Mattick K L, Kaufhold K, Kelly N, Cole J A, Scheffler G, Rees C E, Bullock A, Gormley G J, Monrouxe L V
Centre for Research in Professional Learning, Graduate School of Education, University of Exeter, Exeter, UK.
Cardiff University School of Medicine, Cochrane Medical Education Centre, Cardiff, UK.
BMJ Open. 2016 Feb 23;6(2):e010246. doi: 10.1136/bmjopen-2015-010246.
The 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.
Four UK study sites, one in each country.
185 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).
We 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.
A 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.
培训形式报告建议完全注册与医学院毕业保持一致。作为一项由英国医学总会资助的关于英国医学毕业生执业准备情况的研究的一部分，我们通过定性访谈（30次小组访谈和87次个人访谈）及框架分析，探讨了英国利益相关者对该提议的看法。
英国的四个研究地点，每个国家一个。
来自八个利益相关者群体的185个人：（1）一年级基础医生（F1）（n = 34）；（2）完全注册的实习医生（n = 33）；（3）临床教育工作者（n = 32）；（4）本科/研究生教务长及基础课程主任（n = 30）；（5）其他医疗保健专业人员（n = 13）；（6）雇主（n = 7）；（7）政策与政府部门（n = 11）；（8）患者及公众代表（n = 25）。
我们确定了四个主要主题：（1）F1年作为安全保障：通过对实习医生的密切监督和“签字批准”来保护患者以防止出错；为实习医生提供在职学习的安全环境；（2）对本科医学教育的影响：如果该提议被接受，将需要对本科课程进行“彻底审查”；本科教育可能需要延长；（3）对F1工作实践的影响：需要采取措施保护医疗团队的整合，并确保F1医生保持在能力范围内；（4）财务、结构和政治影响：对实习医生会有成本影响；需要明确本科和研究生医学教育之间的责任。通常，每个主题都包含支持和反对该提议的论据。
将完全注册时间与毕业时间对齐的政策变化需要大量的规划和前期工作。这些发现将为政策制定者的决策提供参考。无论做出何种决定，医学生在本科阶段都应承担更大的患者护理责任，临床实践和专业领域的评估方法需要改进，并且必须分享研究生监督和支持方面的良好做法。
