SHORT REPORTS

 

From dreamers to doers: Navigating the doctoral journey in family medicine and primary care

 

 

Klaus B. von Pressentin^I; Mpundu Makasa^II; Akim T. Lukwa^I; Innocent K. Besigye^III

^IDivision of Family Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
^IIDepartment of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
^IIIDepartment of Family Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

Correspondence

 

 

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ABSTRACT

This article examines the transformative journey of pursuing a Doctor of Philosophy (PhD) in family medicine and primary care through the lived experiences of four African scholar-practitioners. Using the Hero's Journey framework, the authors reflect on the emotional, intellectual and structural aspects of doctoral education, highlighting the unique challenges faced by clinician-researchers in resource-limited settings. Each vignette illustrates the transition from dreaming to doing by navigating identity shifts, funding obstacles, methodological complexities, as well as the need to balance clinical service with academic development. The article offers practical insights for prospective doctoral degree candidates, including the importance of defining one's purpose, building supportive networks, and adopting adaptable strategies. It also calls for institutional reforms to enhance supervisory capacity and funding mechanisms. By merging personal narratives with reflective analysis, the authors aim to inspire and equip future doctoral candidates in family medicine and primary care, encouraging them to view their journey not just as an academic endeavour but as a pathway to leadership, thereby strengthening the discipline's knowledge foundation and enhancing primary care. This contribution serves as a guide for moving from aspiration to action, offering practical wisdom for navigating the complexities of doctoral education in African primary care contexts.

Keywords: PhD journey; primary care research; doctoral experiences; education; graduate; primary health care; Hero's Journey; African PhD graduates.

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Introduction

Despite the growing need for established researchers, especially in sub-Saharan Africa, which contributes only 1% of global research output, the doctoral journey remains daunting for many.¹ This doctoral degree is viewed as a significant investment and its educational purpose differs from a Master's degree (which can be one of three types, namely taught, research or professional Master's). In family medicine, a professional Master's degree is designed to educate and train graduates for advanced professional employment as specialist family physicians. A professional Master's degree typically includes a mini-dissertation describing a single research or technical project. In contrast, a doctoral degree or a Doctor of Philosophy (PhD) requires a candidate to undertake research at the most advanced academic levels, culminating in the submission, assessment and acceptance of a thesis. Higher education frameworks have defined the doctoral degree as requiring a demonstration of high-level research capability and a significant and original academic contribution at the frontiers of a discipline or field.^2,3 The doctoral work can be discipline-based, multidisciplinary or applied research, requiring at least 2 years of full-time study, typically following completion of a Master's degree. Doctoral degree graduates are expected to possess the capability to supervise and critically evaluate the research of others within their fields of specialisation.

High attrition rates and emotional strain discourage potential candidates, even as institutions hope that students will find the process fulfilling. A significant number of doctoral students, in some cases as high as 70%, never complete their degrees.⁴ Studies have also shown that one in every three students contemplates dropping out at some point.⁵ This occurs despite substantial investment of time, money and energy by the doctoral students and their supervisors. Several factors can significantly impact the journey towards completing and attaining a doctoral degree. Reasons or factors may lie within and beyond the student's control, including sociodemographic characteristics of PhD candidates, financial hardships, limited resources and training, the quality of supervision and the coping strategies employed by those undertaking a PhD programme.⁶ The student must learn adaptive mechanisms and techniques to address these obstacles. Van Rooij et al.'s study on doctoral success provides valuable guidance, which emphasises the importance of supervision quality, psychosocial factors, workload, autonomy, a sense of belonging and alignment with supervisors' research.⁷

The evolving role of family medicine and primary care in healthcare systems underscores the growing importance of developing researchers and academic leaders in the discipline. Family medicine PhD students often occupy unique positions as clinicians, educators and researchers. Despite their increasing presence, there is a limited body of literature capturing the lived experiences of family medicine PhD students. Generic guides, such as Brennan's '100 Rules of PhD', offer useful advice but often lack the lived experience and contextual nuance needed to support students.⁸ Resources that integrate the emotional, intellectual and practical aspects of the doctoral journey are scarce, and many students face the dual-identity challenge of balancing their roles as clinicians and researchers.

