Newly qualified medical graduates are poorly prepared to work as trainee doctors, a survey reveals.
The findings, published in Postgraduate Medical Journal, are based on 228 senior doctors’ critical assessment of a wide range of core skills and competencies among trainee doctors at two teaching hospitals in the East Midlands.
Trainee doctors now complete a two-year generic Foundation Programme, which forms the bridge between medical school and specialist or general practice training.
The senior doctors were asked to score how well prepared their F1 trainees were to work as doctors, six months after they had graduated from medical school, using a five point scale.
The junior doctors were assessed against most of the expectations for newly qualified doctors set out by the GMC, in Tomorrow’s Doctors, as well as 18 general criteria.
The senior doctors (107 consultants and 121 specialist registrars) scored the juniors below three on 48 of the 70 items assessed against the GMC criteria and above the midway point for only six of the 20 clinical and practical skills.
Carrying out basic respiratory function tests, prescribing, and more advanced communication skills were some of the areas where juniors performed below par.
But they scored well on basic communication skills and how to ask for help, prompting the authors to wonder whether medical schools have not “gone too far in emphasising risk management and, perhaps inadvertently, helplessness”.
The responses, which reflected a high degree of agreement between the two groups, showed that the senior doctors felt the fledgling juniors were inadequately prepared to start work as a doctor.
They said: “The findings give cause for concern. Senior doctors perceived that the undergraduate medical degree had not adequately prepared F1s for practice, especially in clinical and practical skills.”
Among other things, they call for more opportunities for ward based experiential learning and for senior doctors to be more explicit about what is expected of F1 trainees.
The GMC’s publication Tomorrow’s Doctors is also to blame. The report says: “SpRs and consultants may have inappropriate or unrealistic expectations made more likely by the lack of specific criteria in Tomorrow’s Doctors.
“In addition, the perceived lack of preparedness of F1s is further challenged by the lack of explicit criteria in the work based assessments of the Foundation Programme that F1s must pass to gain full registration with the GMC. As a consequence of the lack of specific criteria, expectations about preparedness for practice at the undergraduate and postgraduate level are not aligned and the transition between medical graduate and first year junior doctor remains highly problematic.”
The authors point out their survey provides only a snapshot of graduates from one medical school and in one area of England, so may not be indicative of trends across the UK. But they also say that their findings back up other broadly similar research.
A GMC spokesperson said Tomorrow’s Doctors had been re-launched since this research’s questionnaires were conducted.
She said: “It is important not to jump to conclusions from this study. Tomorrow’s Doctors will require that students have more opportunity to apply their medical knowledge and skills in hospitals and surgeries before they graduate. ’Student assistantships’, which are work placements, will be rolled out to help prepare medical students for the Foundation programme.
“A lot of work was undertaken to map F1 outcomes to the undergraduate competencies, including clinical and procedural skills. The GMC also agreed a revised Foundation programme curriculum and specific outcomes for F1 doctors which will give medical schools a clear understanding of what they should be preparing medical students for in the workplace.”
I suspect that most ’senior doctors’, if they are honest, will accept that, when they qualified, THEY actually knew precious little - just when they thought they knew it all! The first year is always a ’steep learning curve’ to use the modern vernacular! It is pleasing to see that, at long last, our so-called ‘leaders of the profession’ are beginning to wake up to the long-established fact that medicine is an art and a craft as well as being a science. They are beginning to realise that not all the theories propounded by ‘educationalists’ are necessarily applicable to learning some of the ‘unmeasurables’ in medicine - such as caring and practical skills. They are beginning to realise that some of the ‘old-fashioned’ methods of teaching - at the bedside and in the theatre - are still valid; and that there was a certain camaraderie about belonging to a ‘firm’ (both as an undergraduate student and as a postgraduate trainee), acting as an ‘apprentice’, which is invaluable, immeasurable and provided a rich ‘learning experience’. So, maybe there is still hope - for “what goes around comes around” and perhaps we can get “back to basics” (built on a sound knowledge of FACTS such as anatomy, physiology and pathology and less on the so-called ’soft sciences’ of psychology and ‘inetrpersonal relationships’)! A Retired Orthopod of ‘the old school’!