Students' transition to the hospital environment was difficult. This may become less of an issue as medical curricula become more integrated. Specific strategies to induct students into the hospital, and increased staff awareness of their needs, could also help. Ensuring an inclusive atmosphere may be more difficult, requiring cultural change.

The structure and culture within the medical school and associated hospital trust appeared to offer little support for doctors in their teaching role. This suggested that teaching was not highly valued. Teachers were preoccupied with the practical issues of teaching, leaving little time to consider more fundamental educational issues. These findings have implications for the quality of teaching and implementation of curricular change.

This study is a qualitative evaluation of PRHOs' perceptions of a new final year of the MB BS programme at Guy's, King's and St Thomas' (GKT) School of Medicine, undertaken in 2001 as a precursor to a prospective study. One-to-one interviews were carried out with 16 PRHOs two to four months after starting. These were independently thematically analysed, cross-referenced and joint agreement on the themes reached. PRHOs felt they were well prepared in clinical skills, history taking and examination. They reported lack of knowledge in pathology and therapeutics. The initial 1-4 weeks were stressful because of new responsibility for patients. Relationship with patients and staff changed through acquisition of a definite professional role. They adopted a number of coping strategies to control demands of the post. The PRHOs perceived the course as relevant and good preparation for their posts, with a better balance than the previous curriculum. Greater appreciation of aspects of professionalization in the final year may help the transition further.

In this prospective qualitative study over 12 months, we evaluated the educational and clinical effectiveness of a new final year undergraduate programme in a London medical school (Guy's, King's and St Thomas'). A stratified sample of 17/360 final year students were interviewed four times, and the content was assessed against 32 amalgamated learning outcomes identified in 1997 in The New Doctor. At the beginning of the preregistration year, eight of the learning outcomes were already met, 10 partly, eight remained to be attained and for six, insufficient evidence existed. Preregistration house officers who have been through the final year student house officer programme expressed competence in many of the outcomes of the General Medical Council's New Doctor. The study identified areas such as prescribing where further developments are needed and will help in planning the new foundation programme.