 

Why this guide matters

This article aims to provide a reflective, supportive and practical guide for navigating the PhD journey, drawing on the authors' lived experiences. It seeks to normalise the highs and lows of the PhD experience while inspiring and equipping future candidates and guiding supervisors. We would like to remind readers that embracing the complexity of family medicine doctoral journeys differs from those in other disciplines and even within the same discipline (e.g. dual clinical-academic roles, decentralised and rural settings and a low supply of experienced doctoral-level supervisors).⁹ We have written this contribution for the African Journal of Primary Health Care & Family Medicine (PHCFM) special collection with a specific audience in mind: those colleagues who are dreaming of pursuing a PhD and would now like to find out how best to transition from dreaming to doing.

 

Introducing the approach to unpacking our stories

To support prospective African PhD candidates in family medicine and primary care, we adopted a reflective narrative approach based on the Hero's Journey Framework, as conceptualised by Joseph Campbell and applied to doctoral education by Salter.^10,11 Salter aligns the three main acts - departure and call to adventure, initiation along the road of trials and the return - with key doctoral phases: admission into doctoral education, life as a doctoral student and dissertation completion. Drawing on Salter's adaptation of Campbell's Hero's Journey, we use six archetypes - Innocent, Orphan, Wanderer, Warrior, Altruist and Magician - to frame the evolving psychological challenges of doctoral education. These archetypes reflect different stages of transformation: the Innocent begins with naive optimism and trust in the system; the Orphan enters the journey out of necessity, carrying emotional burdens; the Wanderer seeks independence and meaning amid uncertainty; the Warrior confronts obstacles with courage and determination; the Altruist is driven by a desire to make a meaningful impact while balancing passion and objectivity; and the Magician, embodying the culmination of the journey, integrates the strengths of all previous archetypes to become a wise, independent scholar capable of mentoring others. Together, these archetypes offer a reflective framework for understanding the identity formation and transformative nature of doctoral education.

To bring these archetypes to life, we share four personal vignettes (Box 1 - Box 4), each structured around the early stages of the Hero's Journey: the Call to Adventure (beginning the PhD); Crossing the Threshold (major challenge); and Trials and Allies (supervisors, peers and tools). These stories reveal how identity, purpose and resilience evolve through the doctoral process.

 

The stages of the PhD journey

The narrative arc outlined in our vignettes emphasises the PhD as a transformative journey rather than a simple academic task.^15,16 We must remain aware of this generative process as we pass through thresholds and milestones from the perspectives of a student, supervisor and institution, all of which are used to monitor the doctoral progress. The doctoral journey in family medicine resembles the Hero's Journey, divided into three acts: departure, initiation and return. The call to adventure arises as clinicians feel a stronger pull towards research, often motivated by a sense of purpose or recognition of systemic gaps in primary care. Crossing the threshold signifies the shift from practitioner to scholar, facing challenges such as organising study leave, balancing clinical responsibilities and managing the uncertainty of this new role. During trials and alliances, candidates face obstacles - such as funding setbacks, isolation and methodological difficulties - while drawing strength from supervisors, peers and digital tools. These experiences drive transformation, leading to shifts in identity from dependent learners to independent researchers. Ultimately, the return with wisdom represents not only the completion of a thesis but also a renewed commitment to improving health systems, mentoring others and advocating for evidence-based primary care.

Table 1 summarises the key insights from the authors' journeys, aligned with the archetypes and early stages of the Hero's Journey. Table 2 represents general stages or phases of a PhD, ranging from dreaming to doing to completing.

 

Practical tips for success

We reflected on key tips (summarised in Box 5) that we would have offered our younger selves as we approached the threshold of commencing our PhD journey. Successfully navigating the PhD journey starts with understanding your core motivation. Even if your 'why' is not immediately clear, remaining receptive to discovering it is essential. Think of defining your rhumb line - a steady, guiding purpose that helps you stay grounded, especially when clinical work complements your research. A hybrid approach to balancing your 'day job' and PhD project work can help maintain continuity and focus. These include using the early morning slot, writing and working before usual hours, taking leave for dedicated writing and working or buying out time and splitting the week between part-time clinical and research work. Establishing healthy boundaries and practising self-compassion are essential for well-being.¹⁷

 

 

Persistent challenges in many doctoral programmes include inconsistent funding disbursement and delays in supervisory feedback, which can lead to financial insecurity, slow progress and psychological stress. Students should pursue scholarships, grants and institutional aid to address funding issues. Clear communication and alignment through Memoranda of Understanding (MOUs) can ease supervisory pressures. Institutions should consider mechanisms to streamline scholarship payments, ensure timely supervisor feedback and build supervisory capacity at the doctoral level.

