How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools

Abstract

Background Previous work has suggested that many medical graduates feel unprepared to start work, and that preparedness varies substantially between medical schools. Aim The present study aimed to explore the extent to which different medical schools prepare their graduates for the workplace. Methods This was a multi-method, prospective, cross-sectional study. The primary research sample was drawn from new graduates of three medical schools with differing curricula and cohorts: Newcastle (systems-based, integrated curriculum); Warwick (graduate entry) and Glasgow (problem-based learning or PBL). This sample was stratified on the basis of academic MTAS (Medical Training Application System) score, with five students from each school initially sampled from each MTAS quartile. Purposive substitution was then made if necessary, to ensure representation of the demographic range of students, in terms of age, sex, ethnicity and disability. Focus groups held at each site with Foundation Programme doctors fed into the development of interview schedules. Sixty five of the primary sample graduates were then interviewed before starting their first placement as part of Foundation Year 1 (F1). Fifty five were re-interviewed at the end of their first placement, and forty six again at the end of the F1 year. A cohort questionnaire to assess perceptions of preparedness was devised and administered to each university cohort during the shadowing period before starting F1. Qualitative triangulating data was collected from nearly 100 clinicians (undergraduate tutors, educational supervisors, key managers and members of clinical teams) to provide another perspective on preparedness. Some of these interviews informed a triangulating questionnaire completed by members of clinical teams who work with F1s. Secondary data was examined in the form of assessment data from learning portfolios at the end of the first placement, to identify procedures on which new F1s chose to be assessed early. Newcastle and Warwick F1s also completed a safe prescribing assessment during F1.