First Year Of Clinical Practice Research Articles

An assessment of the simulated performance of basic clinical procedures by junior doctors during the first year of clinical practice

BackgroundUpon entering the healthcare system, junior doctors may lack the skills required to care for patients, and feel unprepared for their role, with considerable variation in the level of proficiency in the performance of particular clinical procedures.ObjectiveTo compare the performance and proficiency (self-report and observed) of the performance of nine basic clinical procedures.MethodsSeventeen interns were observed performing nine clinical procedures in a simulated setting in June 2021 (Assessment 1) and January 2022 (Assessment 2). The observers identified whether each step in the procedure was performed correctly, and provided an overall assessment of proficiency. The participants also rated their own level proficiency.ResultsAt Assessment 1 the number of steps performed correctly ranged from a mean of 41.9–83.5%. At Assessment 2 the number of steps performed correctly ranged from a mean of 41.9–97.8%. The most common median proficiency rating for Assessment 1 was ‘close supervision’, and was ‘indirect supervision’ at Assessment 2. There was a significant and large effect size in the improvement in performance from Assessment 1 to Assessment 2. Low correlations were found between observer and self-reported proficiency in performance of the procedures.ConclusionsThe large improvement in performance across the two assessments is encouraging. However, there is a need to address the variability in performance on graduation from medical school, and to ensure that any assessment of proficiency is not only reliant on self-report.

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice.

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

Career Aspirations of Recent Graduates From Professional Master's-Level Athletic Training Programs

Context Transition to clinical practice is a topic receiving substantial attention. Many reports have focused on the educational program's role and have stopped short of identifying the impact of the initial year of employment on desire to persist and future career goals. Objective To examine the career aspirations of athletic trainers in their first year of employment who graduated from professional master's programs. Design Qualitative. Setting Nine professional master's athletic training programs, variety of employment settings. Patients or Other Participants Seven men and 7 women (age = 25.6 ± 3.7 years). Data Collection and Analysis A general inductive approach was used to analyze data from individual interviews conducted 6 and 12 months into the first year of clinical practice. Multiple-analyst triangulation and peer review ensured credibility. Results Graduates of professional master's programs in athletic training plan to stay in the profession. However, newly credentialed athletic trainers do not plan to remain with their initial employer beyond 2 years; 11 of 14 participants (79%) stated their first job was transitional. The first year of employment did not change participants' perceptions, as the graduates knew upon taking their first job that it would be temporary. Though participants planned to change jobs, most (79%) planned to continue to engage in clinical practice as athletic trainers. Conclusions Understanding newly credentialed athletic trainers' perceptions of the impact of the first year of employment can provide educators and employers important insight to assist in retention and persistence of young professionals. Graduates regard their first years of employment as impermanent. However, the majority do not wish to leave clinical practice. Participants viewed their first job as a way to gain valuable experience that did not dissuade them from continuing in the field. Recent graduates demonstrated ambitions to experience different work settings and higher-level positions with greater responsibilities.

Healthy eating and physical activity among new graduate nurses: A qualitative study of barriers and enablers during their first year of clinical practice

BackgroundNew graduate nurses entering the workforce experience numerous barriers to maintaining a healthy lifestyle including shift work, the high cost of healthy foods at the workplace and high levels of exhaustion which reduce motivation to participate in regular physical activity. Research has documented unhealthy lifestyles among nurses across the profession. However, few studies focus on graduates' experiences during their transition into their careers. AimTo investigate the barriers and enablers to healthy eating and participation in physical activity for new graduate nurses during their first year of clinical practice, and to explore attitudes to participation in workplace health promotion programs. MethodsSemi-structured interviews informed by the socioecological model were conducted with 24 new graduate nurses and analysed using thematic analysis. FindingsFour key themes emerged as barriers to healthy eating and physical activity: time, shift work, work environment, and work culture. Participants indicated a high interest in workplace health promotion programs. DiscussionLimited time and shift work impact on the eating and physical activity behaviours of new graduate nurses which leads to unhealthy snacking to maintain energy, as does high levels of exhaustion, reduced motivation to eat healthy foods, and decreased participation in physical activity. The work culture and environment also influence eating behaviours. Inadequate breaks lead to consumption of foods that are quick to eat but often low in nutrients. ConclusionNew graduate nurses experience the same difficulties in maintaining healthy lifestyles as more experienced nurses. Understanding the barriers which influence their dietary and physical activity behaviours can help inform strategies to improve the health of nurses at a critical time when they enter the nursing workforce.

