitions, doctors can never be fully prepared in advance for aspects of their work.

Transitions are explained in terms of the inseparability of learning, practice and performance and we introduce the concept of the transition as a critically intensive learning period to draw attention to this phenomenon. Also identified are implications for practice, research and regulation.

Much research to date on professional transitions has focused on predicting them and then preparing individual practitioners to navigate transitions as sites of struggle. The purpose of this paper is to critically examine, within the context of professional practice and learning, diverse theoretical approaches that are currently prominent in researching transitions and to propose future directions for research.

The paper begins by describing work contexts integral with professional transitions: regulation, governance and accountability; new work structures; and knowledge development. The discussion then examines transitions research in developmental psychology, lifecourse sociology, and career studies. These perspectives are compared critically in terms of questions and approaches, contributions to understanding professional transitions, and limitations.

The implications for educators are a series of critical questions about research and education directed to support transitions in professional learning and work. Future directions and questions for research in professional transitions are suggested in the final section, along with implications for supporting professional learning in these transitions.

The paper is not intended to be comprehensive, but to identify issues for the reader's consideration in thinking about various forms of transition being experienced by professions and professionals. The discussion is theory‐based, exploratory, and indicative, rather than definitive.

This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and Management on regulating doctors.

This paper takes the form of a review.

Although the UK medical profession enjoyed a remarkably stable regulatory structure for most of the first 150 years of its existence, it has undergone a striking transformation in the last decade. Its regulatory form has mutated from one of state‐sanctioned collegial self‐regulation to one of state‐directed bureaucratic regulation. The erosion of medical self‐regulation can be attributed to: the pressures of market liberalisation and new public management reforms; changing ideologies and public attitudes towards expertise and risk; and high profile public failures involving doctors. The “new” UK medical regulation converts the General Medical Council into a modern regulator charged with implementing policy, and alters the mechanisms for controlling and directing the conduct and performance of doctors. It establishes a new set of relationships between the medical profession and the state (including its agencies), the public, and patients.

This paper adds to the literature by identifying the main features of the reforms affecting the medical profession and offering an analysis of why they have taken place.

The purpose of this paper is to describe experiences of transition from medical school to new doctor in the UK and to examine the development and evaluation of initiatives designed to lessen anxiety and assist transition.

The evaluations of two recent interventions for new doctors are reported, one at organisational and one at the individual level: first, a longer induction programme; and second, provision of a library of medical textbooks on smartphones (the “iDoc” project). The paper also reports on mindfulness training designed to help trainees' well‐being.

These initiatives address different aspects of transition challenges (related to roles and responsibilities, cognitive and environmental factors). Benefit can be gained from multiple approaches to supporting this time of uncertainty.

Given the link between transition, doctor stress and patient safety, there is a need to review existing strategies to ameliorate the stress associated with transition and seek novel ways to support new doctors. The authors argue that diverse approaches, targeted at both the organisational and individual level, can support new trainees, both practically and emotionally.

The paper reports initiatives that support transition, of value to medical schools, deaneries, researchers and trainees themselves.

In recent years, the clinical performance of named cardiac surgeons in England has been disclosed. This paper aims to explore the nature and impact of disclosure of clinical performance.

The paper draws on literature from across the social sciences to assess the impact of disclosure, as a form of transparency, in improving clinical performance. Specifically, it employs the “programme theory” of disclosure.

The “programme theory” of disclosure involves identification, naming, public sanction and recipient response. Named individual (consultant) surgeons have been identified through disclosure but this masks the contribution of the clinical team, including junior surgeons. Mortality is the prime performance measure but given low mortality rates, there are problems interpreting this measure. The naming of surgeons has been achieved through disclosure on web sites, developed between the health‐care regulator and the surgical profession itself. However, participation remains voluntary. The intention of disclosure is that interested parties (especially patients) will shun poorly performing surgeons. However, these parties' willingness and ability to exercise this sanction appears limited. Surgeons' responses are emergent but about a quarter of surgeons are not participating currently. Fears that surgeons would avoid high‐risk patients seem to have been unrealised. While disclosure may have a small effect on individual reputations, the surgical profession as a whole has embraced disclosure.

While the aim of disclosure has been to create a transparent medical system and to improve clinical performance, disclosure may have the opposite effect, concealing some performance issues and possibly strengthening professional autonomy. Disclosure therefore represents greater transparency in health‐care but it is uncertain whether it will improve performance in the ways that the policy intends.

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals.

The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted.

Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel “guilty until proven innocent” within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing “spectacular transparency”, driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a “blame business” is driving this form of transparency, in which self‐interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame.

A relatively small number of people were interviewed, so further research testing the findings would be useful.

Transparency has some perverse effects on doctors' practice.

Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding.

Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice.

The purpose of this paper is to describe the current context of social work as a profession and some of the major transition factors that are affecting social workers and social work organisations.

The paper first explores what social work is, and how it has developed as a profession. It reflects on social work academia and the place of social work educators and researchers. It then goes on to consider three factors that are having a major influence on social work as a profession: concepts of risk; personalisation; and the multi‐disciplinary environment.

The implications of these factors and the kind of transitions they are driving are discussed in the context of some of the potential implications for professional learning.

The paper does not aim to provide a comprehensive overview of all the factors that are affecting contemporary social work – the aim is to offer contextual information to help the reader consider some of the forces at play in social work. The paper does not introduce new empirical evidence, rather it identifies gaps in the existing evidence about these key influential factors.

The implications of social work in transition for society are that efficacy may be impeded if the profession is too inward looking.

This paper draws from the empirical and conceptual work of others – here the aim is to provide a broad overall context within which to consider the more detailed implications set out in further papers in the present issue.

The paper focuses on current debates about police professionalism. It explores the nature and meaning of what has been termed “old” professionalism, which focuses on the role of the police as “professional crime fighters”, and then assesses the extent to which there has been a transition to a “new” professionalism centred on enhanced accountability, legitimacy and evidence‐based practice. The paper aims to show how the recent attempt to embed this “new” professionalism within policing in England and Wales is likely to be compromised by the broader political and economic context of police reform.

The paper is based on a review of key contributions to the debates about police professionalism in the USA and the UK.

The paper provides important insights into the way in which there are competing and conflicting meanings attached to police professionalism and argues that claims that there have been significant transitions from one form of professionalism to another need to be treated with caution. The paper also emphasises the uncertain trajectory of the development of police professionalism in England and Wales in the future as a result of the complex interplay between the different elements of the coalition government's police reform programme.

The paper demonstrates the multiple meanings of the term “police professionalism” and the challenges that surround developing professional policing.