Display options
Cite
Hawkins N, Younan HC, Fyfe M, et al. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC Med Educ. 2021;21(1):165doi: 10.1186/s12909-021-02605-y.
Hawkins, N., Younan, H. C., Fyfe, M., Parekh, R., & McKeown, A. (2021). Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC medical education, 21(1), 165. https://doi.org/10.1186/s12909-021-02605-y
Hawkins, Nichola, et al. "Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation." BMC medical education vol. 21,1 (2021): 165. doi: https://doi.org/10.1186/s12909-021-02605-y
Hawkins N, Younan HC, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC Med Educ. 2021 Mar 17;21(1):165. doi: 10.1186/s12909-021-02605-y. PMID: 33731104; PMCID: PMC7972243.
Copy Download .nbib Format: NLM
Share it on

BMC Med Educ. 2021 Mar 17;21(1):165. doi: 10.1186/s12909-021-02605-y.

Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation.

BMC medical education

Nichola Hawkins, Helen-Cara Younan, Molly Fyfe, Ravi Parekh, Andrew McKeown

Affiliations

  1. Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK. [email protected].
  2. Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK.
  3. University of Buckingham Medical School, Hunter Street, MK18 1EG, Buckingham, UK.

PMID: 33731104 PMCID: PMC7972243 DOI: 10.1186/s12909-021-02605-y

Abstract

BACKGROUND: Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training.

METHODS: 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes.

RESULTS: Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'.

CONCLUSIONS: The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.

Keywords: Cognitive load theory; On‐call simulation; Preparation for practice; Undergraduate medical education

References

  1. Adv Simul (Lond). 2017 Aug 14;2:13 - PubMed
  2. Med Educ. 2014 Feb;48(2):136-45 - PubMed
  3. Med Educ. 2012 Nov;46(11):1055-62 - PubMed
  4. Med Teach. 2012;34(7):526-9 - PubMed
  5. MedEdPORTAL. 2016 Oct 13;12:10483 - PubMed
  6. Med Teach. 2014 May;36(5):371-84 - PubMed
  7. Clin Teach. 2014 Oct;11(6):421-4 - PubMed
  8. Acad Med. 2007 Jun;82(6):542-7 - PubMed
  9. BMJ Open. 2017 Jan 13;7(1):e013656 - PubMed
  10. Med Teach. 2012;34(7):548-54 - PubMed
  11. BMJ. 2008 Mar 22;336(7645):667-9 - PubMed
  12. BMJ Open. 2018 Aug 29;8(8):e023146 - PubMed

MeSH terms

Publication Types