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.
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.
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.
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 ‘
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).
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.
To bring these archetypes to life, we share four personal vignettes (
Vignette 1: Navigating a taught PhD abroad.
My professional journey started with an internship and a senior house officer position at a tertiary hospital, followed by a mandatory rural placement in a primary care setting. After completing my Master’s in Public Health, I worked both as a clinician and a public health practitioner, eventually becoming a district manager responsible for programme planning. Despite nearly 8 years of experience, I found it challenging to identify a clinical speciality that matched my interests, especially in family medicine, which was not available in my area. To enhance my education, I pursued a PhD in Epidemiology at the University of Bergen in Norway.
I pursued a taught PhD that required coursework. After arriving in Bergen, I shifted from a management role in planning and development to being a student. Alongside coursework, I developed my PhD proposal, balancing work and study. I managed my time to handle courses, reading, research and writing. Regular meetings with supervisors and weekly research seminars helped track progress. Listening to peers motivated me and kept me on pace.
Embarking on the PhD journey soon made me realise that I was a ‘senior student’, responsible for demonstrating my ability to work independently and manage my own progress. I was expected to organise meetings with my supervisors and share my work in advance. These meetings focused on specific sections of my research, allowing for discussions that clarified methodology and project details. After completing our coursework in the first year, I experienced feelings of loneliness as we transitioned to working individually in our offices. Each of our research plans varied significantly based on personal interests and locations, leading to different timelines for fieldwork and graduation. Our close-knit group began to feel disintegrated because of the unique demands of our projects.
Key factors in my success included a fully funded scholarship that covered living expenses and research costs, reducing financial stress. However, I needed extra funding for laboratory work, such as Polymerase Chain Reaction testing. Having dedicated supervisors who provided prompt feedback helped me stay on schedule and graduate on time. The programme also allocated funds for academic materials, giving access to essential resources. In addition, milestones such as conference attendance and presentations were supported by these academic funds. Training in a well-structured PhD programme was invaluable, especially because my home country lacked a School of Public Health at the time, making such studies impossible locally. I appreciated that the programme was flexible and allowed me to travel home as often as reasonably possible. Despite the demands of school, this helped me maintain a healthy balance between my school and personal life.
Writing can be daunting, especially for beginners who struggle to conceptualise topics. My focus shifted considerably after discussions with my supervisors, which, although sometimes frustrating, were crucial for pinpointing the right area, formulating a relevant question and closing knowledge gaps. Moving in a new direction required me to familiarise myself with general medicine, but I managed to do this quickly. Along the way, I gained skills in literature searches, writing and responding to feedback from ethics committees and journal reviewers. Using different study designs and data collection tools helped me learn various methods, while managing fieldwork taught me the importance of patience and teamwork. Publishing my first academic article was particularly challenging, but it marked a significant milestone in my PhD journey. Having a supportive team of supervisors, including a senior professor and a recent PhD graduate, was invaluable. Their dedication and commitment greatly supported my academic, social and mental well-being.
PhD, Doctor of Philosophy.
Vignette 2: Balancing clinical roots and academic purpose.
At the beginning of my PhD journey, I was a newly qualified family physician working at a rural district hospital, where I balanced clinical duties with student teaching. The healthcare system was still unsure about the role of family physicians, and I was trying to establish my place. When the opportunity to join a national research project and pursue a full-time PhD to explore how family physicians can strengthen district health services arose, I felt a strong pull – but I couldn’t quite put my finger on why.
During my interview for the PhD position linked to the funded project, for which my supervisor was the principal investigator, I was asked about my ‘why’. I remember honestly replying: ‘I just know I need this opportunity’. It wasn’t a polished answer, but it was true. The sense of purpose became clearer later. Arthur Brooks describes this well: ‘A rhumb line (used by sailors to simplify charting and navigation by providing a fixed course) is a path of constant bearing – it doesn’t always get you there fastest, but it keeps you true’.
The first challenge was negotiating a hybrid model: the project role funded my time, but I wanted to stay clinically active (1–2 days/week) and remain within my rural community. This involved developing an agreement with my supervisor to allow me to spend 3–4 days per week in Cape Town at the university and the remaining days at home supporting my rural district hospital as a clinical family physician. A senior colleague advised: ‘Stay clinically connected – it will keep your research grounded’. That became a guiding principle. Another colleague expressed surprise at my decision to step away from the expected path towards a family physician consultant role, saying, ‘You’re moving away from what you were trained for’. But I saw it differently: I was investing in a broader contribution to the discipline and suspected that my path would lead towards academia.
Early hurdles included navigating methodological considerations (which study designs will be ideal to capture the early impact of our discipline in strengthening the South African district health system), ethics processes (obtaining ethical and gatekeeper permission for fieldwork across seven South African provinces) and imposter syndrome (‘Am I the right person to take on this vital role to study the early impact of my discipline?’ – pivoting between the emic and epic, or insider and outsider perspectives). My supervisor was a reliable guide in helping me overcome these challenges. I also appreciated the support of close colleagues, including the fellow project colleague who mentored me during this early phase of my PhD as a near peer while completing her own PhD. Despite having no formal coursework requirements, I was able to participate in opportunities such as the African Doctoral Academy, which helped me enhance my skills in using software for quantitative and qualitative analysis methods. Rural life itself provided space for reflection. The balance between clinical work and research helped me stay aligned with my purpose.
