Orientation of medical trainees to a new clinical environment (the ready-steady-go model): a constructivist grounded theory study

Anél Wiese,Deirdre Bennett

doi:10.1186/s12909-022-03105-3

Abstract

BackgroundHigh-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety. However, few consultants receive extensive formal training to support new trainees and must create their own ways of integrating newcomers into their clinical team and work environment. We aim to conceptualise the strategies consultants use in the early stages of working with new trainees that will be useful for future faculty development in this area.MethodsWe used constructivist grounded theory (CGT) methodology by interviewing fifteen consultants in three medical specialties, to explore how trainees are integrated into a new clinical environment. We used CGT principles and procedures (iteration, constant comparison, and theoretical sampling) to analyse and construct a conceptual interpretation of the empirical data.ResultsConsultants’ central concern when introduced to a new cohort of trainees was that they had the required knowledge and skills (ready), were adapted and integrated into the new workplace and clinical team (steady), and safely participating in practice (go). Consultants used two broad strategies: formal orientation and informal orientation. Both these approaches had the common goal of intensifying interaction between consultants and trainees to get trainees to a position where they were ready, adapted, integrated, and participating safely and efficiently in practice. Several disruptors were identified by participants that delayed and sometimes completely inhibited the orientation process.ConclusionsThe model of orientation constructed through this research could be a valuable tool to support faculty development initiatives, the reflective learning practice of clinical supervisors, and curriculum design. The disruptors were identified as valid priorities for improving trainee orientation in postgraduate medical education. Future research should involve a longitudinal approach to explore trainee engagement with orientation upon entering a new clinical workplace.

Highlights

High-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety
When trainees start working in a new clinical environment, they require supervision and support to adapt to a new set of circumstances, including changes in the scope of practice, specialty, clinical team, Wiese and Bennett BMC Medical Education (2022) 22:37 clinical supervisors, and service demands [2]
To further explore the resonance of the theoretical model we constructed from our data analysis, we presented the model at a medical education conference to fellow medical education researchers, medical educators and postgraduate trainees who had the opportunity to provide feedback on whether the results resonated with their own experiences

Summary

Introduction

High-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety. The rotational approach of medical training creates upheaval for trainees and consultants but allows for greater diversity and breadth of clinical experience, teaches trainees how to adapt and cope with multiple practice styles and promotes greater trainee independence [3]. The downside of this approach is that it negatively impacts the continuity of practice and education and disrupts meaningful relationships with patients, supervisors, and peers [3, 4]. Consultants and trainees need guidance and support on managing the effects of multiple and frequent rotations, navigating unfamiliar clinical workplaces, and coping with changing responsibilities and expectations

Objectives

Methods

Results

Conclusion