Group mentoring and nurse residents

Group mentoring and nurse residents

A Theoretical Model of Transition to Practice for Athletic Trainers.

The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation. To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs. Qualitative study. Telephone interviews. Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs. Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach. We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies. The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

Bishesh Poudyal: transplantation at a lifesaving discount

Back in 2007, his first year of clinical practice, Kathmandu native Dr Bishesh Poudyal realised that Nepal needed a transplantation centre. “Hundreds of aplastic anaemia, thalassaemia and relapsed refractory acute leukaemia patients were dying because of the lack of a transplant facility”, he says. By delivering presentations and hosting awareness sessions, he sought to convince health policy makers of the need to establish such a facility in Nepal, a landlocked South Asian nation of 30 million people.

Gender Compensation Gap for Ophthalmologists in the First Year of Clinical Practice

To identify the role of gender and other factors in influencing ophthalmologists' compensation. Cross-sectional study. U.S. practicing ophthalmologists. Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P= 0.00). The PSM analysis showed an SWB difference of-$27 273.89 (10.3% gap, P= 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (-$27 793.67 [10.5% gap, P= 0.0013]) and clinic days (-$23 597.57 [8.90% gap, P= 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (-$22 261.49, $-18 604.65, and $-16 191.26, respectively; P= 0.017, P= 0.015, P= 0.002, respectively). Gender independently predicted income in all 3 analyses (P<0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P= 0.03). Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career.

The development of a framework of entrustable professional activities for the intern year in Ireland

BackgroundEntrustable Professional Activities (EPAs) are units of professional practice that capture essential competencies in which trainees must become proficient before undertaking them independently. EPAs provide supervisors with a solid justification for delegating an activity to trainees. This study aimed to develop and ensure face validity of a set of EPAs for junior doctors in the first year of clinical practice in the Republic of Ireland.MethodsAn iterative eight stage consensus building process was used to develop the set of EPAs. This process was based on international best practice recommendations for EPA development. A series of surveys and workshops with stakeholders was used to develop a framework of EPAs and associated competencies. An external stakeholder consultation survey was then conducted by the Irish Medical Council. The framework of EPAs was then benchmarked against the 13 core EPAs developed by the Association of American Medical Colleges (AAMC).ResultsA framework of seven EPAs, and associated competencies resulted from this study. These EPAs address all core activities that junior doctors should be readily entrusted with at the end of the intern year, which is the first year of clinical practice in the Republic of Ireland. Each EPA contains a series of defined competencies. The final EPAs were found to be comparable to the AAMC core EPAs for entering residency.ConclusionsA framework of EPAs for interns in Ireland that are appropriate for the intern year has been developed by key stakeholders. The implementation of the EPAs in practice is the next step, and is likely to result in an improved intern training process and increased patient safety.

Ethical challenges of novice nurses in clinical practice: Iranian perspective.