PhD, Doctor of Philosophy.
Vignette 3: Persevering through scarcity and self-doubt.
My professional career as a doctor has mainly been in academic medicine. Therefore, doing a PhD was not an exception but a necessary part of my career journey. However, there was no opportunity to undertake doctoral studies without switching my speciality from family medicine and primary care, as the required mentorship and supervision were not available in that field. The available opportunities were in other specialities. I was not prepared to join new networks and disciplines. Another challenge was the lack of funding.
As a result of my strong desire to pursue a PhD, I continued to seek support and funding. I regularly shared my aspirations with many colleagues, including juniors, peers and seniors within the family medicine community. This curiosity was noticed by colleagues who could mentor or supervise a PhD and those with access to funding. This recognition marked the beginning of my journey.
Once supervision and funding were secured, the preparation began. Several challenges arose during this phase. The major hurdle was the scarcity of faculty staff in my department who, because of heavy workloads, found it difficult to grant study leave for dedicated doctoral research time. Family issues also arose regarding how to continue meeting my obligations to those under my care. Furthermore, I experienced anxiety from the uncertainty about what the journey would entail and how it would unfold. Finding a research topic proved to be difficult, although reviewing prior research studies was helpful. Inadequate funding was another obstacle; the only support available covered tuition fees, not research expenses.
Once the journey began, new challenges emerged, including balancing work and study simultaneously. Strategising my time between work and research helped a great deal. Some days and times were dedicated to work while others were reserved for research. The colleagues within my department understood the precarious circumstances I faced and reduced my teaching load. For example, I was less involved in undergraduate tutorials.
Difficulties with obtaining research funds also arose. With my supervisor’s help, I continued to apply for research funding but remained unsuccessful. Then, an opportunity arose to apply for research funding from the Ugandan government through my university. I applied and succeeded. Problem was solved. However, it was only for 1 year, with a 1-year no-cost extension. Having an already approved proposal was helpful, as I was ready to begin the research work.
Technology proved to be a great ally. I was in my home country, but had regular online Zoom meetings with my supervisor, even before Zoom became commonly used during the coronavirus disease 2019 (COVID-19) pandemic. I also participated in some workshops offered by the university’s postgraduate office via Microsoft Teams.
Procrastination and writer’s block were regular challenges. I had to find ways to deal with these two obstacles. A PhD involves reading and writing – both tasks that can be somewhat uncomfortable. Using online resources and coaching, such as Daphne Gray-Grant’s writing courses, was very helpful.
Taking a break from the PhD for more than a week can lead to undesirable effects, making it difficult to get back on track and costing valuable time. Developing an open mind is essential if you do not yet possess one. The PhD has many stakeholders, including your supervisors, journal editors and reviewers, examiners and others. The likelihood of encountering divergent views from any of them is high. Be receptive to change, criticism and differing opinions. Personal patience and resilience are vital allies. Many aspects of the PhD journey – such as the time taken for Institutional Review Board approval or the turnaround time for manuscript submissions – may be beyond your control. These delays can cause significant anxiety, especially given the tight timelines set by universities and institutions.
PhD, Doctor of Philosophy.
Vignette 4: Transforming purpose into scholarly impact.
When I began my PhD, I quickly realised that knowing my ‘why’ wasn’t just helpful; it was essential. A PhD is not simply an academic exercise; it’s a marathon of critical thinking, problem-solving and resilience. There are moments when the excitement of a new idea gives way to the grind of data collection, the frustration of unexpected results, or the sting of critical feedback. In those moments, my ‘why’ became my compass. It reminded me that I wasn’t just chasing a degree; I was working towards knowledge that could influence policy, improve lives and challenge the way we think about health and inequality. That purpose gave me perspective, turning obstacles into stepping stones rather than roadblocks.
I have met people who began their PhD because it seemed like the logical next step, but without a strong ‘why’, it’s easy to feel lost or disconnected from the work. For me, my ‘why’ shaped the research questions I asked, the collaborations I pursued and even the sacrifices I was willing to make. It kept me grounded in the bigger picture, ensuring that every late night in front of Stata, every draft revised, and every conference presentation was a contribution to something that mattered deeply to me.
One of the key lessons from my PhD journey so far has been the importance of managing expectations of both myself and the process. Initially, I started with great energy and enthusiasm, but I quickly realised that timelines in academia are often flexible. Supervisors, while supportive, often juggle multiple commitments, which can result in longer turnaround times for feedback. This realisation was initially disheartening, but it taught me to proactively plan around these delays (e.g. setting earlier internal deadlines, scheduling follow-ups or using waiting periods for tasks like literature reviews).