Remember, progress is rarely linear; pace, milestones and planning are essential. Globally, there is a trend towards a more structured and collaborative approach to doctoral education.¹⁸ Supervisors are increasingly working in teams, and doctoral students are more likely to receive targeted interventions at specific stages of their research. They also tend to have milestones marking their progress. Examples of increased structure include the addition of coursework, an examination at the end of the first or second year and a 7-year deadline to complete the study. Success, therefore, depends on careful organisation, such as setting milestone goals and using digital tools to monitor progress. Managing time effectively involves prioritising high-impact tasks using techniques such as compiling writing blocks and scheduled breaks, following the Pomodoro technique, a reliable and sustainable method developed in the 1980s.¹⁹

Academic growth is supported by attending coursework (if offered), academic meetings and conferences, engaging in critical reading and maintaining a research journal. Writing is often viewed as a source of negative emotions, such as frustration and confusion, which frequently dominate the doctoral writing experience. Collaborative writing enhances self-regulation, motivation, emotional well-being, writing quality and completion rates. The doctoral reading process is closely linked to effective writing. Academic and professional identity is formed through activities such as writing and attending academic meetings and conferences. The lack of curriculated support, such as coursework or departmental seminars, has been linked to South Africa's high doctoral dropout rates.¹⁸ Common challenges for doctoral students include defining research problems and managing frustration with the scientific method during real-world research. Although doctoral students are often viewed as independent researchers in training, they may initially face challenges in unstructured situations because of issues with self-regulation. Unlike coursework, research tasks are frequently poorly defined, which can cause anxiety and confusion.¹⁷ When this occurs, reaching out to your supervisor for guidance can help you refocus and monitor your progress. Thriving in your PhD requires a holistic approach: maintaining methodological rigour, starting to write early, seeking constructive feedback, connecting with the scholarly community represented by your academic discipline and planning for your future career.

Building support networks and selecting the right allies - such as supervisors, peers and mentors - is vital. International trends favour more structured, collaborative doctoral methods, which may boost success.

 

Conclusion: From dreamers to doers

Reflecting on our journeys, we offer lived insights to those contemplating a PhD, guiding them from dreaming to doing and to embarking on their own Hero's Journey. In terms of reflexivity, we acknowledge the diversity of our backgrounds, disciplines and contexts. We are three male and one female scholar-practitioners, with varied timelines of PhD completion and professional trajectories across African academic and clinical settings. Our lived experiences shape our reflections on navigating our doctoral work while balancing service, teaching and personal commitments. We recognise that our positionality - as insiders within the discipline and as recent graduates - offers both proximity and hindsight. This dual lens enables us to speak candidly to the emotional, intellectual and structural dimensions of the PhD journey. By applying the Hero's Journey Framework, we seek to honour the transformative essence of doctoral education while recognising the challenges and enabling factors that have shaped our paths. We strive to provide prospective candidates with a grounded, empathetic and contextually relevant guide, rooted in both collective wisdom and individual experience. While our insider perspectives offer depth, we acknowledge that our specific contexts shape our reflections and may not represent all doctoral experiences in Africa. In line with previous regional-level discussions, we propose forming a scholarly core of emerging and established researchers at departmental, national and regional levels to help strengthen the discipline of family medicine and raise its profile.²⁰

A PhD journey is a challenging process, with each step a possible cause of anxiety - from uncertain beginnings to integrating work and discoveries. Despite the difficulties, it is a rewarding experience that makes a significant contribution to society and one's disciplinary knowledge base. We hope this reflective essay inspires prospective candidates to begin their journey with confidence, clarity and a sense of community. Future candidates should see themselves not just as students, but as future leaders in family medicine and primary care.

The authors of this publication received research funding from the National Institute for Health and Care Research (NIHR) (Grant Number: NIHR158451) under the project 'Improving the core functions of primary care in sub-Saharan Africa'. The terms of this arrangement have been reviewed and approved by the NIHR in accordance with its policy on objectivity in research. The author, I.K.B., serves as an editorial board member of this journal.

K.B.v.P. led the conceptualisation, design and drafting of the manuscript. K.B.v.P., M.M., A.T.L. and I.K.B. provided intellectual input and critical revisions.

This work was supported by the NIHR (Grant Number: NIHR158451) under the project 'Improving the core functions of primary care in sub-Saharan Africa'.

The views and opinions expressed in this article are those of the authors and are the product of professional research. They do not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article's results, findings and content.

 

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Correspondence:
Klaus von Pressentin
klaus.vonpressentin@uct.ac.za

Received: 28 Aug. 2025
Accepted: 02 Oct. 2025
Published: 09 Nov. 2025