The transition from medical student to junior doctor: today’s experiences of Tomorrow’s Doctors

Abstract

Medical Education 2010: 44: 449–458 Context Medical education in the UK has recently undergone radical reform. Tomorrow’s Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. Objectives This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. Methods The study used qualitative methods comprising of semi‐structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self‐selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. Results The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi‐professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. Conclusions Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing ‘meaningful’ contact with patients and increasing opportunities to ‘act up’ to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements.

Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey

“…21 Literature about the transition from medical school to residency highlights the value of students gradually gaining proficiency in how to approach and manage clinical problems and decision making. 22 More opportunities for students to manage patients and practice their upcoming roles as residents reflect an important paradigm for future doctors' training. 18,22 Our findings suggest that overnight experiences, once an integral part of undergraduate and graduate medical training, may still have a role in preparing medical students for their future responsibilities.…”

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

“…Through the extended association between clinician educator and student, medical students become trusted to take on more of the role of a practitioner, to 'act up' (Brennan et al, 2010), in a carefully supervised structure (Hirsh, Holmboe, & ten Cate, 2014), carrying out entrustable professional activities (Chen, van den Broek, & ten Cate, 2014;Englander & Carraccio, 2014;Teherani & Chen, 2014;Ten Cate, 2014a). Students form a professional identity through extended patient contact experiences that give them the ability to reason through medical problems while exploring their own feelings in a supportive environment (Konkin & Suddards, 2012).…”

National Undergraduate Medical Core Curriculum in Turkey: Evaluation of Residents

“…From a study which was designed as semi-structured interview, a newly qualified doctor stated "if I hadn't done that (any kind of clinical skills) […] I would have really struggled". As the comment from this study demonstrates, the practice of 'doing', as opposed to just observing, is very important (22). Although developed as part of the curriculum, the skills receiving the lowest scores were either never practiced or insufficiently practiced by the students.…”