How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014

Monrouxe, Lynn V.; Grundy, Lisa; Mann, Mala; John, Zoe; Panagoulas, Eleni; Bullock, Alison Deborah; Mattick, Karen

doi:10.1136/bmjopen-2016-013656

Cited by 176 publications

(269 citation statements)

References 77 publications

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“…This is in keeping with findings of the 2014 report to the GMC on UK graduate preparedness for practice 5. When asked to list skills that benefited most from ‘Going Professional’ and ward simulation exercises, prioritisation and decision making were the most prevalent answers.…”

Section: Benefits and Challengessupporting

confidence: 79%

‘Going Professional’: using point-of-view filming to facilitate preparation for practice in final year medical students

2017

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Section: Benefits and Challengessupporting

confidence: 79%

‘Going Professional’: using point-of-view filming to facilitate preparation for practice in final year medical students

2017

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“…The thematic Framework Analysis method was used comprising: (1) familiarisation, (2) identifying a coding framework, (3) coding, (4) charting and (5) mapping and interpretation26:

Familiarisation : 10 researchers (LVM, CER, AB, KM, JC, CJ, KK, CEK, NK and GS) and two clinical consultants (see ’Acknowledgements' section) each read a transcript from an interview (either focus group or individual interview) across the different participant groups and up to three audio diary transcripts with PGY1 doctors, with each transcript being read by at least two researchers.

Development of coding framework : a series of face-to-face and video-conference meetings were held across 2 days with researchers discussing themes identified inductively from the data. An existing coding framework (developed via a rapid review of the literature)10 was then mapped onto the inductive framework (by LVM), ensuring that all outcomes for UK medical graduates, and preparedness themes and subthemes previously identified, were included as ‘potential codes’. A coding framework outlining all themes, subthemes, definitions and illustrative quotes, alongside coding instructions, was produced to facilitate coding consistency by multiple coders.

Coding : KK led the coding with additional work by CEK, CJ and LVM.

…”

Section: Methodsmentioning

confidence: 99%

“…There are numerous studies published about medical graduates’ preparedness for practice, most of which are quantitative retrospective cross-sectional surveys of graduate perceptions,16–19 with fewer studies employing qualitative or longitudinal approaches and exploring the perceptions of other stakeholders about graduate preparedness such as clinical supervisors 20. A recent rapid review of the literature about preparedness for practice of UK medical graduates,10 found that very few studies defined preparedness for practice and that the evidence was mixed in terms of many aspects of preparedness. There were marked variations across this literature in terms of perceptions of preparedness from one trainee to the next, within trainees across time and across research tools in terms of what new medical graduates report feeling prepared for (or not) 10.…”

Section: Introductionmentioning

confidence: 99%

“…A recent rapid review of the literature about preparedness for practice of UK medical graduates,10 found that very few studies defined preparedness for practice and that the evidence was mixed in terms of many aspects of preparedness. There were marked variations across this literature in terms of perceptions of preparedness from one trainee to the next, within trainees across time and across research tools in terms of what new medical graduates report feeling prepared for (or not) 10. Importantly, the rapid review flagged further limitations with the existing literature (eg, focus on short-term preparedness, and reliance on self-report of recently graduated doctors only) and recommended multisite and longitudinal research designs using a range of research methods: ’to understand the concept and process of preparedness alongside the variety of individual, cultural and organisational issues that might impact on this’ 10…”

Section: Introductionmentioning

confidence: 99%

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New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

et al. 2018

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ObjectiveWhile previous studies have begun to explore newly graduated junior doctors’ preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders’ conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors’ preparedness (or unpreparedness) using innovative qualitative methods.DesignA multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries.SettingFour UK settings: England, Northern Ireland, Scotland and Wales.ParticipantsEight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period.ResultsWe identified 2186 narratives across all participants (506 classified as ‘prepared’, 663 as ‘unprepared’, 951 as ‘general’). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors’ preparedness for the General Medical Council’s (GMC) outcomes for graduates. Stakeholders’ conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders’ perceptions of medical graduates’ preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not).ConclusionOur narrative findings highlight the complexities and nuances surrounding new medical graduates’ preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates’ preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.

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“…In UK hospitals, as internationally, most prescribing (70%) is undertaken by the most junior grades. Those doctors who have most recently graduated (ie, in their first 2 years of practice) have been found to have the highest rates of prescribing errors3 and their volume of prescribing means many patients are affected, generating some concern as to their prescribing competence and preparedness for practice 4. Doctors in the UK who have recently graduated medical school undergo a period of training (see box 1 for further explanation) over 2 years and are termed Foundation year one (FY1) and Foundation year two (FY2) doctors depending on which year of training they are completing.…”

Section: Introductionmentioning

confidence: 99%

Foundation year one and year two doctors’ prescribing errors: a comparison of their causes

Lewis

Seston

Tully³

2018

Postgraduate Medical Journal

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ObjectiveJunior doctors have the highest rates of prescribing errors, yet no study has set out to understand the differences between completely novice prescribers (Foundation year one (FY1) doctors) and those who have gained some experience (Foundation year two (FY2) doctors). The objective of this study was to uncover the causes of prescribing errors made by FY2 doctors and compare them with previously collected data of the causes of errors made by FY1 doctors.DesignQualitative interviews, using the critical incident technique, conducted with 19 FY2 doctors on the causes of their prescribing errors and compared with interviews previously conducted with 30 FY1 doctors. Data were analysed using a constant comparison approach after categorisation of the data using Reason’s model of accident causation and the London protocol.ResultsCommon contributory factors in both FY1 and FY2 doctors’ prescribing errors included working on call, tiredness and complex patients. Yet, important differences were revealed in terms of application of prescribing knowledge, with FY1 doctors lacking knowledge and FY2 misplacing their knowledge. Due to the rotation of foundation doctors, both groups are faced with novel prescribing contexts, yet the previous experience that FY2 doctors gained led to misplaced confidence when caution would have been expedient.ConclusionsDifferences in the contributory factors of prescribing errors should be taken into account when designing interventions to improve the prescribing of foundation doctors. Furthermore, careful consideration should be taken when inferring expertise in FY2 doctors, who are likely to prescribe in contexts in which their experience is little different to an FY1 doctor.

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How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014

Cited by 176 publications

References 77 publications

‘Going Professional’: using point-of-view filming to facilitate preparation for practice in final year medical students

‘Going Professional’: using point-of-view filming to facilitate preparation for practice in final year medical students

New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

Foundation year one and year two doctors’ prescribing errors: a comparison of their causes

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