Abstract
BackgroundNew medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Supporting undergraduate learning in the acute setting can be challenging for junior doctors when balancing teaching and clinical responsibilities. Our aim was to explore junior doctors’ first-hand experiences of supporting undergraduate education in the acute admissions environment(take).MethodsFourteen junior doctors in one teaching hospital in South West England took part in semi-structured focus groups (4–6 participants in each) which were audio-recorded, transcribed, and thematically analysed.ResultsJunior doctors described their educational role as comprising: teaching, demonstrating, coaching, and supervising. They perceived the acute take as a highly variable, unpredictable setting that offered a broad scope for learning. Tensions between doctors’ clinical and educational roles were described, influenced by internal and external factors. Clinical work was prioritised over teaching and participants lacked confidence in supervisory and clinical skills. Doctors felt pressured to meet students’ expectations and lacked understanding of their educational needs. Senior colleagues were highly influential in establishing an educational culture and were often a source of pressure to deliver timely clinical care. Organisations were perceived not to value teaching due to the lack of provision of dedicated teaching time and prioritisation of limited resources towards patient care. Participants managed tensions by attempting to formally separate roles, demoting students to passive observers, and they sought greater continuity in placements to better understand students’ abilities and expectations.ConclusionsEducational opportunities for undergraduate students on the acute take are varied and highly valuable. This study provides insight into the provision of workplace education and its challenges from junior doctors’ perspectives. We highlight areas for improvement of relevance to educational providers.
Highlights
New medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum
New medical graduates feel unprepared to work in the acute environment, citing limited exposure to acute care [6,7,8] and describe current teaching delivery as too theoretical with a lack of practical, clinical-based teaching [6, 9]
Doctors at Foundation Year One (FY1) level were excluded as they had been in post for less than four weeks at the time of the study and had limited experience of clinical teaching
Summary
New medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Acute and emergency care is a dynamic, fast-paced environment, treating increasing numbers of complex patients with a wide range of conditions [1, 2]. This presents challenges both to the provision of care and education [2,3,4,5]. New medical graduates feel unprepared to work in the acute environment, citing limited exposure to acute care [6,7,8] and describe current teaching delivery as too theoretical with a lack of practical, clinical-based teaching [6, 9]. Educational theorists recognise the need for learners to contextualise classroom-based learning through active participation in the workplace [13,14,15] and the key role of clinicians in supporting engagement and facilitating learning [16]
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