Institute of Clinical Education, Peninsula Medical School, University of Plymouth, Plymouth, UK.
Med Educ. 2010 May;44(5):449-58. doi: 10.1111/j.1365-2923.2009.03604.x.
CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self-selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. RESULTS The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. CONCLUSIONS Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing 'meaningful' contact with patients and increasing opportunities to 'act up' to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements.
英国的医学教育最近经历了彻底的改革。《明日医生》规定了本科课程的改变，而基础课程则彻底改革了研究生教育。
本研究探讨了初级医生在临床实践第一年的经历。特别是，本研究试图了解初级医生如何体验从学生角色向执业医生角色的转变，以及他们的医学院教育在多大程度上为这一转变做好了准备。
该研究使用定性方法，包括在英国半岛基础学院的新合格医生的半结构化访谈和音频日记记录。采用目的性抽样，从五个医院地点中选出了 186 名新合格医生中的 31 名。所有 31 名参与者都接受了一次访谈，其中 17 名在一年内接受了两次访谈。其中 10 名参与者还保留了音频日记。访谈和音频日记数据被逐字转录，并在定性数据分析软件包的帮助下进行主题分析。
研究结果表明，尽管最近进行了课程改革，但大多数参与者仍然发现过渡阶段压力很大。应对新获得的责任、管理不确定性、在多专业团队中工作、经历患者突然死亡以及感到不受支持是重要的主题。然而，本科阶段获得的临床经验水平降低了过渡的压力。
医学院需要确保学生能够尽早接触临床环境，允许他们继续与患者保持“有意义”的接触，并为他们提供更多“扮演”初级医生的机会，即使是作为学生。尽管有充分的监督，但患者安全指南对实现这一目标构成了重大挑战，这两个目标并非相互排斥。在处理患者死亡和外科实习等情况下，应向初级医生提供进一步的支持和监督。
