Sturman Nancy, Tan Zachary, Turner Jane
Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia.
Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
BMC Med Educ. 2017 May 26;17(1):92. doi: 10.1186/s12909-017-0931-2.
The transition from medical student to hospital-based first year junior doctor (termed "intern" in Australia) is known to be challenging, and recent changes in clinical learning environments may reduce graduate preparedness for the intern workplace. Although manageable challenges and transitions are a stimulus to learning, levels of burnout in junior medical colleagues are concerning. In order to prepare and support medical graduates, educators need to understand contemporary junior doctor perspectives on this transition.
Final-year University of Queensland medical students recruited junior doctors working in diverse hospital settings, and videorecorded individual semi-structured interviews about their transition from medical student to working as a junior doctor. Two clinical academics (NS and JT) and an intern (ZT) independently conducted a descriptive analysis of interview transcripts, and identified preliminary emerging concepts and themes, before reaching agreement by consensus on the major overarching themes.
Three key themes emerged from the analysis of 15 interviews: internship as a "steep learning curve"; relationships and team; and seeking help. Participants described the intern transition as physically, mentally and emotionally exhausting. They learned to manage long days, administrative and clinical tasks, frequent interruptions and time pressures; identify priorities; deal with criticism without compromising key relationships; communicate succinctly; understand team roles (including their own status within hospital hierarchies); and negotiate conflict. Participants reported a drop in self-confidence, and difficulty maintaining self-care and social relationships. Although participants emphasised the importance of escalating concerns and seeking help to manage patients, they appeared more reluctant to seek help for personal issues and reported a number of barriers to doing so.
Findings may assist educators in refining their intern preparation and intern training curricula, and ensuring that medical school and intern preparation priorities are not seen as competing. Insights from non-medical disciplines into the organisational and relational challenges facing junior doctors and their health-care teams may enhance inter-professional learning opportunities. Workplace support and teaching, especially from junior colleagues, is highly valued during the demanding intern transition.
从医学生转变为医院实习的第一年初级医生（在澳大利亚称为“实习生”）是一项具有挑战性的过程，并且临床学习环境的近期变化可能会降低毕业生对实习工作场所的准备程度。尽管可控的挑战和转变是学习的一种激励，但初级医学同事的倦怠程度令人担忧。为了培养和支持医学毕业生，教育工作者需要了解当代初级医生对这一转变的看法。
昆士兰大学的最后一年医学生招募了在不同医院环境中工作的初级医生，并对他们从医学生到初级医生的转变进行了个人半结构化访谈的视频记录。两名临床学者（NS和JT）以及一名实习生（ZT）独立对访谈记录进行了描述性分析，并确定了初步出现的概念和主题，然后就主要的总体主题达成共识。
对15次访谈的分析得出了三个关键主题：实习是一条“陡峭的学习曲线”；人际关系与团队；以及寻求帮助。参与者将实习生的转变描述为在身体、心理和情感上都令人疲惫不堪。他们学会了应对长时间工作、行政和临床任务、频繁的干扰和时间压力；确定优先事项；在不损害关键关系的情况下应对批评；简洁地沟通；理解团队角色（包括他们在医院层级中的自身地位）；以及协商冲突。参与者报告自信心下降，难以维持自我照顾和社会关系。尽管参与者强调了提出担忧并寻求帮助以管理患者的重要性，但他们似乎更不愿意为个人问题寻求帮助，并报告了这样做存在的一些障碍。
研究结果可能有助于教育工作者完善他们的实习生培养和实习培训课程，并确保医学院和实习生培养的优先事项不被视为相互竞争。非医学学科对初级医生及其医疗团队面临的组织和关系挑战的见解可能会增加跨专业学习机会。在要求苛刻的实习生转变过程中，工作场所的支持和教学，尤其是来自初级同事的支持和教学，受到高度重视。
