Implications of aligning full registration of doctors with medical school graduation: a qualitative study of stakeholder perspectives

Abstract

ObjectivesThe Shape of Training report recommended that full registration is aligned with medical school graduation. As part of a General Medical Council-funded study about the preparedness for practice of UK medical graduates, we explored UK stakeholders’ views about this proposal using qualitative interviews (30 group and 87 individual interviews) and Framework Analysis.SettingFour UK study sites, one in each country.Participants185 individuals from eight stakeholder groups: (1) foundation year 1 (F1) doctors (n=34); (2) fully registered trainee doctors (n=33); (3) clinical educators (n=32); (4) undergraduate/postgraduate Deans, and Foundation Programme Directors (n=30); (5) other healthcare professionals (n=13); (6) employers (n=7); (7) policy and government (n=11); (8) patient and public representatives (n=25).ResultsWe identified four main themes: (1) The F1 year as a safety net: patients were protected by close trainee supervision and ‘sign off’ to prevent errors; trainees were provided with a safe environment for learning on the job; (2) Implications for undergraduate medical education: if the proposal was accepted, a ‘radical review’ of undergraduate curricula would be needed; undergraduate education might need to be longer; (3) Implications for F1 work practice: steps to protect healthcare team integration and ensure that F1 doctors stay within competency limits would be required; (4) Financial, structural and political implications: there would be cost implications for trainees; clarification of responsibilities between undergraduate and postgraduate medical education would be needed. Typically, each theme comprised arguments for and against the proposal.ConclusionsA policy change to align the timing of full registration with graduation would require considerable planning and preliminary work. These findings will inform policymakers’ decision-making. Regardless of the decision, medical students should take on greater responsibility for patient care as undergraduates, assessment methods in clinical practice and professionalism domains need development, and good practice in postgraduate supervision and support must be shared.

Effect of national curriculum reform on medical students’ preparedness for practice: a prospective cohort study from undergraduate to postgraduate periods

“…By immersing themselves in daily clinical patient care, the students' patient management abilities and clinical confidence grew. Similar results were found in the previous literature: medical graduates felt most unprepared in terms of technical skills and patient care, especially when managing complex clinical conditions or providing immediate care in medical emergencies [ 31 – 33 ]. Besides, trainees generally felt more confident and competent over time, and the most common reason for feeling unprepared was having insufficient prior "hands-on" experience [ 34 ].…”