to be hospital pharmacist 9

Group dynamic and the pre-regear

There are many theories relating to group dynamics in the management
literature but one theory that sits comfortably in the pre-reg year relates to
the stages of group formation and how groups go through the same stages.

Bruce Tuckman (1965) proposed a model, known as Tuckman’s
stages, for a group. Tuckman’s model states that the ideal group decisionmaking
process should occur in five stages and this is how groups, e.g. a
pre-reg group, may function:

•   Forming
•   Storming
•   Norming
•   Performing
•   Mourning.

It should be noted that this model refers to the overall pattern of the
group, although individuals within a group work in different ways and may
not go through the stages at the same rate as the whole group. If distrust
persists, a group may never even get to the norming stage, remaining stuck in
perpetual conflict in the storming stage. Although the explanations below
refer mainly to a large pre-reg team, they are equally applicable to working
teams in rotations, e.g. the dispensary, although the stages of group formation
may progress quicker or get stuck at a particular stage because rotations
are generally only for a few weeks.

Forming

This is the first stage of any group formation. At the start of the pre-reg year,
during induction, you will all be trying to get to know each other and get
along with each other. Some hospitals have an induction period for you to get
to know each other better, as well as for getting used to the new working
environment. This stage is sometimes known as the ‘honeymoon phase’ in
which everyone is just trying to get along, with any differences in personalities
being swept under the carpet. 

Everyone is nice and polite with each
other, even if the behaviour and opinions of others differ significantly. The
group is starting to form and, as time progresses, you will start to identify the
characteristics of the other pre-regs. Sometimes this stage is quite quick and,
by the end of the induction period, if you have one, the gloves are off and
there is some movement and jostling among group members as you all try to
find people with whom you will get along and share interests.

This can be a tricky stage for the pre-reg group because you may have
other pre-regs in your group who were your friends at university or went to
the same university as you. You may find yourself going towards such
pre-regs because this is the only common ground that you have; you may
not have spoken to the others while at university because you had different
circles of friends. On the other hand, you may be the only one from your
university and find it rather difficult to break into a group who all know each
other from previously.

The other difficulty is that you may not be a very confident person
and need some time to get to know people; you may not feel comfortable
approaching people whom you do not know. Hopefully others in the group
will make this easier for you by trying to get to know you, so that you do
not need to make the first move. This stage can be similar to starting a new
school, college or university, when you had to get to know your classmates;
the only difference is that now you will be together in a work environment
for a year.

Storming

The next stage can be either problematic for the group or fairly straightforward;
this depends on your relationships with the rest of the pre-regs. Some of
you may find that this stage has gone quickly and smoothly because relationships
have been established and everyone is happy with them. Others may
find that this is the most difficult stage but did not want to speak up and say
something for the sake of the group. 

This could happen because you are a
quiet person and as a result the others have labelled you in a particular way
and not involved you, so you end up with a certain role in the group. This
stage could be difficult if you were used to being one of the leaders and the
centre of attention at ‘home’ or university, when now you are faced with a
situation where you have to compete with other pre-regs whom you do not
know. This may take the form of disagreements over a range of things, from
how to undertake a particular task at work to where to go out with the
pre-reg group.

The honeymoon phase is well and truly over and the true personalities
are beginning to come through as people seek to establish themselves.
Sometimes this can bring out the worst in you and, on occasions, you may
not even be aware of this yourself. All pretence of being polite to each other
has been dropped and tempers can often flare up. A particular difficulty can
be where the pre-reg group is imbalanced in terms of males and females, with
more females in the group. This is generally the balance in hospital pharmacy
where women outnumber men.

You may feel that you are being victimised and perhaps even bullied
by other members of the group, and have to go along with decisions being
made by the majority. You have to decide whether you can be flexible and
join them – if you can’t beat them, join them – or whether you are happy
doing your own thing. In our experience, there have been occasions when
two pre-regs who were previously friends from the same university had a
complete breakdown of their relationship, with the result that they could
not be in the same room together let alone undertake group tasks. This can
sometimes cause the group to fracture and become two distinct, mutually
exclusive groups. Other examples are where an individual has arrived in a
group that was already formed, e.g. for sandwich course placements,
which has disrupted the group with the result that new groups formed.
We discuss the experiences of sandwich course placements elsewhere in
the book.