The aim of this study was to identify the ethical challenges of novice nurses in the first year of clinical practice. Novice nurses experience a lot of ethical complications in the clinical workplace, especially in the first year of clinical practice. These ethical challenges are scarcely studied. Current research was a descriptive qualitative study conducted on twelve novice nurses in educational hospitals affiliated to Arak University of Medical Sciences (from August to December 2018)in Iran. Data were collected through semi-structured in-depth interviews, and informed consent was obtained from all participants. Data were analysed using content analysis. A total of 12 nurses participated, the majority of whom were female (8; 66.6%), and their average age was 23.6years. Findings of this study revealed four main themes: patient: the forgotten part, exposure to inequalities, inattention to professional ethics and facing a state of quandary. Several sub-themes also appeared in this study. These findings can reveal a clear picture of the ethical challenges of novice nurses in Iran. They can be used as a guidance for managers, authorities and nursing stakeholders in order to protect and support these nurses. Further research on each concept is suggested. These findings can be used to inform nursing education, research, management and clinical practice. Meanwhile, the results of this study may be used to formulate a strategy for training nursing managers in order to protect and support the next generation of nurses.

A Mixed-Methods Exploration of the Educational Climate and Safety Climate During the First Year of Clinical Practice in Ireland.

Educational climate (EC) and safety climate (SC) are key determinants of residents' professional development. The goal of this study was to gather longitudinal EC data and data on perceptions of SC in residency, and provide data on practices related to perceptions of EC and SC, by identifying factors associated with and changes in perceptions of EC and SC across the first year of practice, and elucidating good and poor practice relating to key elements of EC and SC. A mixed-methods design was adopted. First, 131 first-year residents in Ireland were surveyed at the end of each of their first 3 rotations (August 2016-March 2017). The survey measured EC and SC using established measures. Next, 69 semistructured interviews were conducted with a representative sample of residents (March-May 2017). An interview schedule was developed to aid in-depth probing of EC and SC perceptions. A deductive content analysis approach was adopted. Perceptions of EC worsened over time. The EC and SC of surgical rotations were significantly poorer than those of medical rotations. Residents were more likely to describe team practices, rather than organizational practices, that contributed positively to their perceptions of EC and SC. Further research is necessary to facilitate improvement of EC and SC for residents, particularly within surgical training. Future research exploring the contribution of organizational practices to EC and SC, the impact of targeted improvement activities, and best practices for involving residents in quality and safety initiatives is recommended.

Exploring the Development of a Mentoring Relationship Among Newly Credentialed Athletic Trainers

ContextMentorship has been identified as a primary organizational socialization tactic and has been directly associated with transition to practice.ObjectiveUnderstand how the mentoring relationship develops for the newly credentialed athletic trainer during the first year of clinical practice.DesignGrounded theory.SettingAthletic training practice settings.Patients or Other ParticipantsThirteen athletic trainers, who graduated from a professional master's program, certified between February and July of 2016, and obtained employment between July to August of 2016, participated in this study (6 female, 7 male, 26 ± 3 years; work settings included professional sports, college, secondary and middle school, and clinic). Data saturation was met.Main Outcome Measure(s)Semistructured phone interviews were conducted with all participants during 3 specific time points (3, 8, and 12 months posthire). All interviews were transcribed verbatim and coded following the steps of a grounded theory study. Credibility strategies included researcher triangulation and peer review.ResultsAll 13 participants recognized a mentor, someone who they believed serve in a mentoring capacity during their transition into clinical practice as a newly credentialed athletic trainer. The development of the mentoring relationship for the newly credentialed athletic trainer appeared to be characterized by (1) identification of a mentor who had experience and knowledge, (2) a recognition of the need to have support and continued avenues for growth as a health care professional, (3) an informal initiation of the relationship through a professional relationship by the mentee, and (4) communication that overtime was reduced in frequency.ConclusionsMentors provide career support and professional growth. Newly credentialed athletic trainers should seek out mentors who can support their continued development. The informal relationship appears to be of the greatest importance during the first few months of practice, and then once comfort and self-confidence improves, the frequency of communication is reduced.

'Waiting in the wings'; Lived experience at the threshold of clinical practice.

