This thesis empirically explores the transition of medical trainees from formal training to practice. This study is framed around professional expectation violation of perceived ideals during early professional transition into practice. Literature suggests that upon entry into practice, new member professionals often encounter violations of professional ideals that were established during training and socialisation. This thesis explores the implication of this experience – how new professionals manage expectation violations. In a qualitative cross sectional case study, I studied medical trainees transitioning into practice in the Kenyan health care system.

These expected ideals surround care competency, conduct and career. Their experience of practice however, reveals violations in these areas, generated by contextual challenges such as practical norms and resource constraints. I identify how the processing of negative moral emotions facilitate moral injury, moral repair and moral disassociation, in newcomer attempt to respond to professional expectation violations. I unpack hidden mechanisms that bring about these responses during practice engagement. I theorise that these responses motivate different violation managing strategies – traumatized departure, peer supported survival and pragmatic acceptance. These findings are integrated into a five-stage process model. This study contributes to our understanding of the role of moral emotion in producing alternative responses to expectation violation during newcomer socialisation into professional practice.