BackgroundThere is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice.MethodsThis was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools.A sample of 60 medical graduates (20 from each school) was targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness.ResultsAlthough selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork.ConclusionsOur data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work.

Medical Education 2010: 44 : 165–176 Context  The effectiveness of multi‐source feedback (MSF) tools, which are increasingly important in medical careers, will be influenced by their users’ attitudes. This study compared perceptions of two tools for giving MSF to UK junior doctors, of which one provides mainly textual feedback and one provides mainly numerical feedback. We then compared the perceptions of three groups, including: trainees; raters giving feedback, and supervisors delivering feedback. Methods  Postal questionnaires about the usability, usefulness and validity of a feedback system were distributed to trainees, raters and supervisors across the north of England. Results  Questionnaire responses were analysed to compare opinions of the two tools and among the different user groups. Overall there were few differences. Attitudes towards MSF in principle were positive and the tools were felt to be usable, but there was little agreement that they could effectively identify doctors in difficulty or provide developmental feedback. The text‐oriented tool was rated as more useful for giving feedback on communication and attitude, and as more useful for identifying a doctor in difficulty. Raters were more positive than other users about the usefulness of numerical feedback, but, overall, text was felt to be more useful. Some trainees expressed concern that feedback was based on insufficient knowledge of their work. This was not supported by raters’ responses, although many did use indirect information. Trainees selected raters mainly for the perceived value of their feedback, but also based on personal relationships and the simple pragmatics of getting a tool completed. Discussion  Despite positive attitudes to MSF, the perceived effectiveness of the tools was low. There are small but significant preferences for textual feedback, although raters may prefer numerical scales. Concerns about validity imply that greater awareness of contextual and psychological influences on feedback generation is necessary to allow the formative benefits of MSF to be optimised and to negate the risk of misuse in high‐stakes contexts.

Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. . Medical education research has not fully addressed this transition or explored ways of improving it for the benefit of patients and doctors.Newly appointed consultants are more prepared for some aspects of their work than others. Training in clinical skills is most positively reported, although even this has room for improvement 2,4 . New consultants feel less well prepared for their management responsibilities 2,4,5 including self- In the light of these issues, a research project was developed to determine the extent to which specialty training provides doctors with the skills they require when they become consultants. 2 MethodA qualitative cross-specialty study was undertaken in the Northern Deanery, UK. The methodology was informed by the constructivist view that knowledge, and therefore meaning, is not discovered but socially Interviewees were from a wide range of specialties including surgery, medicine, A&E, anaesthetics, paediatrics, obstetrics and gynaecology, psychiatry and radiology. Four researchers carried out interviews. The interview schedule for specialist registrars was developed from exploratory interviews with newly appointed consultants and from the literature. Initial analysis of interviews with specialist registrars identified themes which were used to develop interview schedules for newly appointed consultants and medical managers in order to provide triangulation of data. Analysis 3Interviews were tape-recorded, transcribed, and analysed using a framework approach 10. Following familiarisation with the data, a thematic framework was identified from a priori issues, emergent issues (e.g. 'becoming a leader') and analytic issues (e.g. 'exposure to the consultant role'). The framework was then applied to the data through indexing and charting. Finally, through data mapping and interpretation, the key themes within the data set were brought together to address the research question. All authors read transcripts to familiarise themselves with the data and were involved in the identification of the thematic framework and interpretation of the findings. ResultsOverall specialist registrars were very positive about their specialty training.Results focus on areas described as challenging by respondents, and identify gaps in knowledge or practice in different areas: clinical skills, leadership, service management, people management and exposure to the consultant role. Clinical workSpecialist registrars described feeling best prepared for clinical work.They consid...

Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details.

Doctors should consider the transactional or relational preference of a patient in approaching a consultation. Patient feedback can deliver benefits to doctors and patients, but risks must be acknowledged and mitigated against.