During this stage the group starts to establish roles: there are some
leaders, some followers and some general group members, and a team starts
to form. Referring to the team, some prefer to take up the striker, or goal
shooter, role whereas others prefer to act for the defence, leaving the general
team players as the midfield. As the group identifies individuals’ strengths
and weaknesses a team purpose starts to develop. On occasions a hierarchy
may develop in which certain people are looked up to within the team,
playing the role of team captain, but generally a team of ‘equals’ means that
there is flexibility for the range of tasks and situations encountered during the
pre-reg year.

Norming

This stage follows the storming stage and is where the team starts to get
used to each other and members are happy to disclose their strengths and
weaknesses for the benefit of the team. The team are getting used to each
other’s company and there is no pressure from the other pre-regs to always
be a part of the team. There is more honesty and openness and, if you do
not want to get involved in a particular activity, this is accepted by the
others. 

This stage is quite nice because things have moved on from the
conflict stage; if two people do not get on with each other, this is recognised,
sometimes implicitly, and the two keep away from each other or are
polite towards each other without being the best of friends. This is important
in any size of pre-reg group because, if there are only two of you, you
will either just do your own thing or work together; in larger groups,
smaller subgroups begin to develop but the group as a whole still functions
as a team.

Performing

This is the best stage of any group or team and is where you all work well
together with a common purpose and dedication. All know their roles and
are comfortable with them, and work is shared among the team, with
everyone helping each other out. Although we all hope that this stage is
prolonged over the year, in actual fact the group can go backwards and

forwards from this stage as the pre-reg year progresses and brings different
challenges. Towards the end of the year, when preparation for the registration
exam is at its height, if the team is at the performance stage then
everyone is helping each other out with revision and help, support and
guidance.

This stage can be encountered earlier on in the year when, in larger
groups, a group task is given to you and you have to work together to achieve
this. An example of this is if you have been allocated the task to arrange a
departmental party, such as the Christmas party, which is traditional in some
hospitals. The group then becomes a team and you work together to make
sure that the party is a success; this can occur even if the group is going
through the storming or norming stages.

Mourning

Although it is obvious that this stage occurs at the end of the lifecycle of a
group, there are other times in the year when this can also occur. The turn of
the calendar year is when the recruitment for pharmacist positions usually
occurs and it is sometimes at this stage that the team re-forms and goes
through the stages again.

You may find that you are competing with your peers for the same
jobs in your hospital, which may cause some friction and conflict because
this may be the first time that you are in direct competition with each other.
This can be considered as the storming stage revisited and the group
quickly goes through the other stages to the mourning stage once the
winners and losers have been identified. 

Sometimes the pre-reg team can break down into those who have got the jobs that they wanted and those who still have to be successful in the jobs that they want. If you are one of
the lucky ones who have got the job of your choice, you can sometimes find
it difficult to stay within the team as it was before because you may feel
guilty about being successful at the expense of your peers, some of whom
you may think were better candidates than you. Alternatively, you may feel
the opposite and start to move away from the team and look towards the
people with whom you may be working once you have qualified. This may
well alienate you from the rest of the pre-reg team. 

It will mark the end of the pre-reg team and be a watershed moment; it is interesting 

to see how you all react and behave towards each other during the time of recruitment.
The other time that this stage is encountered is at the end of the training
year, when you get your registration exam results. Most pre-reg years finish
very soon after the exam results; some years finish on the day of the results, so
that you have very little time to absorb the enormity of passing the exam and
then saying goodbye to the pre-reg team. There will be some sort of gathering
when you may all be together at the end of the year, although this does not
always happen; in some instances you may take the day off from work to get
your results and never see each other in the pre-reg team ever again; although
disappointing, this does happen.

You will all say that you will keep in touch with each other and with
your tutors, but in reality it is very unlikely that you will stay in touch
unless you have made real friendships during the year. In our experience,
few pre-regs actually stay in touch with each other, or their tutors, after the
pre-reg year; they move on to the next stages in their careers. Even if they
see each other after the pre-reg year, it is never the same as it was during the
year.