Looking 'back to the future': alumni perceptions of a UK undergraduate medical programme

Understanding the behaviour of newly qualified doctors in acute care contexts

CONTEXT

A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area.

METHODS

Focus groups involving 36 clinicians with a variety of clinical experience were conducted and analysed using a qualitative, grounded theory approach. The complex relationships between emergent themes guided the development of a framework that was refined and validated by further interviews with participants.

RESULTS

Six main themes, grouped under three broad headings, emerged from the data: 'transferring knowledge into practice' and 'decision making and uncertainty' (cognitive challenges); 'acts and omissions' and 'identity and expectations' (roles and responsibilities), and, finally, 'the medical hierarchy' and 'performing under stress' (environmental factors). The framework presented within this paper illustrates the complex relationships between these factors.

CONCLUSIONS

Although the potential of metacognitive strategies to reduce medical error is acknowledged, the framework promotes looking beyond the individual to consider the contributions to patient safety of identity issues, role uncertainty and the hierarchical clinical environment. A more distributed approach to situation awareness may help junior doctors to better tolerate complexity and uncertainty. The efficacy of simulation as an educational strategy may be improved by finding ways to recreate the hierarchical and stressful environment in which junior doctors practise. Junior doctors should be aware of the impact of affect and emotion on behaviour, and clinical supervisors should strive to ensure that roles and responsibilities are explicitly discussed.

'The next step'--alumni students' views on their preparation for their first position as a physician

BACKGROUND

Although medical programmes are often thoroughly evaluated, these evaluations more seldom include workplace points of view. The present study focuses on how well a Swedish medical programme was judged to prepare students for work as a physician.

METHODS

Thirty-two competences in physicians' work were identified through interviews. A subsequent questionnaire was completed by 123 programme alumni who had worked for 1-2(1/2) years in different parts of the country. Alumni were asked to rate the importance of each competence, their self-assessed competence as well as how these competences were addressed during their medical training.

RESULTS

The subsequent analysis identified areas where their training programme, according to the alumni, failed to prepare them satisfactorily. Problem areas included competences in clinical skills, handling stressful situations and in applied rather than foundational knowledge about common symptoms and diseases.

CONCLUSION

Despite extensive practical training, medical education still faces some problems in the transition from education to work.

Medical interns' view of their undergraduate medical education in Uppsala: an alumnus study with clear attitude differences between women and men

BACKGROUND

An alumni study of graduates from the medical school in Uppsala, was performed to give input into an ongoing reform process.

AIMS

This study aimed to investigate how medical interns view their undergraduate medical education and the extent to which they felt that the curriculum prepared them for their current positions.

METHODS

A web-based questionnaire was sent out via mail in 2005 to all past graduates who had qualified in Uppsala in 2003.

RESULTS

Replies were obtained from 69 of 102 students (68%). The most apparent suggested change of the education was increased integration of preclinical and clinical teaching. Correlations were found between student satisfaction with the medical school and perceived teacher attitude, encouragement to reflect, and the graduates' perception of having sufficient practical abilities. Significant gender differences were found regarding perceived clinical ability and concerning feedback and encouragement from the teachers.

CONCLUSIONS

Our results suggest more direct feedback from the teachers and more integration between basic sciences and clinical education. Female and male students may have different needs. A key question is therefore to encourage teachers to learn about gender since female and male students should equally experience respectful encounters with teachers and doctors acting as role models.

The importance of knowledge, skills, and attitude attributes for veterinarians in clinical and non-clinical fields of practice: a survey of licensed veterinarians in Quebec, Canada

To improve content validity and the pertinence of outcome assessment tools used for the undergraduate Doctor of Veterinary Medicine program at the University of Montreal's Faculté de médecine vétérinaire, a survey of members of the Quebec veterinary association was conducted. This survey aimed to determine the importance of a list of 71 attributes-categorized as knowledge, general skills, specific skills, and attitudes-for clinical and non-clinical types of professional activities. The results indicated that all basic knowledge components, general skills, and attitudes were equally important for all types of veterinary professional activities, while the importance of specific skills was significantly different for clinical practice and non-clinical fields. It was therefore proposed that outcomes assessment surveys of stakeholders, such as alumni and employers, be analyzed separately for each type of career option.