The transition to clinical practice is challenging. Lack of preparedness and issues with support, responsibility and complex workplace interactions contribute to the difficulties encountered. The first year of clinical practice is associated with negative consequences for new doctors' health and well-being. The contemporaneous lived experience of new graduates on the threshold of clinical practice has not been described. Deeper understanding of this phase may inform interventions to ease the transition from student to doctor. We used interpretative phenomenological analysis (IPA) to explore the individual experience of making the transition from medical student to doctor, focusing on the period prior to commencing clinical practice. Fourteen recent graduates were purposively recruited, and semi-structured interviews were conducted with each, with respect to how they anticipated the transition. We draw on the metaphor of the actor 'waiting in the wings' to describe participants' lived experience on the threshold of practice. The experience of the actor, about to step into the spotlight, was mirrored in participants' perceptions of an abrupt transformation to come, mixed feelings about what lay ahead, and the various strategies that they had planned to help them to perform their new role convincingly. Participants in this study braced themselves for a trial by ordeal as they contemplated commencing clinical practice. The hidden curriculum shaped their understanding of what was expected of them as new doctors, and inspired dysfunctional strategies to meet expectations. Solutions to make the experience a more positive one lie in the approximation of the roles of senior medical student and newly qualified doctor, in explicitly addressing the hidden curriculum and generating cultural change. An emphasis on experience-based learning through contribution to patient care, guided reflection on the hidden curriculum and shifting cultural expectations through faculty development and strong local leadership can contribute to these objectives.

From Suffering to Indifference: Reaction of Novice Nurses to Ethical Challenges in First Year of Clinical Practice.

Background:The first year of clinical practice is one of the most important steps in nursing career life. Although, studies have been conducted on ethical issues in nurses, however, few studies have been conducted on the responses of novice nurses to ethical issues. The purpose of this study was to explore the responses of novice nurses to ethical challenges in the first year of clinical practice.Materials and Methods:This study is a qualitative study with content analysis approach was conducted with financial support of Arak University of Medical Sciences. In this study, about 11 novice nurses selected using purposive sampling from educational hospitals affiliated to Arak University of Medical Sciences. Data were collected by semi-structured interviews. The duration of the interviews was 30-110 minutes. In order to analyze the data, inductive content analysis was used.Results:Data analysis revealed two important, and different responses over time in novice nurses. So that at the beginning of practice, the reaction to ethical challenges was “suffering” and after a few months it became “indifference”.Conclusions:This study showed that the response of novice nurses to ethical challenges in the first year of clinical practice was a transition from suffering to indifference. These findings can be used in nursing education, research and practice. Further research is recommended in this regard.

A prospective clinical study of the efficacy of Hyflex CM rotary instruments in an endodontics undergraduate program

Background/Aim: To investigate the incidence of procedural errors with the use of a novel nickel-titanium rotary system (Hyflex CM, Coltene/ Whaledent, Altstätten Switzerland), evaluate the technical quality of root canal treatments and assess a questionnaire completed by the participants themselves in an undergraduate dental clinic between 2014 and 2017 (Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki). Material and Methods: 118 undergraduate students in their first year of clinical practice performed a root canal treatment on a patient's molar (maxillary/mandibular). None of the participants had previous experience in rotary instrumentation. The periapical radiographs were taken with the use of the paralleling technique for standardization and were collected and evaluated by the investigator. After the root canal treatment was performed the students completed a questionnaire in order to evaluate their training on rotary instrumentation. Results: The overall incidence of instrument separation, apical perforation, root perforation, straightening and ledges was 0.8%, 4.4%, 2.3%, 5.5% and 29% respectively on root canal level. Ledges were detected more often in mandibular mesiobuccal canals. The frequency of root canals with an 'acceptable' filling was 68.4%, while overfilled and underfilled canals were found to be 8.6% and 16.2% respectively. The response rate was high (94.9%), 35% of the participants encountered no difficulty in the use of rotary instrumentation and 98.2% would use it again. Conclusions: The incidence of procedural errors was considerably low and the technical quality of the filled root canals was superior to that of similar studies. The responses of the questionnaire demonstrated a positive attitude toward rotary instrumentation.

How graduate nurses adapt to individual ward culture: A grounded theory study.

