Abstract
BackgroundCurrent research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training.Methods30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students’ clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes.ResultsSix key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning ‘on the job’.ConclusionsThe combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through ‘whole task’ training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong ‘learning while working’.
Highlights
Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor
In considering the role of observational methods in further exploring this subject area, aligned to recommendations of Monrouxe et al [4], we subsequently describe a novel approach; a simulated on-call within the hospital setting for final year medical students with close observation and qualitative reflective debrief
Findings from the analysis of the data are presented according to six key themes (Fig. 2). These offer insight into the challenges faced by final year medical students during their first experience of working as a newly qualified doctor and aid us in our understanding of the factors affecting undergraduate preparation for clinical practice
Summary
Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Despite clear documentation within the literature of specific practice areas for which graduates are repeatedly reported as being underprepared (Fig. 1), there remains a lack of detailed understanding as to why this is, and how we can better support our undergraduate students in preparing . Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires [2]. This methodology limits comprehensive investigation of the challenges identified, does not account for responder bias and, importantly, neglects the perspective of medical students for whom relevant educational interventions could have a significant impact
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