How prepared are medical graduates to begin practice?
A comparison of three diverse UK medical schools
Carol Davies1 and Beate Baldauf2
1Warwick Medical School, 2Warwick Institute for Employment Research
Background
Previous research has shown recent graduates from different medical schools
varied in preparedness for practice (Goldacre 2003, 2007 ) Over 40% felt
unprepared for first F1 posts. However, preparedness varied by school from 30% 89%.
In 2005, arising from the Chief Medical Officer’s Report Unfinished Business
(2002), a curriculum based Foundation Programme for doctors was introduced,
and thus newly qualified doctors’ preparedness became fundamental regardless of
medical training school.
Tomorrow’s Doctors (GMC 2003) specifies requirements & guidelines for undergraduate curricula although schools retain diversity of methods including Problem
Based Learning (PBL).
Preparedness involves knowledge & competency but also confidence to deliver
professional care outside the protected medical school setting.
Newcastle (systems based), Glasgow (Problem Based Learning) and Warwick
(graduate entry) University Medical Schools participated in this study between
May 2007 - December 2008, commissioned by the General Medical Council
(GMC), to inform policy decisions prior to a revision of Tomorrow’s Doctors in
2009.
Aim
To explore extent to which three different medical schools prepare graduates for the
workplace.
Objectives
1. To
explore views of final year graduates & Foundation Year 1 doctors (F1s)
2. Triangulate F1 views with those of clinical staff and hospital staff.
3. Identify recommendations for an update of General Medical Council’s document
“Tomorrow’s Doctors”.
Multi-method study, based on:
Cohort questionnaire recent graduates (n=497, response rate 69%)
Interviews with junior doctors at graduation, 3 months into Foundation Programme
& end of F1 (n=66, 55, & 46 respectively; approx 1/3 at each school)
Interviews with educational supervisors, undergraduate tutors, portfolio assessors
(n=74)
Main findings
Place of qualification has little impact on preparedness
Largest differences between schools preparedness for paperwork &
some clinical tasks (calculating drug dosages, basic respiratory function tests)
F1 portfolio data (293 assessment in total) & prescribing assessment (n=127
Warwick & Newcastle only)
Questionnaires to range of hospital staff working with F1s e.g. doctors,
pharmacists, ward managers, nurses (n=80)
Common themes across 3 schools
Discussion
Early exposure to clinical practice key theme
underlying preparedness
Common areas of preparedness and
unpreparedness across three schools, reported by
F1s and the whole range of professional educators
and staff interviews.
No variation by MTAS quartiles or gender
F1s prepared for basic communication & clinical skills
e.g. history taking & basic procedures
Agreement across all the respondents & data sets
supports findings & recommendations.
F1s unprepared for prescribing, role & duties of an F1 doctor,
acutely ill patients, complex communications, on-call &
on nights, prioritising work, managing time & hospital systems
Preparedness more analogous to confidence, rather
than predicting performance (Morgan 2002).
Lack of focus on common prescribing scenarios
Perceived preparedness & competency comes with practice in real clinical setting.
Transition to F1 steep learning curve
Students move gradually from peripheral role to more central role & greater
responsibility.
Shadowing F1 jobs very helpful
Some F1s completed more portfolio procedures than others
Learning opportunities limited by lack of formal student role in clinical teams & length
of F1 shadowing.
Preparedness will be improved by more experiential learning - at present
experiential learning is variable, dependent on organisational factors & inter-personal
relationships of students & clinicians
Final report
Illing J, Morrow G, Kergon C, Burford B, Spencer J, Peile E,Davies C, Baldauf B,
Allen M,Johnson N, Morrison J, Donaldson M, Whitelaw M, Field M “How
prepared are medical graduates to begin practice? A comparison of three diverse
UK medical schools” Final summary & conclusions for GMC Education
Committee. September 2008
Contact details
Carol.Davies@warwick.ac.uk; WMS; Beate.Baldauf@warwick.ac.uk; IER
POSTER TEMPL ATE BY:
www.PosterPresentations.co
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Study Recommendations
1. More structure & consistency of undergraduate clinical placements across specialties
2. Greater role and involvement for students in clinical teams, with due regard to
patient safety.
3. Shadowing of F1 jobs: more structure & content.
4. Specify limits & responsibilities of F1 role
5. Prescribing focus on commonly prescribed drugs at F1