To increase understanding of strategies graduate nurses use on a day-to-day basis to integrate themselves into pre-existing social frameworks. Being a graduate nurse and transitioning from a novice to beginner in the first year of clinical practice is stressful, challenging and overwhelming due to steep learning curves and adjusting to working in professional environments. How graduate nurses socially adapt and fit into ward cultures is a hurdle to successful transition and can be difficult. A qualitative constructivist grounded theory methodology was used. Seven adult, Registered Nurses were recruited using a purposive sampling technique. Participants were undertaking a graduate nurse transition programme, in one of two acute care, adult public hospitals in South Australia. Data collection conducted in 2016 used individual interviews consisting of open-ended questions in an unstructured format. Transcripts were transcribed verbatim. Data analysis processes included initial and focused coding, theory building, memo-writing and theoretical sampling. Three main categories: self-embodiment and self-consciousness, navigating the social constructs and raising consciousness, supported by subcategories describe the main strategies graduate nurses use to facilitate adaptation into complex clinical environments and ward cultures. Subsequent concept and theory development explains how graduate nurses find the social and professional balance to fit in. Understanding the graduates' adaptation strategies can inform improvements in graduate nurse transition programmes. Facilitating and enhancing graduate nurse adaptation is the precursor in creating more resilient nurses ready to face the challenges that exist in today's work environments.

Coping Strategies of Newly Graduated Nurses (NGNs) in the First Year of Clinical Practice: A Grounded Theory Study

Background: The first year of clinical work is one of the most important steps in the career life of nurses. Although some studies have been done regarding NGNs, a few studies have been conducted about coping strategies of newly graduated nurses in the first year of clinical work. The aim of this study was to explore and describe the coping strategies of NGNs in the first year of clinical work in Tehran, the capital of Iran. Methods: This study was conducted using the grounded theory methodology. In this study, 20 participants were selected using a purposive and theoretical sampling method. The data were collected by semi-structured in-depth interviews. For data analysis, the constant comparison method based on Strauss - Corbin approach was used. Results: Data analysis revealed that two strategies were used by NGNs, which included �positioning� at the beginning of work and then later, stabilizing the obtained �position (place)�. The core category of this study was �struggles to settle in the workplace.� Conclusions: This study showed that NGNs tried to create a perfect position in the ward and then consolidate the created position. The results of this study can serve as a good guide to develop training and supporting programs for NGNs and be used in helping them adapt better to the new position. However, it is recommended to do further studies in this regard. © 2018, Shiraz E-Medical Journal.

Developing and evaluating a foundation preceptorship programme for newly qualified nurses.

In 2014, an innovative, three-tiered foundation preceptorship programme for newly qualified nurses was developed in Oxford University Hospitals NHS Foundation Trust. The programme was to be mandatory for newly qualified nurses commencing Band 5 posts in the trust, and has a structured curriculum that integrates skills development, preceptorship and clinical supervision. Aim To evaluate the Oxford University Hospitals NHS Foundation Trust foundation preceptorship programme for newly qualified nurses commencing Band 5 posts in the trust. Method Data were collected through questionnaires and focus groups with newly qualified nurses and nurse managers in the trust. Findings Respondents indicated the foundation preceptorship programme had positive value and improved the experience of newly qualified nurses during their first year of clinical practice. Newly qualified nurses wished to regularly reflect with experienced nurses and obtain feedback on their practice from clinical experts to develop their clinical skills. A professionally-regulated agreed percentage of preceptor-preceptee supervision time may enhance preceptorship standards. Conclusion The foundation preceptorship programme had several benefits for newly qualified nurses and nurse managers, and their feedback on the programme was positive. The development and evaluation of the foundation preceptorship programme may inform the future education and training of newly qualified nurses during their first year in clinical practice.

A longitudinal and multicentre study of burnout and error in Irish junior doctors

BackgroundJunior doctors have been found to suffer from high levels of burnout.AimsTo measure burnout in a population of junior doctors in Ireland and identify if: levels of burnout are similar...