Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.

Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO.

Overall, given that most graduates and supervisors perceived the preparedness as 'quite well' or less, the undergraduate course had only partially met its objectives. A mismatch in ratings could be attributed to either inappropriate expectations on the part of the educational supervisors or the graduates or an inaccurate assessment by either group of respondents.

In the new integrated undergraduate medical programme at the University of Manchester, fifth-year students spend several weeks shadowing the pre-registration house officer (PRHO) whose post they will take over. The concept of 'shadowing' emerged from a set of interviews conducted with graduates during their first PRHO job. Graduates felt that shadowing helped them to gain familiarity with the work environment; with orientation to the role of a PRHO; and with specific learning, such as disease management, on which they could then get feedback. We hypothesize that shadowing provides an opportunity for focused apprenticeship learning of the future PRHO role. Further research may clarify the specific values of shadowing and how it might lessen the stresses faced by new graduates during the transition from student to doctor.