Another unexpected challenge was the administrative burden of the PhD, especially when coordinating data collection. Ensuring timely payments for research assistants, troubleshooting fieldwork logistics and maintaining team morale required meticulous organisation. For those pursuing a thesis by publication, the current journal turnaround times add another layer of complexity. Some institutions require all articles to be accepted before submission, so building buffer time into the timeline (and considering preprint options or parallel submissions where permitted) is crucial.
Beyond logistics, the PhD can be a profoundly isolating experience. Unlike structured coursework programmes, there’s no built-in cohort, and few people truly understand the nuances of your research, which means well-intentioned advice sometimes misses the mark. This isolation is especially acute for those joining a new institution without existing connections. To counter this, I’ve learned the importance of seeking out mentors (both within and outside my field) and nurturing peer networks, even informally. Discipline and time management are essential, but so is self-care. It’s easy to become absorbed by the PhD, but the degree is temporary; relationships, however, are not. I’ve seen colleagues lose touch with family and friends, only to regret it later. Setting boundaries (e.g. dedicated ‘off’ hours, regular social plans) and remembering that the PhD is just one part of life have been vital for my well-being.
PhD, Doctor of Philosophy.
The narrative arc outlined in our vignettes emphasises the PhD as a transformative journey rather than a simple academic task.
Key insights for each step of the Hero’s Journey.
| Archetypes and journey stages | Vignette 1 | Vignette 2 | Vignette 3 | Vignette 4 |
|---|---|---|---|---|
| Archetypal expressions | Orphan and Warrior, navigating isolation and institutional gaps with resilience | Wanderer and Altruist, balancing clinical service with academic purpose | Warrior and Caregiver, demonstrating perseverance and adaptability in the face of structural and personal challenges | Magician and Altruist, integrating resilience and strategic reflection to transform obstacles into opportunities for personal and scholarly development |
| Call to Adventure | I wanted to maintain my generalist clinical identity, so I pursued a PhD in epidemiology when no suitable speciality existed locally. | I was a newly qualified FP in a rural hospital, drawn to a national research project that aligned with my deeper purpose. | I always knew a PhD was part of my academic path, but I lacked mentorship and funding in family medicine. | I needed my PhD to contribute knowledge that could influence policy and address health inequities. |
| Crossing the Threshold | Transitioning from manager to student was tough; coursework and proposal development were overwhelming. | Negotiating a hybrid model to stay clinically active while doing research was my first major challenge. | I struggled to get study leave, manage family obligations, and secure research funding. | Managing fieldwork logistics and journal timelines added unexpected administrative weight. |
| Trials and Allies | My scholarship, committed supervisors and flexible programme helped me stay balanced and focused. | My supervisor, near-peer mentor and rural setting helped me stay grounded and reflective. | I leaned on tech tools, a study companion and online writing resources to overcome procrastination and isolation. | I built informal peer networks, set boundaries for self-care and stayed anchored by my ‘why’. |
FP, family physician; PhD, Doctor of Philosophy.
The doctoral journey mapped: dreaming, doing and completion.
| Phase | Activities |
|---|---|
| Pre-PhD: The dreaming phase | This stage involves exploring motivations and expectations, selecting the right programme and supervisors and striking a balance between clinical work and academic objectives. Also, consider whether your topic is sufficiently original and broad, what qualities to seek in a supervisor and whether you need a co-supervisor. Are you ready for a 4–5-year commitment, and how will a PhD: Doctor of Philosophy benefit your career? A potential supervisor and academic institution will likewise assess the PhD from an educational perspective: does the candidate have prior scholarship, and will supporting them in obtaining a PhD help in developing an experienced researcher (progressing from emerging to established) who can supervise others and advance in discipline or field? |
| Year 1: Foundation of the doing phase | Learn how to learn. Doctoral students begin by learning the language of academia, developing a research concept note into a full proposal and building relationships and support networks. There are several opportunities for learning the skill sets required for the doctoral project. |
| Year 2: Deep dive and data | This stage involves data collection and analysis, navigating ethical and gatekeeper approvals and managing time, energy and imposter syndrome. |
| Year 3 and beyond – towards completion: Writing and identity | Students use writing for thinking, identity and preparing for defence and post-PhD life. Late-stage PhDs involve intense, deadline-driven writing and revision, with students often struggling when major revisions arise near submission, especially after a period of silence on feedback. These issues can negatively impact work quality and well-being. An early, structured feedback calendar can prevent this. |
PhD, Doctor of Philosophy.
We reflected on key tips (summarised in
Key tips for your PhD journey.
Remember to review these key tips regularly during each phase of your PhD journey:
Understand your core motivation.
Establish healthy boundaries and practise self-compassion.
Pursue scholarships, grants and institutional aid to address funding issues.
Maintain clear communication and alignment with your supervisor and institution.
Organise yourself: pacing and planning are essential, including setting milestone goals and utilising digital tools to monitor progress.
Attend coursework (if offered), academic meetings and conferences, engage in critical reading and academic writing and keep a research journal.
Build support networks and choose the right allies such as supervisors, peers and mentors.
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
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.
Academic growth is supported by
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.
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.