Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on‐call simulation

Abstract

Background Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. Methods 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students’ clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. Results Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning ‘on the job’. Conclusions The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through ‘whole task’ training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong ‘learning while working’.

Exploration of "Online + Offline" Blended Teaching Mode in Molecular Biology Experiment Under the Background of COVID-19

“…We investigated the learning outcomes of 400 undergraduates in Dalian Medical University who were taught under this teaching mode. Our results show that students' mastery of the content and, more importantly, their hands-on skills are improved under this model, which better supports their challenging transition from medical students to junior doctors and beyond [17] . Abbreviations ICC: immunocytochemistry; q-PCR: quantitative real time polymerase chain reaction.…”

Effectiveness of an “online + in‐person” hybrid model for an undergraduate molecular biology lab during COVID‐19

“…We investigated the learning outcomes of the undergraduate students in DMU who were instructed under this teaching model. Our findings revealed that the students' mastery of the course and, more importantly, their practical skills improved under this model, which better supports their challenging transition from medical students to junior doctors and beyond 32 . However, there are certain limitations in developing effective curriculums for students and training teachers to effectively utilize digital teaching techniques.…”

“…Our findings revealed that the students' mastery of the course and, more importantly, their practical skills improved under this model, which better supports their challenging transition from medical students to junior doctors and beyond. 32 However, there are certain limitations in developing effective curriculums for students and training teachers to effectively utilize digital teaching techniques. As the pandemic continues to spread, the importance of hybrid learning comes to the forefront.…”

Junior doctors' experiences with interprofessional collaboration: Wandering the landscape

“…With negative IPC outcomes, junior doctors' strong negative emotions isolated them in a selfcentred rumination process that prevented them from learning from other team members. 42,43 By judging the value of a collaboration by its outcome, also called outcome bias, junior doctors made an inference regarding the collaboration only based on the outcome rather than evaluating the whole collaboration with all its information. 44,45 A curriculum focused on workplace learning should provide two types of formal reflective spaces for junior doctors: one space for discussing IPC independent of the clinical outcome being good or bad, to help junior doctors create the habit of reflecting on teamwork and awareness of how their perception of teamwork can be influenced by the context in which it takes place.…”

“…With negative IPC outcomes, junior doctors' strong negative emotions isolated them in a self‐centred rumination process that prevented them from learning from other team members. 42 , 43 By judging the value of a collaboration by its outcome, also called outcome bias , junior doctors made an inference regarding the collaboration only based on the outcome rather than evaluating the whole collaboration with all its information. 44 , 45 …”